Mobile devices usher in new era in healthcare delivery

By Dr. Bill Crounse, M.D.

Is there such a thing as being too tied to your work? One physician, while vacationing with his family in Arapahoe, N.M., used a Smartphone to access patient updates from the ski slopes some 12,000 feet above sea level. The doctor knew he had left his patients back at the hospital in good hands. He just felt the need, as doctors often do, to check and see how they were doing.

While this may be one of the more extreme examples of physician commitment, the story illustrates how many of us now rely on technology to improve the healthcare we deliver and to solidify relationships with our patients.

Indeed, in contrast to the common perception of physicians as technophobes—stubbornly attached to their pens and clipboards—I've found that most doctors readily adopt technologies that meet a business need or improve the quality and safety of patient care. The first handheld devices, for example, quickly developed a following among doctors who found the devices convenient for taking notes, accessing information, and managing their schedules while making patient rounds.

Though few people may think of doctors this way, we are information workers. We require access to current information about diseases, medications, laboratory and imaging data, and patient histories to determine the most appropriate treatment. It's all in a day's work, providing our patients with the excellent healthcare they deserve.

The difference is that, unlike most information workers, we cannot always be at our desks to reference the material we need. We require information in the exam room, at the patient's bedside, and, sometimes, when responding to emergencies out in the field.

For physicians, having timely access to critical information can make the difference between life and death.

It is no surprise, then, that the healthcare industry in general and physicians in particular have emerged as leading adopters of mobile and wireless technology. The challenge remains to develop specific kinds of mobile technologies that meet the complex requirements of clinicians and other healthcare practitioners.

The right device to meet your needs

In healthcare, there is no such thing as a one-size-fits-all proposition. This is true when we are treating our patients, and it's equally true when we are selecting technology support for ourselves. For physicians, what constitutes the right device is often dependent upon the environment where it will be used, the task to be performed, and the complexity of the application to be deployed on it.

For making rounds in the hospital, many physicians have adopted the Microsoft Windows Mobile-based Pocket PC or a Pocket PC Phone Edition. These small, light devices fit easily in a lab coat pocket and enable physicians to stay connected to the office while in transit. Doctors use the Pocket PC for many tasks: To connect to the hospital data network and access patient records, to write prescriptions, to record patient notes, to capture charges, and to check e-mail messages and calendars while moving among hospital rooms. The Smartphone offers similar benefits and is particularly useful for physicians who want to carry a very compact device with powerful features.

The Tablet PC is a popular choice among physicians who need to view radiological images and other large data sets. It can be used to perform all the same tasks performed on a Pocket PC, but the Tablet has a larger screen, greater storage, more processing power, and more data input options. Physicians can hold the Tablet in one hand like a clipboard and take notes with a digital ink pen (or stylus). They can then convert the handwritten notes to typed text with the click of a button. It is also possible to record digital voice memos using the Tablet PC and transmit these voice recordings through e-mail.

Because the Pocket PC, Smartphone, and Tablet PC are all built on the familiar Microsoft Windows operating system, physicians can use on these devices popular Microsoft Office programs such as Microsoft Word, Microsoft Outlook, and Microsoft Excel. The availability of these programs on the easy-to-navigate Windows platform accounts in part for the popularity of mobile devices: They extend the impact of the Microsoft Office System from the office to the hospital room to anywhere a busy physician might be.

But to fully serve physicians, mobile devices must meet additional business requirements. These requirements—to improve operational efficiency, customer service, and regulatory compliance—are where the Microsoft Windows platform adds special and unique value.

Here are some of the ways Microsoft, working in partnership with a large number of manufacturers and healthcare software providers, is helping to transform the power of mobile computing for medical practitioners.

Ensuring access to records

In early 2004, National Health IT coordinator, Dr. David Brailer, announced his plan to develop a national health information network, providing secure access to the medical records of all Americans. Initial estimates indicate that providing healthcare workers with access to these electronic records could save the industry about $140 billion US each year through improved care and reduced duplication of medical tests.

Such records are of little use, however, unless doctors have the capability to access them. This is where mobile devices built on the Microsoft Windows platform offer a distinct advantage.

Every mobile device built on the Windows platform complies with open-standard specifications and uses the Microsoft .NET Framework to help ensure interoperability. Microsoft also works closely with its healthcare solution partners to help ensure they build their applications in compliance with open-standards. With a Windows Mobile-based device, you can be confident that you can connect to and communicate with a hospital or clinic back-end system and access the patient information you need.

The cost advantages of accessing patient records and other medical information electronically cannot be underestimated. Middlesex Cardiology in Middlesex, Conn., saves up to $80,000 US each year after deploying a wireless practice management solution in their group. Now, each physician in the practice can access patient data, including vital signs, lab test results, and information from previous consultations, directly on their Windows Mobile-based Tablet PCs.

According to John Colebaugh, administrative director of the Connecticut cardiology group, "Having an electronic medical record on Tablet PCs has been a lifesaver. We easily move information among our three clinics. Doctors can get at patient information anywhere in the clinics, at the hospital, when they are at home, or even on vacation." Colebaugh continues, "We also avoid nearly all of the old transcription costs. We used to pay $10,000 in outsourced transcription fees a month. Now we are spending only $40,000 for the entire year."

Providing better care through better information

While the Microsoft .NET Framework helps ensure the interoperability of hospital back-end systems and Windows Mobile-based devices, the Microsoft Visual Studio .NET development system facilitates the rapid development of important new healthcare software and services for use on mobile devices.

According to Bill Keay, enterprise mobility specialist at Microsoft, more healthcare applications are being developed for the Windows Mobile platform because the .NET environment offers such tremendous value for software developers. "Developers can write an application for the Tablet PC using Visual Studio .NET, and then recompile the code to build the same application for the Smartphone or Pocket PC within a matter of hours," says Keay. He cites as one example the popular Epocrates RX Pro service available on the Pocket PC. RX Pro provides detailed information about more than 3,300 prescription drugs, including dosing information, contraindications, and multiple-drug interactions. Because the service has been so well received by family physicians, Epocrates is now in the process of adopting RX Pro for the Smartphone.

The value of having applications that provide this type of information can make a significant difference in the quality of healthcare physicians provide. In addition to protecting patients from medical errors, physicians can also use RX Pro to check the availability of low-cost but equally effective generic drugs. Conservative estimates suggest that just a one-percent shift to generic drug use can save patients more than $1 million US each year.

NxOpinion is another valuable healthcare program that can be run from a Windows Mobile-based device. This real-time diagnostic tool provides physicians with current and relevant information to aid in the diagnosis of non-chronic illnesses. Developed by Dr. Joel Robertson, president and founder of the Robertson Research Institute in Saginaw, Mich., NxOpinion has proven to be especially useful in teaching hospitals and rural clinics where access to labs, specialists, and other resources is hard to come by.

"My vision," says Dr. Robertson, "was of a truly global medical solution. One that would save lives worldwide through faster and more accurate diagnoses, regardless of the level of medical resources available to the healthcare providers, and regardless of the languages or cultures of those providers and their patients." To realize this vision, Dr. Robertson developed NxOpinion using Visual Studio .NET so it could be loaded on a Tablet PC or a Pocket PC. These mobile devices make it possible to extend the expertise of NxOpinion to doctors throughout the world.

Protecting patient confidentiality

While the promise of better healthcare through better access to medical records is beguiling, it also creates a new layer of responsibility for physicians. We all must do all we can, particularly in this age of regulatory compliance, to protect our patients' privacy and confidentiality. When it comes to technology, it is imperative that physicians use only those devices that employ the very highest standards of security available.

To ensure that physicians can meet these obligations, the Windows Mobile platform includes robust data and message encryption. As evidence of efforts by Microsoft to comply with the highest security standards, the company recently received FIPs-140-2 certification for its Windows Mobile platform. This means you and I can send and receive patient data with the confidence that privacy and confidentiality are protected by the latest security technology. In fact, encrypted data properly stored on a device with enhanced security is better protected than sheets of paper carried on clipboards and stored in metal filing cabinets.

Only the beginning

Now, with smaller, lighter, and smarter devices supported by faster processors, wireless technology, and greater battery life, it is no longer a matter of whether a physician will use mobile technology. It's a question of how far we can go toward improving patient care and decreasing healthcare costs using powerful information technologies supported by mobile solutions. The top of a mountain in Arapahoe is pretty far. But Microsoft and its development partners believe it is only the beginning.

Dr. Bill Crounse, M.D., is the global healthcare industry manager for the Microsoft Corporation. Dr. Crounse is responsible for working with industry partners and healthcare organizations to help them benefit from using Microsoft technologies and solutions. Prior to joining Microsoft, Dr. Crounse was vice president and chief medical information officer for Overlake Hospital Medical Center and the Overlake Venture Center in Bellevue, Wash.

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