The beginning of this new century presents some interesting dichotomies. The world is experiencing a technological revolution in every aspect that affects human activity. Yet in contrast, the gathering of information in the health-care environment is still in the dark ages in many cases.
The health of patients is directly contingent on the vital data that are acquired, collected and distributed among all health-care providers. So how does the professional community in this tech age respond and collect data ? The simple answer is, in general, very poorly. Volumes of patient data, reams of paper, and endless numbers of reports and forms are created, and then they are stored and often are extremely inaccessible.
The question arises: “Is there a solution to the woes of treating physicians that will positively impact patient care directly?” In order to treat your patients most effectively, you must be able to analyze all the patients’ information rapidly and coherently. Certainly the utilization of computerized patient records is the beginning to this portal of effective healthcare.
Software programs have the capability to effectively collect and retrieve patients’ clerical demographics, and thus make it possible to process the billing, insurance, reimbursements and office statements. But this is not the total solution that is necessary.
It’s the collection and distribution of the clinical data linked to the patient’s personal demographics that will be the ultimate catalyst for truly effective and portable health-care delivery. Those of us who have witnessed the transition from simple paper accounting and bookkeeping to today’s programs are now poised for the coming era: mobile computing (m-health), as it relates to healthcare.
Cutting-Edge Technology
April 2001 marked the first anniversary of Windows CE 3.0 “Pocket PC,” a software operating system for hand-held/palm-sized devices that finally delivers the promise of interactive, real-time patient care computing. This technology allows you to record the vital clinical data as it is occurring with minimal effort. This technology gives you the ability to chart the patient’s progress, create SOAPs and record histories. You can also document examinations, outcomes and a host of other clinical parameters.
Pocket PC allows data to be transmitted to the host computer in a number of ways. Serial, USB (universal serial bus), and infrared transmission of this data are available, varying with the manufacturers of the hardware. Presently Pocket PC also offers a unique tool — namely, wireless connectivity to your office LAN, making seamless transmission and connection to all of your patient data efficient and fast.
To further increase your portability, these Pocket PCs offer cell phone capabilities as well as Internet access. Thus, you can finally access all patient data from a mobile, hand-held device — while you’re also in touch with anyone you would like across the globe. As an additional benefit, if you live in either a remote or congested area, or if you need to make home calls in an emergency; global positioning satellite software (GPS) is available.
Future Growth
Is mobile computing just hype or is it “as good as it gets”? Yes, it is a powerful technology now, but it will expand exponentially in the coming months and years. The processing power of the Pocket PC hardware is currently at 150-206 MHz with 32/64 megabytes of RAM. Already on the engineering table are versions with an estimated speed of 500+MHz, with not only more built-in memory, but a complete unification of all the versatile functionalities — wireless, phone, GPS, voice etc.
Since the Pocket PC is the mobile extension of your office computer, it’s important to understand that it functions as the input device for capturing data. Presently, the mobile computer is enabled by touch-screen or stylus. It provides for keyboard, text, handwriting or touch selection as methods of input. Current technology allows for voice recording similar to a tape recorder, but it does not yet permit voice-enabled input.
However, already on the market outside of the United States are cell phones and other devices that are voice-enabled using Pocket PC. The software available for this technology is amazing. All the features to which one is accustomed with the Windows desktop will be available for Pocket PC. The learning curve is thus reduced, and the familiarity in this case leads to love, not contempt.
The demands on program design will be many. The software must be easy to learn and use. It must be fast and stable, and the workflow must be intuitive. The design must capture the relevant clinical data, and the input must be simple. The good news is that a few such programs are already available and will only become increasingly advanced.
Practical Applications
As with any revolutionary concept, the important question about mobile computing is whether it will actually be used by physicians. The medical community in general is notoriously archaic in its data acquisition methods, even while the latest treatment technologies are being used.
Many physicians still use paper charts, records and forms. The technophiles will use transcription, or even better, voice recognition software. But for this health-care revolution to become reality, mobile computing patient records must be universally adopted. Then instant reviewing, charting, sending and sharing of the patient’s data will occur. The benefits to the patient’s well-being are obvious, and the cost-saving potential is enormous.
Paper claim handling now accounts for approximately 25% of health-care delivery. Wouldn’t the insurance companies be better off if they promoted paperless claims; perhaps a portion of that administrative cost savings would pass through to patient reimbursement benefits.
The financial benefits accrue for the chiropractic practice as well. Overhead costs will decrease, labor costs are reduced, and reimbursements are speedier with quicker turnaround time. Other, not-so-obvious benefits also occur. Patient contact will improve, allowing better doctor-patient interaction. Treatment profiles will be more readily available, thus increasing the doctor’s quality of care and outcomes. Better outcomes result in more successful practices, with all the ensuing benefits.
The ability to instantly and accurately document the patient status on a hand-held computer could increase your malpractice defensibility, as well as decrease your professional liability. It follows that those who adopt mobile computing may reduce their risks substantially, while increasing their profitability.
Potential Limitations
Are there other barriers to adoption of this technology?
First and foremost: No matter how good the hand-held computer is, the limiting factor will always be the desktop version of the parent software.
Since the Pocket PC is an extension of your office software, it is the desktop program that is the ultimate repository of all this newly acquired data. Initially, the biggest obstacle you may encounter in converting to mobile computing is a possible resistance to change by you and/or your staff. You will have to purchase the equipment to go mobile; but cost should not be a major issue, since the hardware is inexpensive as compared to a notebook or tablet computer.
Driving Forces
The driving forces for adoption of a mobile computing system are clear. The government is already proposing a $1.50 surcharge for every paper HCFA form. In several states, legislation is either introduced or contemplated to mandate computerization or typewriting of medical doctors’ notes and prescriptions to reduce errors. While this legislation may not immediately apply to chiropractors, it is an indication of what is on the horizon: Computerization of patient records and data with instant mobility.
The result is the creation of Electronic Health Records (EHR) for every person, which empowers the patient’s control of health-care decision-making and emphasizes connectivity with personal records. To achieve the EHR requires not only Computerized Patient Records (CPR) but also m-health (mobile computing) and e-health (Internet medical technology).
Successful implementation of EHR will abolish paper-based medical records that 95% of provider organizations presently maintain parallel to their computer systems. This change alone could save an estimated $90 billion annually.
Medical competitiveness, level of efficiency, and quality of treatment may be in direct relationship to the rate of progress toward a paperless, mobile system that incorporates digital documentation of all clinical, clerical and administrative processes.
Finally, the type of technology envisioned in Stanley Kubrick’s “2001: A Space Odyssey,” is closer to becoming a reality: “Good morning HAL, I’m not feeling well. Please send my health records to Dr. C for examination. I’d like to make an appointment!”
