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Physician Use Growing Slowly

By Carol S. Miller; RN, MBA

Handheld personal digital assistants (PDAs), such as Palm Pilot M130, 500 or 515, Sony Clie, Visor Prism or Pro, Psion, RIM Blackberry, Zaurus, iPhone, Zune and other comparable PDA OS platforms, have revolutionized the communication world this past decade. PDAs and their future counterparts are becoming the catalyst for physicians to use information technology, are becoming the intro for physicians into the world of the electronic medical record software, and becoming the virtual office tool, enabling providers to communicate away from the desktop as well as away from his office practice. The reasons for increased utilization with physicians are portability, pocket-size, provides easy access to information at point of care and regardless of location, improves practice efficiency and workflow, improves drug related decisions and decreases adverse drug events.  

PDA Components

The common uses of PDAs by physician practices are:

• Personal applications such as scheduling, telephone directories, dictionary, “to-do lists” and others
• Drug databases
• Clinic suite that ties into the hospital information system
• Charge and procedure capture
• Communications, from provider to provider, provider to hospital, provider to office, and vice versa

Palm Operating System

Palm OS still represents the standard in handheld computing, assisting individuals to manage and access information at any time, at any location.  Handhelds are easy to use.  Physicians are using the Palm OS and/or compatible PDAs to access their office schedules, receive downloads of clinical information on their patients, and enter clinical services and charges when performing services at remote locations.

PDA Selection

In selecting not only the PDA but also the software, the physician needs to answer the following questions:

• What would you like to use the PDA for – clinical reference data, patient information, non-clinical applications, personal data, etc.?
• What information do you need to know about the patient that the PDA can simplify?
• What is the connection route between the hospital, managed care, or lab and your practice? In other words, how do you get access to the data?
• What are your price considerations?
• Do you need a color or black and white screen?
• What is the system support and warranty?
• How do you plan to connect to the office or hospital? 
• Do you want to go wireless or obtain information via a telephone connection?
• Do you plan to render care outside of your office practice, such as in the home, a clinic, hospital setting, etc?  If so, what would you like included on the PDA that would improve communication with the office and save time at point-of-service in documentation?

HIPAA

HIPAA regulations do not specifically address the specific term PDA, but the regulations do include guidelines for protecting patient information and transmission of this data that can impact the use of PDAs.  Physicians are utilizing handheld digital assistants whether they contain clinical information; or just resource data, may be or not are password protected, and may or may not be officially supported by hospitals or clinics.  Providers as they prepare for future applications and usage of PDAs involving patient information must understand the scope of the new HIPAA regulations as it impacts on patient data collected, stored or transmitted.  Any application involving patient identifiable data must be HIPAA compliant.  The key issues are how to protect the patient information stored on the device, i.e., if lost or stolen, and second how to protect patient information transmitted during a synchronization or wireless transaction.  Probably the most vulnerable aspect is the loss rate with recent studies indicating at least 30%.

Security

Most providers using PDAs for patient data utilize a user ID or password level of security. To maintain security, the provider should be required to re-enter their user ID or password every time they enter the application. Likewise, each PDA should have a “time out” feature, requiring a provider to re-enter his ID or password again. This feature will not prevent individuals with technical skills from accessing this information – the only mechanism is encryption.

Synchronization versus Wireless Applications

1. Synchronization transfers information from the enterprise database to the PDA, i.e., hospital lab or x-ray results, patient demographics, consultative notes, and others.  It is important that the hospital or hospital system authorize and approve the physician for using and transmitting this information and in turn, the provider authenticates and validates his agreement with the hospital before data is transmitted.  In addition for protection, an audit trail of who synchronized and what data was transmitted should be maintained by the hospital system.

2. Wireless providers have immediate real time access to patient data; however this process of transmission is more vulnerable than synchronization.  Wireless solutions can utilize a public or private network. HIPAA require encryption for the transmission of data over the public networks – Encryption is optional for others. Sharing data from a wireless over the Internet represents potential security issues; however, more and more technical firms and providers are using a wireless VPN that allows PDA users to connect securely from remote locations just as laptop users do today.

Other Issues

The other issues are who owns the PDA. If the provider does, he or she should be responsible for the security; however if the hospital does, the hospital should be responsible.  More current applications of Palm OS will include built-in modems for easier wireless communication, improved secure transactions, and ability of greater resolution for graphics, and other Web-based services. In addition, current and future applications will include refined voice dictation.  As an example, MDEverywhere’s package called Everynote allows the provider to digitally record notes and in turn links with MDEverywhere’s coded patient encounter.

The Blackberry

A very versatile product is the Blackberry.  It has web browsing capabilities, embedded wireless modem and can (1) write, send receive and respond to messages right from the unit, (2) access web information, (3) has nationwide coverage with no roaming fees, (4) has voice mail message capabilities, and (5) can be the size of a pager or PDA. The next feature with Blackberry will be its text messages to cell telephones.  New units start around $150-$300 with monthly service charges of $20-$50 depending on the plan.  The wireless Internet connection can be accomplished through Go.Web. 

Assessment

The typical cost for a PDA averages between $300 and $600 – depending on color or black and white – plus the cost of additional software and accessories.  For wireless connectivity, the physician will need to connect with a communication partner. Reference sites for PDAs are: www.handheldmed.com (for clinical, reviews, and news), www.pdamd.com (PDA resources), www.freewarepalm.com (free software programs), www.palmpilot.com, www.handspring.com.  The active shopper can refer to www.zdnet.com or www.palmblvd.com

Conclusion

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