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Study Tracks Effectiveness of HP Palmtop in Hospital

Study Tracks Effectiveness of HP Palmtop in Hospital

The house staff of 21 resident physicians used the HP Palmtop for signing out patient information, referencing drug interaction data, reviewing protocols for different medical situations, and more.

By Scott M. Fishman, M.D.

Physicians at Greenwich Hospital and the Yale University School of Medicine conducted this experiment over a year ago using the 95LX to explore its potential for improving physician productivity and enhancing patient care. The physicians use a 1MB 95LX with various programs stored on 1MB RAM cards.

The 95LX was chosen primarily because of its small size and power. The fact that it really fits in a pocket means that it's more likely to be carried around and used.

Medical Software Used in the Study

The study used the 95LX along with a suite of physicians reference software marketed by Computer Books (now sold by EduCALC). The software includes Patient Manager for maintaining patient files, notes, lab results, etc.; Pharmaceuticals, a drug reference giving information on the class of the drug, recommended dosages, warnings and contraindications; Drug Interactions reference, which searches for interactions between up to 20 drugs at a time; and Physician's Reference, which explains and calculates formulae used in patient diagnosis and treatment.

The project also used Palm Reference, a software program that manages medical journal references. In addition, a number of custom PhoneBook (.PBK) files were created containing relevant hospital numbers, schedules, and selected outlines for managing common problems in medical practice. We have also developed a series of MEMO outlines for a number of internal medicine topics (see MEDTXT.ZIP <ON DISK ICON>).

The project also tested a limited version of the desktop program Iliad, which allowed 95LX users to do quick hypothesis testing (product not available).

Methodology

Each resident and intern was outfitted with a 95LX and medical software on RAM cards. The 95LX/RAM card combination replaced reference books, index cards, numerous schedules and phone lists normally carried by physicians in a hospital situation. The software served as a reference database of medications and drug interactions, a patient record management system, and a personal schedule manager.

Outcome

This was the first time a large group of physicians attempted the coordinated use of palmtop technology to improve patient care. The study was a qualitative success.

The 95LX/RAM card system made the sharing of patient information easy. RAM cards with patient information were easily exchanged and data could be downloaded into a central computer system or printed out and put in the patient's permanent chart. It's quite common to find a single physician on call, looking after patients from a number of different physicians. The ability to quickly access the notes of the patient's primary physician was invaluable.

The Palmtop was also used to review protocols for managing different medical situations (for instance, there were files on dealing with insulin shock and renal failure). One great advantage the Palmtop has over a reference book is that it is a dynamic resource that changes with experience. The physicians could add to the reference files as their experience and knowledge increased. And every physician on staff could access that knowledge to improve patient care.

The biggest plus about the Palmtop was that it was able to do many different things. Just being able to look up dosages was valuable, having a hospital directory with you at all times was worthwhile, having outlines of medical interventions was beneficial, and the BUILT-IN applications added to it's usefulness. But the whole was greater than the sum of the parts. Those who took the dive and used it for many different tasks found the Palmtop to be very beneficial. And because the machine was so feature rich, it's value grew with their knowledge and experience.

On the other hand, some physicians were a bit technophobic. They were attracted to one or two of the features, but didn't think there was enough there to continue investing their time with it.

Palmtop Technology and the Future

The increase in medical knowledge is starting to burden the profession. It is no longer possible for the individual clinician to know everything he or she needs. The Palmtop is a good support tool that can help the physician quickly access needed information and the experience of other physicians.

Recent advances in remote communications allow the Palmtop PCs to become Remote Terminals. Radio-frequency or cellular technology will offer future physicians a wireless connection to their personal records, those of their hospitals, as well as all other major medical data banks such as the national library of Medicine, MedLine, FDA bulletin board, or any other database or expert system. Wireless connections between physicians and their patients could make possible instant, real-time data sharing whereby, for example, a cardiologist could receive ECG information as an ICU patient was experiencing an arrhythmia.

Many times, medical emergencies happen when an inexperienced staff physician is on call. Wireless technology can put the needed data in the hands of more experienced physicians, who can interpret and design the most effective intervention.

Hewlett-Packard has made positive advances with the 100LX. The improved screen made it easier to read data and display PCX graphics files of certain medical conditions. AppManager made it easier to use other DOS programs. And the BUILT-IN software itself is much improved. HP might consider adding an internal modem to future versions of the Palmtop, and give it more CPU power to run computation intensive programs. The addition of a backlit screen would help in situations with poor lighting.

Technology can support the thinking process, but it can't do the thinking for us. In the end, a knowledgeable human being will still have to be there to carry out the intervention and interact with the patient. Portable technology helps the physician network with his or her colleagues and benefit from their experience.

Technology continues to advance medical science, which is rapidly becoming an information science. To use or not to use; in the end it's a personal choice. But for those who must have quick access to that kind of information, palmtop computers may be the only choice.

HP Palmtops in Medical Education

iPhone Life magazine


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