Care from anywhere: Mobile solutions extend medicine's reach
A host of new software solutions seek to leverage mobile devices in ways that make physicians more effective and more efficient
Two indelible images of medicine as practiced in the 20th century:
| • | A white-coated doctor sits behind his desk at the end of a long day, microphone in hand, recording case notes with a Dictaphone. |
| • | A surgeon, summoned from a social engagement to the hospital for a late-night emergency consultation, stands in her evening gown before a bank of illuminated x-rays, deciding if surgery is necessary. |
But that was then. This is now:
| • | Stuck in traffic, a physician unfolds his cell phone and dials up his medical group's Practice Management System (PMS). He punches in a patient's name and proceeds to dictate case notes through the phone. |
| • | A neurologist on a ski lift in Taos, N.M., receives a brain CT scan over his personal digital assistant (PDA) that enables him to participate in the critical care of a stroke victim being treated hundreds of miles away at the UCLA Medical Center in Los Angeles. |
Welcome to medicine in the 21st century, when mobile technology is being leveraged to extend the diagnostic and clinical reach of medical professionals in ways that just a few years ago would have been inconceivable. And solutions are well past the research and development (R&D) stage; they've entered the mainstream.
Out of town but at the patient's bedside
That neurologist on the Taos ski lift, for instance, was taking advantage of the integrated clinical information system (ICIS) developed by Global Care Quest (GCQ), a Los Angeles–area technology company spawned by the efforts of UCLA neurosurgeons to acquire the data they needed to make good clinical decisions remotely. That effort, which began with the streaming of electroencephalography (EEG) results over mobile devices, has taken wing.
Now, says Dr. Neil A. Martin, chairman of UCLA's department of neurosurgery and founder and chief medical officer of GCQ, ICIS is used across multiple medical departments by about 200 UCLA clinicians. And GCQ recently struck a deal to deploy the solution at a medical group in Grand Rapids, Mich.
"The time has come, with high-speed cell networks and powerful handheld devices, when using a phone is seen as a key part of the information ecosystem," Martin says.
Data sources (including but not limited to vital signs and results of lab tests and radiological exams) are streamed to a central server and then sent out to a variety of platforms: desktop and tablet PCs, handheld devices, and a flat-panel display in the intensive care unit that updates staff on the patients they'll see during rounds.
Data is accessible on the Web or through wireless transmissions based on Microsoft Windows Mobile 5.0 and 6.0. And in keeping with the security concerns surrounding patient information, transmissions over ICIS Mobile are encrypted.
Using ICIS Mobile, medical center staff have been able to reduce critical care situation decision cycles of 30 to 90 minutes down to just three to five minutes. A case in point was the occasion when word reached Martin at Dodger Stadium that one of his patients had suffered a cerebral hemorrhage.
"Rather than having to leave the game, drive through L.A. traffic, and make the patient wait 30 to 45 minutes for treatment," Martin recalls, "I was able to use my mobile device to review the medical information and determine that the patient didn't need immediate surgery."
Mobile can help you manage your practice
Not as dramatic from a diagnostic, life-saving standpoint, but delivering impressively to the bottom line, is a solution from Charlotte, N.C.-based IQMax, which links clinicians to backend systems through handheld devices.
Though a lack of real-time clinical data means the IQMax application doesn't lend itself to "tele-medicine" the way ICIS does, the solution nonetheless allows doctors to pull patient histories to their mobile devices and augment their understanding of cases. However the real return on investment (ROI) is delivered by the dictation and charge-capture functionalities.
Company CEO Paul Adkison points out that medical transcriptionists traditionally spend 20 to 30 percent of their time attempting to match recordings of case notes with the correct patients. That time and money (and hassle-factor) are saved using the IQMax solution, which allows clinicians to input patient data into the system up front in a way that clearly links it to the relevant dictation.
Similarly, because IQMax allows doctors, with a few keypad strokes, to clearly specify the service they've just delivered and enter it into the Practice Management System—as opposed to scribbling something on an index card and tucking it in a pocket, pending manual entry later on—the proper charges are made. This meant a savings of $225,000 annually in the case of just one provider, Adkison says.
The solution, which can be used on virtually any mobile platform, has been installed in 60 medical facilities with more than 3,000 users in 28 states. Meanwhile the software-as-a-service (SaaS) version hosted by IQMax has processed information for more than 5.5 million patients.
"All that through the phone that's on your hip right now," Adkison says.
A wave that's about to crest
The future is primed to hold ever more sophisticated applications that are ever more broadly acceptance by clinicians.
A hint of the coming sophistication is provided by the next-generation solution from Global Care Quest: An application that provides doctors with a clinical update on all the patients in their care, ranks those patients from most to least acute, and automatically reports changes in patient condition. The application currently is being tested in a pilot program at UCLA.
As for the acceptance of this and as-yet-unimagined solutions, Martin says, "We're at the tipping point for the broad deployment of phone-based systems in health care. I think you'll see a rapid up-tick in adoption in the next two to three years."
 | Dr. Bill Crounse, M.D.
Dr. Bill Crounse, M.D., is senior director, worldwide health for 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. Also, read Dr. Crounse's Healthcare Web log to get more insights into the latest technologies and trends in the healthcare industry. |
