Notes

Outline

HandHelds, The Holy Grail of Healthcare? Neil Smithline, MD, FACP HIMSS Healthcare IT Solutions Las Vegas June 10, 2002

Overview When do physicians to adopt technology? What’s a handheld? What’s available now? Will they work in your office? Is there a handheld in your future?

Introduction Whither the promise of handhelds My quest Leaders of all major companies

History of Handhelds

1. Why Physicians Adopt Technology, Why They Don’t Are we Luddites? “New machines destroy jobs”

Cost reduction vs. Profit Three Cs Cost Complexity Convenience

2. What Is a Handheld? Who’s Jerry Kaplan? You can palm it Cost — $200 " $1000 NSYNC Cradle vs. Wireless LAN

Selected PDAs

Palm m500 Palm OS 4.1 8MB RAM $325 Expansion card slot LCD monochrome screen Successor to the popular Palm Vx.

Handspring Visor Pro Palm OS 3.5.2 Pro 16 MB RAM $250 External springboard Camera Music Washington Manual Rx

HP Jornada 720 MS Pocket PC 2002 32MB RAM $900 32 bit StrongARM processor

Compaq iPAQ 3870 MS Pocket PC 2002 32-64 MB RAM $400-$650 Multiple capabilities

OQO — Ultra Personal Computer OQO's PC is a full-function computer Microsoft Windows XP Professional and a 1GHz Crusoe TM5800 processor Measuring 5 x 3 x 1 inches , 9 ounces 4 inch, VGA color LCD, touchscreen 256MB onboard RAM; 10GB  hard drive; 1394 FireWire, USB, audio, OQO-link connectors; and 802.11b and Bluetooth wireless

3. What Functionality Is Available Now? Other

e-Prescribing 1999 Institute of Medicine (IOM)  44,000 deaths from medication errors Brigham and Women’s Study* Recommended drug use: 16% " 81% P<0.001 % doses > recommended max: 2.1% " 0.6% P<0.001 *Arch Intern Med. 1000;160:2741-2747

Similar Rx Features in PDAs CPOE Drug allergy checking Drug interaction checking Health plan formularies

Dictation Many CE and some Palm OS devices Cumbersome: two-fisted dictation Include header Retrieve and store digitally

Charge Capture Drop down lists of CPT codes and ICD-9 codes Coding edits Beacon Partners/MDeverywhere 13,000 outpatient visits, Investment of $17,000, Total revenue realized > $100,000 6 to 1 return on investment

Other Uses Electronic Medical Record (EMR) Practice Management Systems Picture archiving for x-rays Hospital info: meds, labs Pharmacy and nursing systems EKG and pulmonary function Managed Care Lab ordering and results

How Are Handhelds Used Now? American Medical Informatics Study* Reference: Drug interactions, Dx codes, treatment regimens, viewing patient data, laboratory values

Using Handhelds Now? Harris Interactive Poll* 15% in 1999 " 26% in 2001 33% if < age 34 30% if hospital based 33% if large groups 29% do not expect to use in the next 5 years Harris predicts: ½ all doctors using a handheld by 2004 or 2005

Using Handhelds Now? Cyberdialog-Deloitte Study* ¼ physicians using Web at least weekly 55% of users are daily users 24% professional users Are the 24% C-D users, the same as the 27% cited by ePocrates? Same as 26% in Harris Poll?

Who Provides What*

Wireless Sync Allscripts   Touchworks Prescribing Charge capture Dictation Rx Cabinet ACP-ASIM evidence-based treatment guidelines Mdeverywhere & MedAptus Charge capture OnCallData Rx Lab

Cradle Sync Allscripts   Touchworks MDeverywhere ePhysician Prescribe Charge Capture MedAptus Charge Capture iScribe Prescribe Charge Capture

Features Vs. Ease of Use

Prediction: Standalone Æ Integrated PMS integration: Ultia EMR integration: Epic, NextGen Platform integration: Patient Keeper

Ultia Wireless iPAQ interface with clinical modules of The Medical Manager Rx, transcription, lab, view patient chart Fully supported by MM, including web server as part of monthly fee Connects to EckerdRx and Walgreens Web portal: anywhere access

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EPIC EMR Additional interface device—ancillary tool First function: charge capture Download data: meds, problems, orders, recent labs, allergies, immunizations…. These require infrequent response Rx in future as demand requires Cradle synch or wireless

Epic Architecture

NextGen EMR Standard device: Fujitsu B Series mini-notebook Use iPAQ as highly portable interface device Charge capture Problem list Rx and Template-driven consult notes

PatientKeeper—Common Platform

PatientKeeper

4. Will They Work in Your Office? I. Operating systems (OS) Palm vs. Windows CE II. Wireless III. Integration

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OS — Windows CE Goal — bring as much functionality of desktop PC to handheld CE application programming interfaces (API) largely identical Windows 2000

OS: Palm vs. Windows CE And the winner is….

II. Wireless Marconi—100 years ago sent messages across the Atlantic Why is wireless so confusing? Cell phones Satellites From antennas to your office Within an office or hospital

Wireless and PDAs Both Wireless WANs and LANs Wireless LANs IEEE 802.11b  < 200 - 300 feet BlueTooth  < 30 feet 2.4 GHz range Interference from microwaves/cell phones. Why bother? Limited memory Real time updates

Local Wireless 802.11b 1-54 Mbps < 300 feet PC/notebooks Cisco, Lucent, 3M BlueTooth 30-40 Kbps <30 feet PDA/cell phones Nokia, Ericsson

Wireless Facts Security for WLANs is fair Turn it on, change the password, encrypt HIPAA? Speed is very good:  11 Mbps Cost Wireless network interface cards for PCs and PDAs < $200 Access points < $600. Why wireless?

Wireless Security Vernier Network ReefEdge Bluesocket’s Wireless Gateway

III. Integration $5,000 worth of technology sitting unused in a heap Duplicate data entry is expensive Physicians: NO Handhelds must integrate with practice management software and other applications being used in the office

Are Handhelds for You? Twenty Questions Technology and Value How much value add Integrate  today? Charge for new/upgrade PMS? Will the PDA require  a WLAN WLAN cost?  Who will maintain? If no WLAN, computer accessibility        to physicians to sync

Twenty Questions — Charge Capture Will it increase revenue?  In the office?  In the hospital? Save data entry time?  Cost? Layoffs? How much revenue do illegible and lost hospital charges cost you? Will physicians respond to the prompts?   Are they available? Will coding edits reduce denied claims?  How many?

Twenty Questions — e-Rx What functionality will physicians use? # Rx per physician per day Value add to patient by e-faxing the script # Pharmacy calls/day Save time, reduce errors, reduce cost?  What is real value to the practice?

Twenty Questions — Hands On Web demo? Live demo? Let the doctor drive. Who trains?  Replacement staff training? Value to practice: efficiencies, cost, new revenue and patient satisfaction?  Is it worth the cost?

Holy Grail 2010 Not King Arthur’s Handheld (Not Monty Python’s either)

"Josephe," Josephe, Bishop of Sarras and son of Joseph of Arimathea promises to entrust the Holy Grail when he dies — to  Alain who kneels in prayer.

Holy Grail Most enduring legend Cup used by Christ at Last Supper Used by Joseph of Arimathea at cross He transported it to Britain Mysterious, blighted castle, Fisher King Quest of the knight = self realization

Handhelds = Holy Grail? Both mystical experiences Few users doing transactions Landscape littered with tombstones Answer?

Handhelds Tomorrow Cell phone PDA pager convergence One device does it all: XScale in phones Multiple, integrated applications Every single doctor will use one Every married one too

The PDA of 2010 Better battery life, more features, more software Replace laptops? Enhanced connectivity Audio and video

Cell Phone of 2010 BlueTooth — synchronization with peripherals Phone/scheduling work as one Cell phone-PDA integration

Cell Phone of 2010

Health Care Holy Grail of 2010 We will all carry one integrated PDA Scheduling

Holy Grail—Empty Pail? Half of companies with market presence a year ago are gone or moribund Total user base of handhelds for transactions just a few thousand ROI studies justify CC for large institutions.  Other 80%?

Holy Grail  —  When? When Functionality The young convince the graying Three Cs Cost Convenience Complexity

Explosive Growth Thank you