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Handhelds Hardware Science

Digital Doctoring 116

Posted by michael from the little-black-bag dept.
ssajous writes "This is an interesting article in the NY times which talks about PDAs quickly finding their place in the world of medical billing and keeping track of patient's care, there is a lot of money in the medical field, but also currently a lot of unnecessary paper work. I like what I see!!!" I don't think Palm makes a tricorder card yet, but it's only a matter of time. The last time I saw a doctor, he was doing things the old-fashioned way - I would guess it will take a while before this sort of technology is widely used.
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Digital Doctoring More

Digital Doctoring

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  • newton (Score:4)

    by spoot ( 104183 ) on Monday January 08, 2001 @08:53AM (#523163) Homepage
    believe it or not the Newton had made a lot of inroads into this before Steve killed it. A lot of the apps for the Newton were specifically medical/hospital.
  • When you're sitting there, in a cold doctor's office, with only a sheet over you, and nothing but drug literature to read, it's great to be able to pull out a Palm and play a little Freecell, or even tweak a few web pages.
  • Just about every doctor in my local hospital uses a Palm Pilot to keep track of patient information. The hospital system here in Greenville, SC. issues them to all residents and interns (Palm IIIxe currently) for use in charting. They use special software that allows them to automatically update computer patient charts.

    Security concerns aside, this is a really great idea because it allows multiple people to at least read a record (i believe they have a check-out mechanism to prevent more than one person from writing to the chart at a time).

  • They can take pictures with Kodak's CoolPix, and then show the doctors what the hell caused the injury.

    Of course, there's the ambulance chasers, who whip out their PDAs and start taking names for litigation. However, the PDA is the number 2 favorite of the ambulance chaser; number 1 is the instantly inflating balloon for putting under women's shirts to feign the third trimester.

  • it becomes easier to input data into these things. Working in a medical/computing field, I know that paperwork is a pain in the ass and there's no way around doing the paperwork. But for now, I'd much rather spend the time filling out my forms, than Graffiti-ing my information in, erasing the mistakes, then reverifying that it's all correct.

    Maybe when they have good voice recognition for the Palm, then it might really look like a sexy alternative to pad and pen. But not yet.

  • I worked in the Medical Software business and let me tell you it is SCAREY. I worked for one of the largest medical software companies in the USA who claimed to be "modern". However, they were still coding in COBOL 74 (that is GOTO logic for those who don't know). I soon realized I had to get out of there. You would be amazed at how screwed up Medical Software/Hardware really is.....
  • Yeah, I am sure that you are tweaking web pages... probably tweaking your helmet, no?
  • my brother is a doctor and he uses his Visor regularly. Mostly it helps him explain to people whats wrong, without having to get out a big text book and show them the pictures. he loves it.

  • Problems w/ Digital doctoring (Score:3)

    by drin ( 83479 ) on Monday January 08, 2001 @08:57AM (#523171)
    There are a number of problems with the concept of digital assistants in medicine. I worked in the field for some time and ran into all of them...

    o Resistance
    But I've *always* done it this way
    o Portability
    How do you move from patient to patient and
    get data into a centralized database reliably?
    o Reliability & Security
    Medical data must be valid, authenticated, and
    readily available. Having a system crash when
    you're evaluating someone's heart condition is
    unacceptable.
    o Legal considerations
    Doctors' notes are considered as legal
    documents when looking at medical malpractice
    and other legal-medical collisions. How do you
    verify that the electronic format is the same
    as the paper one when there *is* no paper one?

    There are more, of course, but these are the big ones I ran into time and again. The bottom line is that while Hippocrates and other PDA software packages are useful, the likelihood of the medical profession accepting the widespread use of portable technology for medical data entry and retrieval is slim anytime soon.
  • ...a good idea. The Palm and Palm-based PDAs could definitely speed up things. One thing that comes to mind is insurance adjusters. They could bring out their PDA, take in all the information they need, hook it to a laptop and have everything done in a fraction of the time. PDAs are going to gain a wide use. I know I use my Visor a ton.

    -=-=-=-=-=-=-
    The COBOL Warrior
  • Yeah, and the patient's life support machine in the next room is bouncing him off the walls in rythmn to your pong game, bonkers from the RF radiated by the cellular modem in it. :) Seriously, most Dr's offices and Emergency rooms have "no cell fone" signs. People don't stop and think that their PDA applies...
  • COBOL? Not so long ago, I worked at a company where the main application was coded in MUMPS. Read more about this scariness here [radix.net] .
  • Do the PDAs need some sort of jacket to prevent them from gathering/transferring germs/deseases in cracks and crevices? What do health regulations say about electronic equipment in hospitals? Does each electronic product have to be certified or something by a governing body as safe for use in a medical facility?

  • Re:newton (Score:4)

    by jim.robinson ( 135817 ) on Monday January 08, 2001 @09:00AM (#523176) Homepage

    And from what I've read it sounds like the Newton was a very big hit for those who used it to track their patients. The pilot strikes me as too small to use for this purpose. I bought one a few years ago, right before they started to really catch on. I ended up ditching it and hunting down a used Newton MessagePad 2000.

    For those interested in a very good article about the use of a PDA in medical settings, I highly recommend reading A Day in the Life of my Newton [risley.net].

    Jim

  • To a new everything, so that now there is a complete PC (Windows) in every office that brings up your history, the works...and even sends prescriptions over to the pharmacy for pickup. Of course, when they implemented it at first there were tremendous problems (like 3 hour lines for drugs) but they seem to have worked it out now. I'm just afraid that I'm going to go in there for something serious one day and his machine is going to crash in the middle of something important, thus giving Blue Screen of Death a whole new meaning. (Ok, I bet I'm not the first one to say that. :))
  • Yeah, I am sure that you are tweaking web pages... probably tweaking your helmet, no?

    Not yet, but after our current baby is born, I may consider the vasectomy, which apparently involved a bunch of helmet tweaking.

    I'll ignore the USian slant to your post which assumes I have a helmet to tweak, instead of the turtleneck that the Europian slashdotters are wont to possess.
  • My wife's OB was using a Palm over three years ago to keep track of his rounds, set up followup visits, and keep brief notes on his patients. He was the first in the office to try it out, but even then he'd been getting a lot of (positive) comments from the other Dr's in the practice.

  • Handspring Attacking the Market (Score:3)

    by Devout Capitalist ( 94813 ) on Monday January 08, 2001 @09:02AM (#523180)
    HandSpring [handspring.com], the Palm spinoff, is actively courting this market. They have a hot plug-in system that lets doctors carry several different handspring modules [handspring.com] as plug-ins. You can see a demo here. [franklin.com]

    The books published by Franklin [franklin.com] for all the hand top OSs. It's just that the hot swap HandSprings allow people to carry several around.

    A small piece not mentioned in a good article.

  • Well, here in Israel all the doctors in the clinics use computers, but desktops, I think using a palm would be an improvement for them. It's portable, and has a touch screen which is much more comfortable for immediate use.
  • where I work for the IT dept. PDA's have become a favorite for doctors and marketing. Altho it still seems like it's more of a statis symbol than anything else. It's the next best thing to a laptop, which is another statis symbol amung the Dr's. Plenty of laptops at the hospital never leave their docking stations. But PDA`s on the otherhand.. those are in just about everywhere.
  • I've been working lately at several clients that are in the medical field - everything from an HMO to a clinical software developer - and Palm use is becoming more widespread in this industry every day.

    Many doctors and nurses are beginning to use Palms and specialized software to handle patient information, take notes, and do quick research on different medicines (there is a pharmaceutical references Visor module). What's more, I've seen a lot of use of the wireless Palms as well.

    For the most part, this is great. However, my biggest concern is the base infrastructure - these PDA's tend to interface with grossly outdated software.

    --

  • Seriously, most Dr's offices and Emergency rooms have "no cell fone" signs. People don't stop and think that their PDA applies...

    The vast majority of PDAs don't have transmitters. Cel phones do, and can (theoretically) interfere with the nifty cool wireless EKGs heart patients are wearing while hospitalized.

    My PDA is no more harmful to medical machinery than the CD player in the nurse's lounge.


    --

  • the only cell modem in it is the one mandated by the NSA.
  • The reason why they won't allow things like this in a hospital is because of strict rules regarding such items. For instance have you ever noticed that when you go into a hospital they ask you to turn off cell phones, beepers, any tiny gadgets etc? Its for the well being of the patient its also so that none of their equipment malfunctions while performing operations. Hospitals are a sensitive area because when the EKG starts flat lining but the person is still alive and it was all because of your cell phone, it'd have a very adverse affect on the hospital itself and the dead patients which they could charge you with homicide for; knowing or not.

    Yes it would be nice to have things and organizers like these in HMO's and other places but not in a hospital. I'm sure you wouldn't like it if you knew that a loved one died because some person had to know when his/her next meeting was going to be.

  • My friend users hers all the time (Score:3)

    by HomeySmurf ( 124537 ) on Monday January 08, 2001 @09:10AM (#523187)

    My friend is a doctor in large hospital in NYC, and she uses her Palm all the time. It has replaced a least a half dozen heavy manuals she used to keep in her pockets. Many companies now sell e-text versions of their reference works. She got it to reduce the number of reference works she had to use, but I think it is better in that it facilitates better searching and indexing. She is young, and young doctors liker her use them all the time, it is the older ones in power that are technologically resistant.

    I think that it is unfortunate the medical field has been so slow to adopt technology like this. If anyone knows the history of MYCIN, it is amazing to me that the medical field has ignored such powerful diagonostic tools. In the end I think it is the public that suffers.

  • Mandatory no-reg link (Score:1)

    by Anonymous Coward
    Here [nytimes.com]

    Personally, I don't see why /. doesn't just use these instead of the "please sign in or register" links.
  • I havnt seen a need for PDAs in my own life. They have always been neat little toys as far as my life was concerned. Some people really need them, but I think for the most part, they are status symbols and/or toys. My thinking changed after I saw my brother in law's Visor at Christmas. He is a medical doctor and he had a great database stored in his PDA. He had diseases and different conditions loaded in the prepackaged database that he could update as well. It seemed as if he found it very useful at work. Reading about Doctors and PDAs just reminded my of this minor enlightenment of my own.
  • My MD has one of the early Palms and has been very interested in my Visor every time we meet. Last time he told me one of the pharmacutical reps was offering him a brand new color Visor just as soon as they can get them. Seems they figure its a good way to get more branded info infront of the MD and get on their good side - so they write perscriptions for the Real Stuff not some cheap Generic Equiv.

    My doc wasnt too keen on taking it, since he already has one and doesnt use it a whole lot (office, billing, schedule not tied in, etc.) But since its free he might just take one for each of the MDs in his group.

    The PDR on springboard looks pretty interesting!
  • This summer, while working at a hospital in Maine, I did a job for a doctor who was setting up his office for a network. He was really nice, but rather hard to work with...

    Anyway, he was one of the first people in Lewiston to buy a PDA, and he's still got one now (Handspring 8MB model). He carries it everywhere with him, keeps all of his stuff in it, and uses it for everything. And oddly enough, this has become typical in that hospital. If there's a market to be had for PDAs, it's probably indeed with anyone who collects data - and doctors fit snugly into that category.

    CAP THAT KARMA!
    Moderators: -1, nested, oldest first!

  • My sister bought a Palm IIIxe just for this purpose. She's become so reliant on it that she freaks whenever she needs to change the batteries. She didn't bother getting a computer. She hotsync's with a computer at the hospital dedicated for PDA's synchronization. She usually uses it as an intermediate step between when she meets the patient and when she files a report (on paper). She also uses it as a medical reference due to the quick nature of data retrieval. Imagine seeing a "Starting MS-Windows...." when a patient has reaction with drug conflicts and your searching for a quick remedy?
  • Here's the challenge..
    What do you think we will see in our lifetime, and which will be more difficult to code for:
    1. Reliable, 99.99% rock-solid voice recognition? 2. Artificial Intelligence 3. Slashdot being bought by Microsoft 4. Larry Ellison, Bill Gates and Richard Stallman joining a wife-swapping group. 5. Handwriting recognician software that can actually read a doctor's handwriting? (Have any of you actually seen a readable prescription in your life?)
    My vote goes to the first four as most likely.
  • The Palms make a great PDA: they are simple, the applications work, and the batteries last a long time.

    But as a software platform, I think they are not all that good. They have megabytes of memory now, but they suffer from 64k limits somewhat analogous to what DOS used to impose on programs. And while PalmOS is conducive to letting experienced PalmOS programmers write tight, simple applications in C, for many custom applications, you want something like Java, Smalltalk, or even VisualBasic.

    Palm has made steps to offer Java and to upgrade the processor and OS. Let's hope those will happen soon.

  • "He's in convulsions from waiting too long in the emergency room! Quickly, beam me Pimp Wars, STAT! C'mon... we can get through this..."
  • Actually, there's a nifty little program out there called Xenoprobe ... maybe not quite as good as a real tricorder, but humourous, and doesn't require a plug in card.

    My sis uses her Visor for some real med progs, too. Drug interaction lists are a lot easier to carry on PDA than the binders (constant updates) it otherwise requires.

  • I've learned about this first-hand: Last year, My wife was diagnosed with Type II diabetes in the aftermath of a failed pregnancy.

    People diagnosed with Type II diabetes often have to test their blood seven (7!) times a day (or more!) in the first few years, and record the results, time/date, and diet info for their doctors. Manually, this can be a pain in the ass, especially when full records for 2 months need to be given to a doctor.

    Right after being diagnosed, my wife found out about Glucopilot (see http://www.healthetech.com/), an award-winning program for the palm OS, which prompted her to buy a Palm V and a hard case. It does a wonderful job of recording, handling, and outputting & graphing the data. With the purchase of a small cable (made one myself, ha!) it can read the output of some blood sugar testers directly and eliminate the manual entry of numbers all together.

    Her doctors, both of whom where unfamiliar with the program, were astounded by it and the detailed data it provided when she show it to them, and they began mentioning it to their other patients.

    It's not just the Glucopilot software though, My wife found several other programs for the Palm that she uses to track diet, and other medical info like details on her menstral cycle, sudden sickenesses, and anything else.

    Where this really makes the impact is on the day-to-day lifestyle front. She has a tiny case that she carries with her eveywhere she goes because it is so compact and totable. It holds her Palm V, and her blood testing gear. Because the form factor is so friendly, and the software provides such immediate feedback on blood-level trends, etc, she has displayed incredible dicipline in taking readings and entering data as it occurs. And that dicipline has seriously impressed me and her doctors, and is probably why they are saying she will be able to control the condition without needing insulin shots, etc.

    The palm has been great for collecting all my loose data in one place, and I see specialized, easy-to-use medical tracking and info software as providing great benefit to people who have problems that are ongoing and have to shared with their doctors.

  • Sharp has a camera that plugs into their WinCE PDAs. We looked at using it at the Fall 97 Comdex. It was specifically for wound documentation on claims. The biggest problem at the time was storage and battery draw. Cameras have come a long way since.

  • Whole sites devoted to medical palm pilots (Score:3)

    by Booker ( 6173 ) on Monday January 08, 2001 @09:33AM (#523199) Homepage
    Burdie's medical palm pilot page [angelfire.com]

    The Healthy Palm [hypermart.net]

    and others... [angelfire.com]


    Thing is, though, I'm not sure I'd trust, for example, a pregnancy-safe drug list I just got off some guy's home page...

    ---

  • Yeah, I used to work for the Medical Informatics Group in the University of Missouri Health Sciences Library. We provided IS services for Doctors, Professors and Health science students of all stripe. The Med. Students loved the Newton for its software that allowed them to efficiently track their patients. I'm surprised that it has taken Palm this long to catch on. That was back in 96-97.
  • What's interesting is the amount of medical students snatching up palms in preparation for entering rotations. My wife is currently a second year medical student about to enter rotations this summer and she along with many of her classmates are buying some sort of palm device specifically for their rotations. There are a slew of databases containing drug information, disease/symptom data, etc. There are apps for patient tracking. It will be interesting to see how long it takes hospitals and clinics to incorporate new procedures utilizing palms into their existing procedures. I'm skeptical about the rate at which hospitals will adopt said procedures. It's been my experience w/ large academic hospitals (which are usually the most eager to try new technologies) that it's very difficult to get the physicians to adopt new procedures. Palm based procedures may appeal to the new generation of doctors but there are a lot of stubborn older physicians that are set in their ways.
  • Many of the current meters have the ability to download the readings. My First Step records 50 readings internally and keeps date and time information and even logs averages and trends. Upload to the PC once a week and send in.
  • One of our developers is currently working on implementing a ticketing system for us peons (admins) to use. The idea is, we'll carry around the palm pilots, when there's a call, we input the ticketing info into the pilot -- we then sync up with the server twice a day. Personally, I'd rather not have these things. I already look like Dilbert...the last thing I need is another gadget. (As it is, I don't use paper).

    g
  • FYI - There is a fairly decent VB plugin for Palm development. Due to the custom UI widgets, it's not as easy to do cross-platform development as one would hope, but it certainly does work well. www.appforge.com [appforge.com]
  • I work in a large hospital, in the ER, and currently we are trying to phase in handheld, and small 'touch-screen' patient-charts, called 'echarts.'The problem lies not in the fact that they're bulky, that they use a pseudo-windows UI, and that they use stubborn LCD displays. It probably has nothing to do with the fact that their login is the last name and the first initial of any employee. Most likely nobody knows that they communicate via RF so that they can connect to the network. I doubt they remember when the backup power generator turned on, and scrambled that RF connection. The REAL reason that nobody wants to use them is because they're different,bulky,and difficult if not downright impossible to navigate. At least the paper forms are color-coded, and all look pretty, with the cute nurses' curly little handwriting. These chunky boxes look cinder-blocks wrapped in rubbery plastic. I'd bet that when someone comes up with a more ergonomic, eye-pleasing design, the doctors, nurses, and techs will be more willing to convert to the Paperless Way. But for now, the things sit in the corner, collecting dust along with the dot-matrix printers, almost totally unused. Not until these devices are used from the beginning, i.e. in the nursing and medical schools, will doctors et al be willing to trust life-or-death info to them!
  • Why would it be any different from, say, a doctor's ballpoint pen? Why should the fact that it's electronic make it more prone to transmitting disease? Doctors are already carrying a variety of objects on their person from patient to patient, and I don't see why adding a Palm to the mix should change anything.
  • The big clinic that my kids' pediatrician works in has laptops with wireless LAN posted throughout the clinic. As soon as the doctor completes the exam, he inputs the data directly. Not quite a PDA, but a pretty slick paperless setup nonetheless, and of course, it's all tied into the clinic's centralized databases and apps.

    I assume they use laptops so that they can more easily be swapped out for maintenance, repairs, etc. And the wireless LAN simplifies a lot of networking issues, I'm sure.
  • The PalmOS machines are getting better all the time, though. More memory and expandability mean more OEM possiblities for these devices as a prebuilt User Interface. Visor is putting a lot of effort into promoting the expansion slot in their PDAs for all sorts of purposes. The people I know in the Medical Device community are looking into this quite a bit.

  • After I got my m100, I was lookign at memory upgrades. One of the sites I found is by an MD.

  • Wouldn't wireless PDAs make more sense in the fast moving world of a hospital? (I can't imagine a nurse docking while in an emergency room).

    For that matter, are there any PDAs that work with the current 802.11b standard for PC base stations?

  • First off, the reason cell phones aren't allowed in hospitals is because they use RF (radio frequency) signals, which can interfere with all kinds of things, from pacemakers to MRI machines.

    AFAIK, pagers are allowed without restrictions in a hospital. Every doctor I've ever met has been wearing one, regardless of where they are. Maybe someone with more knowledge of how pager signals work can explain why they are better than cell phones (maybe much less signal power??).

    Also, palm pilots are allowed just about anywhere as well. They don't give off any (or much) RF power, and there is little chance of a palm pilot causing "equipment malfunctions while performing operations."

    LL
  • The Blue Screen of Death is a Windows NT phenomenon.

    It happens when the Kernel crashes, and (surprise, surprise, to all the zealots) it actually has useful post-mortem data on it about why the machine crashed.

    So there by definition was no 'Blue Screen of Death' in 1988 at a computer convention. There may have been a system crash that resulted in a frozen screen display of some kind, and it may have even had a blue background. But it definitely was NOT a BSOD. Windows NT didn't exist in 1988.

  • Seems they figure its a good way to get more branded info infront of the MD and get on their good side - so they write perscriptions for the Real Stuff not some cheap Generic Equiv.

    Oh, yes. It's scary the way drug companies court doctors and hospitals. (Even veternarians, too, to a lesser extent.) For example, for one new allergy drug the makers sponsored a seminar: "the invitation included round-trip airfare to California, accommodations at a luxury hotel, and a participation fee of $1,000..." [lycos.com]

    The PDR on springboard looks pretty interesting!
    My doctor just got a Visor (I think); it wasn't a pharm. company comp, she bought it herself. She's like a kid with a new toy; got a bunch of medical references on it, including the PDR. (That's the Physicians Desk Reference [pdr.net], a honking big book that lists every drug on the market, its actions and contraindications. Worth consulting whenever you are prescribed a new medication.)

    Tom Swiss | the infamous tms | http://www.infamous.net/

  • How can you read an article about devices like this growing in popularity, then see comments from numerous people explaining the projects they have worked on developing stuff like this, and then lead off your comment with 'The reason they won't allow devices like this in the hospital....'??

    The devices which are restricted in the hospital are cell phones and other devices which emit a lot of RF. Further, there are probably some hospitals where patient/public-carried electronic gadgets in general are discouraged if they might be a distraction to the patients/staff.
  • I worked in the IT dept. at a hospital in Philly, and found that they are slow to embrace new technology, for the most part. When I was there in '97, they were installing new Windows 95 (yeah, I know) boxes for use on a NetWare 3.12 system. But the 95 boxes were running a 3270 emulator to talk to the old medical mainframe! Those were expensive dumb terminals, let me assure you. And they crashed way too often.

    You might think this is stupid, but there is a reason why they use old technology: it's tried and true. When your rinky-dink website crashes because of a minor bug in the software, that's annoying. When the ICU-1 server crashes, patients die - no joke. We had to operate at < 1 min. unscheduled downtime per month, or we were replaced.

    So the palm thing is cool, but don't expect doctors carrying around PDAs to diagnose for quite some time - at least, not in any official policy. On the other hand, my dad is a doctor, and he now has a drug database on his palm, as well as a diagnosis kit, and he loves them both ;)

  • I can see "resistance" being a major factor.

    The "portability" factor could be solved by having either an encrypted wireless ethernet connection for the PDA's or maybe an infrared port in each room. The encrypted wireless ethernet would be the most secure.

    "reliability & security" - I think that there'd be a heart-monitoring machine in the room with the patient if their heart needed monitoring. Besides, I think we're only talking about hospital records here - not patient monitoring. For reliability I'd imagine that they'd have some sort of failover and clustering server with a large RAID storage system. Security would only be as strong as the designers create it.

    And if "Legal Considerations" are taken into account - I would imagine that there would be some sort of "on the fly" encryption that each Doctor's PDA would have that would put a unique digital signature onto each doctor's report.

  • I think the point is that you can throw away a ball-point pen if you think it's been exposed to infected blood or what not. It's hard to sterilize a Palm.

    It's an interesting question, I think. Consider how they wrap or otherwise sterilize everything that comes into contact with you (tounge depressors, ear lookers, etc). Everything in the doctors office either get's thrown away after it's used, or get's sterilized. What happens if a doctor washes his hands, opens up his Palm to look something up, then touches something that get's put inside you. Has he just run an infection risk?

    I honestly don't know, but considering how careful they are with everything else, I'd say it's an issue.
  • When going over the future of paperless medical data entry at the 97 fall Comdex, the main app that was felt to be a minimum was voice recognition. The need for hands free data entry while on rounds was the most important. You can use your hands when doing a patient interview but for entry during an exam, it needs to be hands free.
  • I worked on a project a few years ago to integrate the Palm into the routines of doctors at a major university hospital. The project started out by allowing doctors to access an online database to lookup test codes when ordering a test for a patient. This was done by setting up a web clipping applet on a PalmVII and changing the previous webpage a bit. The project was a success despite the fact that some docs preferred the 'old way'.

    The next phase of the project was to allow the doctors to access patient records via the palm. This of course would require a 'key' in the palm that would allow only that unique palm on top of authentication to the server to have access. It would then be tested with a fake patient database and evaluated. It would then go in front of a board to determine the security and applicability of the process and whether a 'live' test group be started.

    At that time (1999) many doctors were very apprehensive about using this, I hope things have changed by now..
  • First. It needs to be transparent. If a Doc has to hotsync before each patient, the palm will live in it's cradle... never used.. it must be wireless.

    Second. Easy to use. Doctors have the worst handwriting on the planet. either they are just plain lazy or have no handwriting skills, but it is universal... doctors can't write. so you expect them to use hand writing recognition system like on the palm?? not likely. Until the doctors are forced to write legibly (as in prescriptions too!) they will not comply.

    Third.. Price. Doctors are usually cheap. They will not pay $500.00 per wireless palm and $900.00 for the wireless portal and then $20,000.00 for the software. they will stick with the antique foxbase based dos-text medical system on netware 3.x forever. Why? because what is available out there sucks (ALL medical practice software is a messy joke that can barely be called software. and the Windows based stuff is a collection of bugs at best) and is insanely overpriced.. ($3500.00 per workstation license fees for a program that fits on a floppy and was written in the 80's? bite me buddy!)

    The medical field is plagued with many problems.. the first is crappy systems and software that scare the doctors. if we get rid of the crap and start charging sane prices.... maybe the doctors will start looking at it.
  • I don't see a palm as any more dangerous than the pagers that most people in hospitals wear. Given that those have been in common use in hospitals for longer than I've been alive, I'm sure whatever issues there are have been addressed.
  • I come from Springfield, MO, a major medical town for the area where many doctors now employ palm devices to track complicated lists of patients, numbers for pharmacies, and other information. This IS a step forward in medical technology, using something that doctors can carry around and track patient lists, but many times these PDAs are not in the hospital "network", and do not exchange information, such as patient status or call schedules. But of course, this is a large leap in technology, and the medical industry needs something to be more efficient with the ever lowered spending with medicare and the HMOs. Perhaps this technology, when used correctly, can improve productivity, but for now, it is limited to being something for personal use by many doctors.
  • A lot of people in ER's, especially the nurses, are using PDA's to keep track of patients. One person I know uses a little palm app to quickly jot down all the incoming patients for triage, and then hotsyncs to her computer to produce initial patient records. She then keeps track of who is where the same way.

    If you add on wireless connectivity and a durable piece of hardware (ie, spillproof, drop-proff), PDA's in ER's would work really well for everyone (no more paper charts till they leave!)
    -MR
  • But the big move is away from handwritten info in charts. At my pappy's hospital, they are seriously looking at switching to a chart system that is filled out via a series of check boxes that can later be filled in a la bubble sheet tests so that the chart can be scanned into a computer database. Apparently they work better since they can be filled out and read more quickly (most humans are visually oriented creatures, and besides, it's true. many doctors have abysmal handwriting.)

  • We have found the following to be true: (Score:3)

    by frog51 ( 51816 ) on Monday January 08, 2001 @10:28AM (#523226) Homepage Journal
    o Portability - use Symbol 802.11 enabled Palm and have spread spectrum radio coverage throughout and either a telnet or html client.

    o Reliability & Security - NEVER USE MICROSOFT!!! Use AS/400 if you want absolute reliability, or Unix if you want high reliability with ease/cheapness of coding/updating.

    o Legal considerations - there are many ways to sign/legally encode a file...discussed elsewhere.

    This only leaves the "We've always done it this way" brigade - work on them:)



    Frog51
  • There really isn't any easy way to upgrade the m100. That's part of why they can be sold so damned cheap. If you want to upgrade the memory on your m100 or IIIe you need to take it apart and desolder the RAM chip from the board. There is a description of this process here [cmu.edu] given the domain name on this link I'd say that it's probably a pretty reliable source. I've not tried to do this yet either with my IIIe or with my girlfriend's m100 since my soldering skills aren't all that I'd like them to be.
    _____________
  • Electronic devices per se are fine in hospitals, and I tend to spend a lot of my time setting up rf networks in hospitals (802.11 kit in UK is limited to 100mW output power) with no problems - in fact we often hook heart monitors to mobile bridges so patients can be moved without having to take a trolleyload of hardware with them, or drug trolleys with a laptop and rf network card to make patient record updates easier and more accurate. Its devices with the output power of mobile phones (1/2 a watt and up) which can interfere with sensitive heart monitors.

    Although I have seen a Vodafone antenna siuated on the top of the Royal Infirmary in Edinburgh!!?!


    Frog51
  • This is true, but a pager is worn at the hip and is generally not touch unless a page has been recieved. Even then most of the doctors and nurses I work with will not touch their pager or anything else with gloved hands. A pager is therefor a low infection risk.
  • We've done a lot of consultation with hospital staff in the improvement of quality of care, including bring staff up to par on standards of care for different problems. What I've seen is pretty scary. While overall care is ok, many many times standards are missed which results in increased patient suffering and longer hospital stays.

    Consistent use of handheld computers could very easily improve the care that patients recieve across many settings. For example, the Doc checks off Diabetic and gets a list of recommendations like running certain tests, foot exams, and setting up outside education and consultation, which could also be suggested contingent on certain criteria.

    Personally, I'd feel much better if my Doc relied on a standard reference in treating me. Doctors are not all super-intelligent and many have lots of trouble remembering important information, particularly for less common ailments.
  • Where I work it is a rediculous waste of time to try and decon anything and everything someone touches. The fact of the matter is that most of the germs that one could get from a surface like that are pretty much dead from the light already. Only a few viruses are contracted through the dermal layer, and those are pretty rare. So long as you don't go catheterize yourself, or perform a throat-sweep with your own finger, you're fine. Since doctors and nurses wash their hands after every patient, etc.the dangerous germs are pretty much killed right there anyway. IN addition to that, there really is no difference from and electronic chart and a regular one. We in the ER reuse the same bunch of clipboards upon which all of the patient's paper is clipped.If you were worried about the charts, you'd also have to consider the actual paper, wheelchairs, desks, pens, door handles, syringes (just kidding), all the equipiment like the EKG monitor, the oximeter, etc. People forget that for the most part, the human body does a kick-ass job at protecting itself. I've worked in the ER for a long time, and I've NEVER contracted any type of disease, save for an occasional cold. But I could just as easily catch that at the supermarket!
  • Long ago, before Jobs canned it, one of the classic Newton markets was the vertical/health market. Lots of software companies offered software to doctors catering from patient tracking, medical records to digital books on procedures, information and diagnosis. Most of those companies switched to Palm as soon as Apple closed Newton Inc.

    All in all is good to see the technology and uses getting some public recognition.
  • I'm currently involved in the development of tools which clinicians can use to find the relevant recommendations contained in a clinical practice guideline, given a particular 'case' (patient characterists, availability of resources, etc.). This kind of project is much more involved, and more complicated, than a reference app -- the kind of thing that tells you which drugs interact with which other drugs -- but it is potentially much more useful.

    It's important, I think, to talk about the real potential, and the real danger, of this kind of automation...

    Automating the delivery of recommendations from medical Guidelines improves the quality of care because physicians are often too busy to consult lenthy, complicated print guidelines. Having them in electronic format alone isn't much help -- these systems have to pull patient characterists from existing medical record systems and offer recommendations based on those variables. In other words, they have to be able to step through a series of logical statements and offer an evaluation to the physician. This will, in the long run, greatly improve patient care, because decisions will more often be based on empirical evidence rather than on convention or tradition.

    The danger is NOT that physicians will blindly follow recommendations (any good system should offer a natural language explanation of how it arrived at a recommendation, which the physician can then accept or reject), but that HMOs and insurance companies will tweak these systems so that the underlying algorithms favor reduced cost rather than highest patient quality of life.

    Unfortunately, physicians are no more or less computer literature than any other professional group (which is to say, not very), and so we, as developers, have an ethical obligation to articulate very clearly how these systems function, both to the clinicians who use it, and to the public.

    Having said this, I would much rather have my physician pull out his handspring and look at survival curves for various drug treatments than to have him give me 'drug x' because that's simply what they 'do' for my condition!
  • The biggest problem at the time was storage and battery draw.

    Add to that the fact that any WinCE device crashes on execution of any program (provided and downloaded alike), and you have a troublesome PDA.

  • As a medical student soon to be starting residency, I've asked all my potential residency programs about PDAs. As you'd expect, the results vary widely. Some programs actually have a Palm III and V compatible hotsync cradles at every computer workstation and nurses station in the hospital and clinic. Using AvantGo, everyone's call schedule is updated with each hotsync.

    PDAs still have a ways to go in regards to managing patient data. Currently, it takes too long to access each patient's information and make the necessary changes to be worthwhile. However, the PDAs have great drug databases(epocrates), physiology calculators(MediCalc) and pregnancy calculators(Pregcalc). Also, when checking out patients to the person on call, you can beam your patient list to their PDA. It would be interesting to see the software that querist mentions in the above post.

  • Industry data indicates that a full 20 percent of American physicians already carry hand-held devices, if only to keep track of schedules and stock holdings...

    Just what I need when I'm hemorraging--my quack checking his RHAT shares...
  • The data makes it's way into a centralized database because the Palm devices are hotsynched on a regular basis. Originally, the whole point in PalmOS technology is to serve as a remote data collection/viewing terminal. The Palm devices aren't (usually) meant to be the final repository for anything.

  • Quite. I used to admin at Baylor College of Medicine, and one of they med students got one, and was all the rage. There was talk of making all sorts of things there, but I had left to have more time for my own school before anything got implemented.
  • Consider how they wrap or otherwise sterilize everything that comes into contact with you (tounge depressors, ear lookers, etc).

    Yes, everything that comes into contact with the patient. The PDA will not come into contact with the patient. In cases where a transducer connected to the device comes into contact, it will be disposable or sterilizable.

    Nothing new, no new issues at all.
  • I work for Lernout and Hauspie. We make voice recognition products specific to healthcare - and have prototype handheld voice recognition devices running Linux on the compaq i-paq. In my own estimation, the cross over is not far away. I'm betting we will release a VR handheld for use in healthcare.

    See this link for healthcare product info at L&H [lhsl.com].

    See this link for L&H's press announcement about L&H's Linux PDA [lhsl.com].


    See these slashdot stories about L&H's Linux PDA:

    http://slashdot.org/article.pl?sid=00/03/31/143222 6&mode=thread [slashdot.org]
    http://slashdot.org/article.pl?sid=00/02/05/092820 0&mode=thread [slashdot.org]
    http://slashdot.org/article.pl?sid=99/11/10/185920 8&mode=thread [slashdot.org].
  • well, michael's doctor might not be on the cutting edge, but I just finished an internship this last summer at MD Anderson in Houston (big cancer hospital), and at least a fifth of the doctors i interacted with had some kind of device w/ i/o capabilities -- usually a palm that they used to note things and organize information that they would be putting into their computers later (this is a research hospital). it made them faster, IMO.
  • Do the PDAs need some sort of jacket to prevent them from gathering/transferring germs/deseases in cracks and crevices?

    No they don't. A protective jacket would not do any good because the jacket would then be gathering germs and transfering them from one patient to the next instead of the PDAs case. Yes you could have disposable jackets made, but these would have to be custom made and because of this, (and the fact that it is for medical equipment) it would become extremely expensive.

    Earlier this year we purchased a number of portable computers to be used by the nurses to reduce the amount of paper that the nurses had to transport between patient rooms and nursing stations. During this the same issue arose.

    Electronic medical equipment must be cleaned after each patient. If you see medical equipment in a hospital that is grimy or looks like it may have been used before, you have the right to refuse the use of that equipment or you can report it to the hospitals Infection Control Officer or your State Board of Health.
    Also all AC powered medical equipment should be checked by the facilities Biomedical dept before being placed into service.

    Doctors, nurses, and other hospital personel may carry pagers and cell phones, but these should be checked with the hospitals Biomedical dept. to ensure that they do not interfere with other hospital equipment such as telemetry systems. These may be worn into patient care areas as long as the patient is not in isolation, in which case no equipment is to be brought into or removed from the room unless it is under controlled conditions by authorized personel.

    Also a doctor should not be handling any unsterilized equipment while in gloves, this includes personal electronic equipment like PDAs. This prevents the spread of infection from the patient to the equipment and therefor on to the next patient.

    Most doctors I am acquainted with make this a strict practice in order to not bring infections/ illnesses home to their family or themselves. I know of some doctors do not do this, I also know that none of these doctor will ever practice medicine on myself if I can help it.

  • I didn't think there was any way for a doctor's signature to get worse... and now, their penmanship is going to be even more cripped when they sign their prescriptions on their little touchpads...

    yes. bad doctor joke...


  • The tricorder for Palms is here [jeffjetton.com].

    Can't live without it. How else would I know if the people I meet are terrestrial or not?

  • I am currently working with an MD designing a desktop/laptop/palm databse application used soley to record information during the exam, track patients, and generate legible reports.

    This Doc, and I assume most others who work out of hospitals, has access to a text-based computer system that, among other things, allow him to check on lab results remotely.

    He and I were discussing the fact that, while entering in data at the patients bedside is fairly easy, going back and entering lab results as they come in is a major drag.

    Does anybody know anything about the computer capabilities at these medical labs and wether or not there is any history of these people allowing third party software vendors to access this information in a standard format like XML or text files? It seems to me that in order for desktop and Palm-based medical applications to be really useful, there needs to be some way for the application to dial into the lab and query the server for the latest lab results.

    Of course, the security ramifications boggle the mind.
  • Stating the truth is not flamebait - 95% of my customers are banks, hospitals and organisations with large mission critical databases. Some have even tried using MS NT clustering as a high reliability/availability solution. It has never worked.

    Basically the Windows operating system is just not as solid as Unix, and Unix is not as solid as OS/400.
    OS/400 can run non-stop, even during upgrades of hardware and software.
    Some Unixes can give you 99.99999% uptime
    Top documented MS cluster gave 99.2% uptime

    This may sound like a very small difference, but when 20 minutes downtime can cost upwards of £4 million, it just makes sense to use a mature OS.

    Flamebait - I think not:)


    Frog51
  • I have recently had the opportunity to sit in on a Medical Informatics panel at a Philadelphia area hospital and discussed the role of technology with a cross section of doctors, administrators, and residents. One the largest issues that the residents had was portability. They complained about previous experiments involving laptops because they were cumbersome to bring to the point of care. this is one way in which the PDA's shine, and sub-laptop devices could find a niche. At this hospital they have a set amount of money that is set aside for purchasing new hardware/software for the residents. This could be spent on laptops, PDA's, or sun workstations if they felt so inclined. This makes any decvice a tradeoff for some other gadget. Security is also a large concern because if the patient information is not secure then the hospital is open to many lawsuits. It seems that the use of opensource products should be encouraged but the level of technical expertise is not very high, and there are support questions. the other issue that comes up is the availability of software. What software is out there and being used now?
  • Absolutely.

    I have a Comapq [compaq.com] iPaq that works great with either wired or wireless NICs (PC Card type II). I'm going to be using it with the Ricochet PC Card as soon as they hit the market.

  • Bah. I've already had medical care negatively affected by Palm technology.

    My husband and I were in the ante-something area at the hospital (the pre-delivery room), and the staff OB had just confirmed that I was really in labor. My husband whips out his Palm to get our OB's home phone number, and the next thing I know, here's the doc pulling his slightly-different-model out and they're doing compare-and-contrast.

    Now, while I like techtoys as much as the next geek, at that particular point (contractions every two minutes) I felt it was more important to yell "HEY, CAN I GET SOME DRUGS HERE?"

  • I receive my MD in a few months, and let me tell you - I can't imagine big American hospital medical care without a Palm. You have no idea how many times I've sat in the OR, reading the list of medications that a patient has filled out about themselves, and have to use Epocrates [epocrates.com] (literally the best free program EVER written) to sort out what's going on based on phonetics. Sounds crazy, huh? Trust me, it's an improvement.

    Anyways, I think the fact we (doctor-types) get labeled as "always want to do it the old way" is a sign of intelligence. Systems for med info can't tolerate the kind of crap you have to put up with your standard freshmeat development cycles(ie. paper and handwriting may suck, but it works). However, I think once you have an exmaple of a breakthrough and useful and reliable UI, like epocrates and some others, there pretty much >80% incorporation across the resident housestaff at the big hospitals.

    Don't forget the network effect when it comes to patient tracking software because of the Palm-to-Palm beaming. Once some programmer-doodz figure out a quick checkbox way to initiate patient records, you'll get widespread acceptance. It really is only the patient record setup time that is the bottleneck now, as I see it. I would kill to have an accurate Palm-based patient census. We're carrying ~10-50 patients per, and right now it's the lowest level team member's (ie. intern) job to type an MS Word file EVERY 3AM with all the updated info.
  • Yeah, it's chapter 11, reorganization. We should be OK, though.
  • It might have something to do with the fact that, discounting minute emissions from a local oscillator, pagers are receivers, as opposed to transmitters. Banning pagers would be like banning FM radios or televisions. Cellular telephones, however, are transmitters as well, increasing concerns about interference with medical devices.

    The usual IANAD, etc.

  • I've heard from more than one doctor who prefers electronic texts on a handheld not only because it makes access easier, but because of how it makes the patient feel.

    Even the best doctors need reference works. But patients expect doctors to be omniscient, or near it. They get anxious when they see a doctor consulting a book before making a diagnosis. A doctor who nods thoughtfully and gazes at the screen of a Visor, on the other hand, seems like a tech-savvy, all-knowing genius.

  • I write front ends for medical databases for hospitals and larger medical offices and from my experience...

    1) Most hospitals DON'T have a lot of money to spend on these things. (Despite what you may think when you get a bill.) If you don't believe me, just ask your next ER doctor about the latest cost cutting measures -- or if you want to hear a more realistic answer ask a NURSE about the latest cost cutting.

    2) While PDA's may not be cutting edge technology, 95 percent of hospitals are on the trailing end of the technology curve. (Many of our client are still mainframe or DOS based!) Don't expect this to catch on like is implied above.

    -Derek
  • I work for the IT department in a UK hospital. We have an ever increasing number of (CE) PDAs. They are probably not used for medical things but they are keeping our consultants organised and in the right places at the right times.

    Like the rest of the planet we are looking into wireless networking. The UK National Health Service hopes to sort out an electronic patient record for everyone.

    Maybe we will see that paperless office one day?
  • There's also the matter of ensuring the security of data carried on the
    handheld device (or anywhere on a computer system, for that matter).
    Generally speaking, security and patient privacy are the reasons why
    hospitals and clinics are reluctant to put many types of patient information
    online (particulary chart information). If a hacker gets your credit card
    number, you generally are not out much (if anything), and you can replace
    the number easily. If a hacker gets your medical information (or, more
    likely, if some employee at the hospital or clinic decides to look up your
    info during the employee's coffee break), it can be well nigh impossible to
    undo the damage there. Plus, as mentioned in the article, HIPAA (Health
    Insurance Portability and Accountability Act) will require healthcare
    providers to take much better care of their confidential patient data (or
    face stiff penalties).

    This is not to say that paper records are that secure. In fact, it is
    probably the case that electronic records can be much more tightly
    controlled than paper ones. It's really analogous to airplanes and their
    safety. The airlines may have fewer accidents and fatalities per mile
    travelled and per passenger, but the accidents that do happen are real
    doozies.
  • yes, i am glad that it meant so much to you that you needed to comment (and you took enough time to logout too! -- but then again, you probably never had an account --only a comment).

    Yeah, it was early in the morning, and much of it isnt clear in retrospect, but hell, at least I have the balls to take credit for my words, inane or not.

  • I'm a doc and can attest that our handwriting is indeed bad, but curiously enough most do grafitti just fine - even the old farts are catching on.

    I thought the Newton had a lot of potential and even hacked up a few things in Newton script to help with rounds, but the thing was too slow until the 2000 came along. A doc acquaintence started a successful software company with it though.

    I guess we're cheap if you're talking about charging me $20,000 for software that I can put together for free with existing GNU/open source/free tools such as Linux/BSD/Apache/gcc/perl/interbase/postgres.... Free software is a great idea for medical applications that will catch on. You're right about the antique software that's still used by a lot of hospitals and clinics.
  • As a busy doc who has thought a lot about these things, I would have to respectfully disagree. The vast majority of docs do not refer to "practice guidelines" in their daily routines. No more than the average programmer refers to Dijkstra in his daily activities. And it is all too easy to forget that medicine is still much more of an art than a science - and as such, it is not easily encapsulated in a set of rules or guidelines. Science has its place and is desireable in many ways, but there are precious few prospective randomized clinical trials. And there are serious flaws in treating specific patients as if they were the average case.

    Experience and intuition (together with a basic medical fund of knowledge) are still much more effective in diagnosis and treatment than automated systems. There are so many important visual and nonverbal clues that come into play - and this is where "automated decision making" falls flat. This kind of problem requires serious AI that is nowhere near fruition. Perhaps one day we will have a medical "Deep Blue", but not any time soon. The heuristics are much more complicated in medicine than in chess.

    The real potential lies not in aids to decision making. After all, it is only the rare & unusual case that forces a trained doc to hit the journals & books anyway. But there is big potential in saving time, since docs are incredibly busy and time pressured. Palms are very helpful in this respect.

    The other areas where software and computers are going to be helpful is in pattern recognizion. Reading EKG's is commonplace (though still pretty bad). Automated reading of EEGs, XRAYs, and pathology slides will be common soon enough. Docs are also very interested in robots since they are potentially more precise and do not fatigue during surgery.

    But I must agree wholeheartedly with you about the darker side of your type of software - it will be used as a tool for insurance companies to cut as many corners as possible and exert more control over medical decisions for their shareholders under the pretense of the computer software "knowing what's best for the patient". Like it or not, the vast majority of important advances in medicine are not based on quantitative scientific studies, but are instead the result of a experience-based darwinian process resulting from reasonable practice variability. Once the insurance companies (armed with your software) impose widespread mediocre (but cost effective) "practice guidelines", then I fear that medical progress will be slowed and medicine will lose its heart and soul.
  • I'd still say no as they seem to be tied to Graffiti - too slow and inaccurate. I'd hate to see something as important as medical notes dependent on this.
  • 1) Why bother, though, when they're built in to WinCE and EPOC machines as a rule? Which also then give a bigger screen size so allow a better interface and more info on screen at once?

    2) I'd actually dispute that, having used it for some time. I found it reasonably inaccurate and very slow. The WinCE system seemed better in a short play but I now can't see myself leaving the world of keyboards and my Psion 5. As accurate as any keyboard and nearly as fast as a normal keyboard. Lots less inconvenient than it looks, too.

    I'd rather have something supported too, but there are better supported products. The PalmOS really isn't the be all and end all of handheld computing - in fact, I'd say it's a pretty bad solution.
  • 1) You miss the point. Go to the alternative platforms and you get the voice recorder without needing to add anything to your machine, PLUS you get a bigger screen and all the adantages that gives. Realy, try a Psion or WinCE machine and you'll realise how small a PalmOS screen really is.

    2) Surely a significant part of the problem though is trying to scrawl them down in a hurry? Whereas graffiti, if it's to achieve usable accuracy, really needs you to be slow and precise...

    3) Gladly, but it seems daft to deliberately pick such a poor choice.

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