Palm-based Wireless Computing to Improve Access to Health Information and Coordination of Care James J. Cimino, M.D Department of Biomedical Informatics Columbia University New York Presbyterian Hospital Broward General Medical Center Grand Rounds July 7, 2005
47
Embed
Palm-based Wireless Computing to Improve Access to Health Information and Coordination of Care James J. Cimino, M.D Department of Biomedical Informatics.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Palm-based Wireless Computing to Improve Access to Health Information
and Coordination of Care
James J. Cimino, M.DDepartment of Biomedical Informatics
Columbia UniversityNew York Presbyterian Hospital
Broward General Medical Center Grand RoundsJuly 7, 2005
What are we trying to fix?
• Errors!• Information-related causes of errors:
– Lack of access to patient information– Lack of access to health knowledge– Poor communication and coordination of care
How do we study causes of errors?
• Surveys• Focus groups• Observation• Use of clinical information systems
– Observation with “think aloud’– Logfile analysis
What did we find?
• Information needs are 1/3 each:– Patient information– Institutional or administrative information– Health knowledge
• Information needs and resources are context-specific• Information needs are frequently unresolved• Team members can’t identify each other• Communication is delayed and inefficient
Proposed Solution:
• A wireless, handheld device that:– Connects to the clinical information system– Provides local knowledge resources– Provide context specific on-line knowledge– Supports communication among team members– Does not depend on infrared or wireless Ethernet
Where We Are
Physician Team
Intra-teamCommunication
Nursing Team
Inter-teamCommunication
Intra-teamCommunication
Interaction with ClinicalInformation System
InformationResources
InformationNeeds
Where We Want to Go
Physician Team
VirtualWhiteboard
Nursing Team
InformationResources
Infobuttons
Hand-Held Devices Choices
• Linux– Sharp
• PalmOS– Palm, Handspring, Sony
• PalmOS+Phone– Kyocera, Samsung, Handspring
• PocketPC– Compaq
Palm Platforms
• Palm VII+ all-in-one device/service- connection time, not HIPAA-compliant
• Palm Vx with Omnisky+ add-on, all-in-one service, “always on”- not HIPAA compliant, out of business
• SmartPhone+ all-in-one-plus-phone, HIPAA-compliant- smaller screen, connection time
• Treo 600/650+ all-in-one-plus-phone, WiFi, color, camera- cost, connection time
management, session management, logging• Data Access Modules (DAMs) for patient data• Medical Entities Dictionary (MED) for translation• Patient-listDepartmentReport headersDetails
Security
• End-to-end Secure Socket Layer• ID-specific IP address• Host IP address restrictions• ID and Password• SecurID• Timeout• System logs• Login failures generate e-mails• Screen lock (potential)
PalmCIS Login
PalmCIS Patient Selection
PalmCIS Laboratory Results
PalmCIS Radiology Results
PalmCIS Summary Reports
PalmCIS Microbiology Reports
PalmCIS Cardiology Reports
PalmCIS etc…
Information Resources
Infobuttons
• Information needs arise while reviewing clinical information
• Needs can be predicted based on context– Task– User– Patient– Patient data
• Queries to on-line information resources can resolve needs
• Match concept of interest to class(es)
• Identify context based on class(es)
• Retrieve question(s) for context
• Sort by “priority”
• Return HTML page of links (URLs)
PalmCIS Infobutton: Culture Result
PalmCIS Infobutton: Sensitivity
Navigational Issues
• Trade-off: data per page versus click-to-data ratio• Minimum required information versus fewest clicks• DetailsDepartmentHeaderDetails is inefficient• Can previous path predict future path?• Log files used to identify most-common paths• PalmCIS keeps track of user’s path• Provide list of shortcuts to next likely report
PalmCIS Shortcuts
Impact of Shortcuts
• Improve efficiency
• Reduce back clicks
• Optimize traversal paths
Log Files(control)
Log Files(intervention)
control intervention
Impact of Shortcuts
• Improve efficiency
• Reduce back clicks
• Optimize traversal paths
• Benefits– Facilitate access to
information– Assist in answering patient-
specific questions– Serve as reminders of what to
look at and patient problems
Log Files(control)
Log Files(intervention)
Virtual Whiteboard
• Identify team members and roles• Permit messaging between team members• Asynchronous communication• Palm-based and desk-based
Add Task Get Task
Cost
• Treo 650: $500• Sprint PCS: $60/month• Annual cost: $970/user• Server equipment extra• Personnel extra
Research Issues• Usability study
– PalmCIS– Shortcuts– Infobuttons
• Understanding whiteboard functions• Structured note entry• Where are handhelds better than desktops?• How do we study usefulness and impact?
– Usage logs– Increased access to information resources– Faster access to clinical data and alerts
Next Steps
• Redesign of clinical data presentation– Create efficient, task-specific views– Based on experience to date
• Complete integration of Virtual Whiteboard and note writing with WebCIS
• Explore use of Wi-Fi• Design randomized controlled trial• Get funding for larger deployment
Conclusions
• Secure, usable, wireless, handheld access to patient information and health knowledge is feasible
• Cost is not a big factor if replacing cell phone, PDA and beeper
• Integration into workflow and educational processes is biggest challenge
• Understanding appropriate “niche” functions is critical to success
• Answers are not obvious - research is needed
Acknowledgments
• Elizabeth Chen, PhD• Jianbo Lei, MD, MA• Larry McKnight, MD• National Library of Medicine Training Grant