|
Illustration by Amy Ning/ The Register
|
Digital Doctor
More physicians are using PDAs, PCs and other e-technology to improve patient care.
By LISA LIDDANE
The Orange County Register
December 5, 2001
When Dr. Scott Rudkin makes his hospital rounds, he brings an invaluable medical assistant.
He carries a point-of-care device, or PCD, more widely known as a personal digital assistant, or PDA.
This palm-size machine is loaded with a lot of information: Rudkin's schedule, as well as several encyclopedic medical references - in case he needs to verify a condition or symptom. Rudkin, an emergency care physician at UCI Medical Center in Orange, also writes notes about his patients' conditions in the PCD. Later, he transfers that information to his patients' records.
In the past two years, Rudkin and an increasing number of doctors have embraced more e-health technology. They use PCDs and electronic medical records for searching, retrieving, storing and sending medical information rapidly - with little or no paper.
In an online survey of medical groups, 78 percent said their doctors use handheld devices or PDAs "for clinical, business and personal functions" this year, up three times from PDA use last year. The survey was conducted by the Medical Group Management Association.
Doctors hope that these e-health advancements - designed to make the practice of medicine more efficient and effective - will also improve the quality of patient care.
Although it's too early to tell whether these technologies are accomplishing exactly that, the technologies have helped them respond faster and more accurately to their patients' needs, said Dr. Alpesh Amin, vice chairman for the department of clinical affairs at the University of California, Irvine, School of Medicine.
A wide range of applications
From the doctor's office to the patient's hospital bed to the pharmacy, these are the popular applications of e-health technologies, according to Dr. David Litke, president-elect of the Orange County Medical Association:
Prescribing medications: In some cases, a patient doesn't need to take a written prescription to a pharmacist. The doctor sends the prescription via desktop computer to the pharmacist. Doctors and pharmacists say this reduces the risk of prescription errors.
Dispensing Solutions Inc. in Santa Ana last month teamed up with ePhysician Inc. in Mountain Viewto offer technology enabling physician groups to write and transmit prescriptions wirelessly, using a PCD.
Checking a drug's profile for side effects, interactions with other medications, and whether the drug is in the patient's health plan formulary before prescribing it. A doctor either taps on his PCD or uses a desktop PC to retrieve a drug reference electronic book.
Writing, sending and receiving e-mail to and from patients. A doctor may receive e-mail on his PCD, laptop or desktop PC and write and send e-mail to his patient immediately, instead of being paged or getting a message the next day from his office.
Gathering, storing, sending and receiving patients' medical information, including lab tests and specialists' reports.
A study conducted by researchers at the Hospital of the University of Pennsylvania showed that handheld devices are a superior alternative to manually collecting and entering information when evaluating quality of care in hospital intensive-care units.
The study was presented last month at the American College of Chest Physicians meeting.
Studies are being conducted on these applications.
UCI's Rudkin recently began research on whether doctors and patients like the use of PCDs. In his study, 32 doctors - 14 faculty members and 18 residents at UCI Medical Center -- received handheld devices to take with them on their patient rounds. The physicians and their patients will answer a questionnaire on whether they liked the use of the handheld device during doctors' visits to patients.
Rudkin said digital technology is especially crucial in two places: the ICU and the emergency room, where seconds often count in diagnosing and monitoring conditions, and in getting the right medications and lab test results.
Doctors and patients warm to technology
Doctors who use these technologies often find themselves liberated from the tyranny of paper. In the Orange offices of Dr. Gregory Pecchia and his associates, a now-empty space behind the front desk used to house tall shelves filled with patient files. Instead, the front desk and patient offices each have terminals from which patient information can be retrieved.
As soon as a patient arrives, he or she is "entered" into the daily system. A clock tracks how long the patient waits, ostensibly to prevent long waits. Once a patient is in an examination room, Pecchia accesses the patient's records on a terminal. The patient will be able to see his or her entire medical record as Pecchia is viewing it and entering information - medications, number of visits and nature of the visits, e-mails, phone calls, hospitalizations, notes from specialists. Documents from other offices that still use paper are scanned and converted into files and entered into the computer system.
When Pecchia is out of the office, he can respond to his patients quickly via e-mail that he writes on his PCD.
Scott Abendroth, 38, who recently was seen by Pecchia, is impressed by the quick availability of information from the electronic medical records. He says he likes seeing his medical information clearly organized and accessible to him and his doctor through a computer display instead of a file folder.
There's another benefit. "It's easy to ask a question from my doctor and request prescription refills by e-mail," said Abendroth, from Corona. "I get a response quickly."
Paperless medical offices such as Pecchia's are slowly becoming more common.
According to a survey of 593 health-care groups, 21.6 percent of health-care organizations have an electronic medical record system and 67.9 percent are considering it. The survey, released in October, was conducted by the MGMA and Pfizer Health Solutions Inc.
Patient privacy needs to be ensured
While electronic medical records can mean efficiency, they're not without problems, said Dr. Paul Tang, chairman of public policy for the American Medical Informatics Association. Better federal laws are much needed to protect patient privacy and electronic medical information security, he said.
Patients need to find out from their doctors who stores and manages the medical information - if the server is in the doctor's offices or is at another company.
"What happens to the patient information if the doctor severs business with that company?" Tang said. Tang's concern is that federal laws are not sufficient to protect patients' information.
Pecchia said the system in his practice is HIPPA-compliant. "This means that it adheres to the standards of confidentiality and security required of any health-care informatics system," he said.
HIPPA is the Health Insurance Portability & Accountability Act of 1996. It calls, among other things, for security and privacy standards to protect the confidentiality and integrity of patients' health information - including electronic versions.
Tang said PDAs may be getting a lot of attention as more studies are finding them favorable for health care use, but the PDA is only one small tool in a larger project. The PDA is only as good as the information it's capable of storing, linking to and processing.
If patient security concerns are addressed properly, the future of medical information may mean just a few taps on the PDA. UCI's Amin said we're not too far off from the day when patient information will be processed digitally and flow seamlessly to the parts of the health care system -- the health insurer, the doctor's office, the medical group, the specialists, the hospital - with hardly a sheet of paper used.
|
