February 2001

Medicine Goes Mobile

by Ron Levine

• SIDEBAR: Wireless Access Meets the Medical Record

Medical centers and clinics are especially well suited to wireless solutions. A doctor's need to refer to a patient's medical chart is as basic a requirement as a stethoscope. To explore the advantages of wireless access to electronic content, we examined medical records applications. While record keeping will forever be a necessity in health care, paperwork need not be.

Technology Enters The Examination Room

Midwest Heart Specialists, a 34-physician cardiology group in the Chicago area, accesses patients' medical records using wireless LAN technology at its four offices and six satellite locations.

Patient charts are called up via handheld wireless terminals that accompany the doctors into the examination rooms. With this approach, patients' records are always available and legible, and because the information is entered immediately, the charts remain up to date at all times. If patients see several physicians within the group, each doctor will have access to the records about treatments and medications prescribed by others, avoiding potential problems such as bad drug interactions or disparate therapies.

Unlike paper records, electronic charts can be directly queried for specific treatment or medication information. Key data (such as drug allergies) can be highlighted, and the doctor has immediate access to drug interaction research, and symptom and diagnosis information. A direct search is not possible on paper charts with chronological entries (in which each doctor begins writing where the previous entry ended); doctors have to read the chart line by line to get a full picture of the patient's treatments or to find specific data.

Midwest's search capabilities may have saved lives recently when one manufacturer recalled a medication because of an interaction with other drugs. With the computerized charting system, all patients having that prescription were quickly found and contacted. In this case, there wasn't time to read the paper charts of the 30,000 patients Midwest Heart Specialists serves each year.

Midwest uses 60 handheld Sharp Mobilon TriPad PV-6000 wireless terminals throughout its facilities. The devices weigh only 3.2 pounds and are easily carried from room to room. Each terminal contains a wireless adapter card and an antenna that transmits seamlessly to one of five access points hard-wired into a standard Ethernet LAN.

The actual wireless technology is a RangeLAN2 system manufactured by Proxim, Sunnyvale, CA. The system supports a data transfer rate of 1.6 Mbps per channel with 15 independent channels available. The wireless access points and the associated internal adapter PC cards operate in the 2.4 GHz frequency band and utilize frequency-hopping spread spectrum radio frequency (RF) technology. According to Proxim, this license-free technology is both highly secure and immune to interference.

Midwest's two-story main building contains an access point on each floor; the single-story clinics each have one access point. The LAN connects to a WAN server at the main office that also services the 90 desktop PCs used for other office applications (the mobile system is dedicated to medical record keeping).

"This system has worked very well, both in the office and off-site," says Michael O'Toole, MD, of Midwest Heart Specialists. "Through normal phone lines, our doctors can establish a direct dial-up connection to access secure patient records at all hours - from their home or from the hospital emergency room. Heart problems don't keep office hours."

Taking It on the Road

"When I was growing up, the doctor made house calls." The next time Gramps adds this one to his stories of walking five miles to school, the kids of Greenville, SC, can tell him about the "doctor van."

Lena Warner, a pediatric clinical nurse specialist at the Children's Hospital of Greenville Hospital System, spearheaded a mobile van project that has brought checkups, sick visits, immunizations and sports medicine right to the driveway of families. Exam rooms have replaced the original living room, kitchen and bedroom of a large recreational vehicle. There was not, however, room for rows and rows of patient records.

Like Midwest Heart Specialists, Warner found that electronic documentation was the answer, though her dilemmas were different; Warner's project suffered from a lack of storage space and highlighted a need for mobility.

The traveling staff often encounters the "sick sibling" phenomenon, where upon arrival at the home, other children in the family are discovered to also need treatment. In the early stage of the project, they brought medical charts for all children with appointments, but they didn't have room to carry medical records for siblings "just in case." As the mobile practice became a success, the task of pulling and replacing charts for the day's appointments became very time consuming. These challenges, along with the space problem in the mobile unit, made finding an electronic solution imperative.

To go paperless, Warner's staff is now also using a Proxim RangeLAN2 system and Sharp Mobilon TriPad PV-6000 handheld terminals with wireless adapter cards and antennae. The Ethernet access point is mounted on the ceiling of the van and has a range of 1,000 feet, allowing the staff to take terminals into the houses of children who cannot come out to the van (because of feeding tubes, etc.). Data is transmitted from the terminals through the access point to a MedServer Mobile file server in the van. This mobile server, provided by e-Medrecords, Sparta, NJ, is loaded each day with patient records from the hospital's main system and offloaded again at the end of the day.

E-Medrecords also installed its Compu-Kid, a pediatrician's medical records program, which takes advantage of the touch-screen interface on each of the van's two handheld terminals. The system handles scheduling, with details on each appointment, and charting, with prompt-driven, single-click displays that ease the process of documenting physical exams. Charting capabilities include growth percentage charts, vaccine inventories and immunization scheduling.

Sharing the Benefits

While McKessonHBOC's solution initially focused on improving internal information and operational practices, the company says the Web-capable architecture will support two-way customer communications. By putting the same scanning devices into the hands of the customer, they could view an item's description, units of measure, order dates, frequency of orders and other information necessary for placing orders. In addition, customers will be able to download invoices, which could then be used to scan and validate receipt of goods.

Deploying an automated distribution system coincides with a number of complementary McKessonHBOC directives to create an Internet health care marketplace. The company has announced an Internet-based supply chain management venture that is intended to provide physicians, consumers and other users Internet portal access to stored healthcare data.

"We provide easy access to the data in these systems along with visual integration of data," said Graham King, president of McKessonHBOC's Information Technology business. "We believe health care providers will use the Internet as a change agent to improve their financial and clinical performance, building on the information stored in the systems."

Ron Levine is a freelance writer with Coast Writing, Carpinteria, CA. For more information, contact ron@coastwriting.com.

Wireless Access Meets the Medical Record

How can you streamline the age-old medical practice of keeping patient records? Health care reseller eWebcare.com, of Tampa, FL, took a wireless, paperless approach with a turnkey solution that combines wireless LANs, handheld computers and its unique, electronic clipboard patient care software.

The system replaces paper-based, information-gathering procedures and outside transcription services. This eliminates the outdated method of handwriting patient care information, only to copy those same notes into the computer later. Entries made by the doctor are more accurate than paper-based charting, which is subject to transcription and data-entry errors.

EWebcare.com's CareSide data-entry software is geared exclusively for clinics, hospitals and other health care facilities, and the system was designed with nontechnical users in mind. Rather than demanding extensive typing, the program is mouse-driven. Preprogrammed menu selections allow symptoms, diagnoses and other patient information to be entered directly into a central database with a few clicks of the mouse. Typing is reduced to only those entries that may not appear on the listings.

"We designed our systems so that [doctors] can concentrate on the patient, not struggle with their new laptop," says Jack Willhoite, co-founder of eWebcare.com.

The CareSide solution has been installed at more than 90 clinics and hospitals. These turnkey charting solutions consist of the CareSide application software, Fujitsu PT510 and Mitsubishi AmityVP laptops preinstalled with wireless adapter cards and antennae, and the access points that receive the radio waves to and from laptop antennae. The access points are installed strategically throughout a facility, allowing the laptops to be moved from area to area while maintaining a seamless connection to hard-wired LAN and stored patient records.

With the combination of CareSide and wireless connectivity, the doctor creates and updates charts in paperless fashion with immediate access to the host LAN and its database. The next patient's chart is easily pulled up while walking down the hallway to the following examination or hospital room, and the small size of the laptop doesn't interfere with face-to-face doctor-patient contact.