(c) 2005 Medical Software for PDAs 1 Point-of-Care Computing: PDAs, Health Care and the HIM Ralph La Tella B.App.Sc.(Hons). AFACHSE Health Information Management Association of Australia

What are PDAs? FOR MORE INFO...  Handheld or palmtop computers  Originally designed as PIMs (Personal Information Managers)  All PDAs come with built-in software  Information may be entered using handwritten gestures, using virtual (on-screen) keyboard or by mini- keyboard

3(c) 2005 Medical Software for PDAs Do PDAs make sense? Desktop Computer Size Size Cost ++++ Cost ++++ Simplicity ++ Simplicity ++ Versatility Versatility Security Security TCO TCO Handheld Computer Size + Size + Cost ++ Cost ++ Simplicity Simplicity Versatility Versatility Security + Security + TCO ++ TCO ++

4(c) 2005 Medical Software for PDAs Personal vs. Functional FeaturePDAPC/Laptop Start-upInstantSlow Functional Philosophy User-centric Application- centric Overhead (OS gets in the way) Single tier, transparent Multiple tiers, very visible PDAs – Truly personal, portable computing power

The PDA Market: OS Wars FOR MORE INFO... Palm OS Pocket PC Low average price. Average price higher than most Palm OS. More software available (including health care related titles). 80,000 (Source: DAD Enterprises) Better integration with other Microsoft products. Fast, transparent operating system. Formal operating system structure. Trying to look too much like desktop PC OS.

Palm or Pocket PC ? Only the two most popular (Palm & Pocket PC) have a large developer focus and thus hold the majority of market share Only the two most popular (Palm & Pocket PC) have a large developer focus and thus hold the majority of market share Avoid immediate redundancy (built-in) Avoid immediate redundancy (built-in) Caveat Emptor Caveat Emptor FOR MORE INFO... The Palm OS logo and the Pocket PC logo are the Registered Trademarks of Palm, Inc. and Microsoft, Inc respectively and are used in this presentation purely for illustrative purposes.

7(c) 2005 Medical Software for PDAs Medical Relevance: Why PDAs in Healthcare? Clinical working environment is highly mobile with decisions made at the bedside. Clinical working environment is highly mobile with decisions made at the bedside. The size, shape and performance of computing devices that can be used in such an environment are constrained by the environment (Arshad et al 2002). The size, shape and performance of computing devices that can be used in such an environment are constrained by the environment (Arshad et al 2002). Handheld computers (PDAs) mobilise caregivers from the constraints of accessing data at fixed terminals. Handheld computers (PDAs) mobilise caregivers from the constraints of accessing data at fixed terminals.

PDAs in Use: Who, what and when? Who uses a PDA & why? Who uses a PDA & why? More than 50% of doctors in the USA (Skyscape survey, Dec 2003). More than 50% of doctors in the USA (Skyscape survey, Dec 2003). 85% of physician agreed that by using a PDA they had decreased the number of potential medical (prescription) errors. 85% of physician agreed that by using a PDA they had decreased the number of potential medical (prescription) errors. Almost 90% of the doctors surveyed concluded that PDAs help them provide better care. Almost 90% of the doctors surveyed concluded that PDAs help them provide better care. Almost 20% of respondents concluded that PDA use enabled them to treat at least 3 more patients per day. Almost 20% of respondents concluded that PDA use enabled them to treat at least 3 more patients per day.

9(c) 2005 Medical Software for PDAs Skyscape Survey Does PDA use improve the overall quality of patient care? Does PDA use improve the overall quality of patient care? How? How?

Potential Benefits of PDAs in Health Care By providing access to data where and when it is needed: By providing access to data where and when it is needed: Through the sequential review and entry of data (via interactive, web-based forms and databases), and Through the sequential review and entry of data (via interactive, web-based forms and databases), and The retrieval of data (lab results and other Dx) at the patients bedside. (Journal of Surgical Endoscopy 16(1):221 – 3 Jan 2003) The retrieval of data (lab results and other Dx) at the patients bedside. (Journal of Surgical Endoscopy 16(1):221 – 3 Jan 2003)

How are PDAs used? Communication. Communication. Document Management (e-Texts). Document Management (e-Texts). Database Management (DBMS). Database Management (DBMS). Electronic Textbooks. Electronic Textbooks. Medical Calculators. Medical Calculators. Coding (CPT/ICD-9). Coding (CPT/ICD-9).

Point of Care Computing: A summary DATA RETRIEVAL DATA CAPTURE The Point of Care Legacy Information System “Handhelds will likely become vital tools in the practice of medicine”. Dr Peter J. Embi Cleveland Clinic Journal of Medicine Vol. 68, (10).

Here Opportunities for HIMs Development Database Design / Forms Design Diagnostic tools / Clinical Pathways Integration of PDAs & Legacy Systems Security & User Access Protocols / VoIP Training Provide PDA training to Clinicians Provide Multimedia Materials for students Provide technical support to users P.O.C Resource Management Create PDA compliant web applications Quality Activities for Mobile Systems Providing Data Analysis Services Clinical Data Warehousing & Distribution PDAs / POC systems: The New HIM / Medical Informatics Frontier

Where to from Here? There has never been a better time to add-value to your career: There has never been a better time to add-value to your career: For those in Health I.T / Health Informatics For those in Health I.T / Health Informatics Extend your knowledge to PDA / Tablet PC applications particularly in the area of Relational Database applications – for the majority of you the transitional learning curve will be flat. Extend your knowledge to PDA / Tablet PC applications particularly in the area of Relational Database applications – for the majority of you the transitional learning curve will be flat. Champion the cause. Be at the leading edge – clinicians WILL turn to you for support & training. Champion the cause. Be at the leading edge – clinicians WILL turn to you for support & training. For those in traditional HIM environments: For those in traditional HIM environments: Find out how your knowledge of specific processes could be ported over to PDAs to provide niche solutions both within the MRD and other departments (e.g. record tracking using a bar code enabled PDA). There is an amazing lack of standards (in terms of data items required by various clinicians). Your skills are invaluable. Find out how your knowledge of specific processes could be ported over to PDAs to provide niche solutions both within the MRD and other departments (e.g. record tracking using a bar code enabled PDA). There is an amazing lack of standards (in terms of data items required by various clinicians). Your skills are invaluable.

Case Notes Project: MedLogs Client: PMEFQ Scope: A tool forming the basis of a system of assessment of 1 st year (junior) doctors Initial Costing: (by non-HIM, IT- only, Canadian firm) = AUD$120,000 Final Costing: (HIM) Nowhere near 10%

Recommended Software for Development HandBase HandBase Easy to learn and use Easy to learn and use Has desktop PC component so you can build databases on your PC then download to your PDA Has desktop PC component so you can build databases on your PC then download to your PDA Handheld databases may be uni/bidirectionally synchronised with MS Access tables Handheld databases may be uni/bidirectionally synchronised with MS Access tables Relatively inexpensive Relatively inexpensive Pocket PC and Palm PDA versions Pocket PC and Palm PDA versions Able to synchronise to web-based database Able to synchronise to web-based database

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