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ACCESS TO CARE
PDAs Show Promise for High-Tech Medics (2003)
by Karen Fleming-Michael
When handheld personal digital assistants hit the market in the late 1990s, the Army's Telemedicine and Advanced Technology Research Center immediately started exploring how clinicians could use them, both on the battlefield and in military treatment facilities.
Medical PDAscalled MDAs at TATRCcan improve medical record keeping, give providers instant access to medical information and patient histories, alert providers to lab results, speed up the flow of patient information among providers and commanders, and shorten the time first responders spend on the battlefield filling out forms.
"In an ideal world, these small, mobile devices would give us untethered access to medical information," said TATRC's Dr. Rufus Sessions.
Additionally, MDAs exploit the already powerful capabilities PDAs offer. Scheduling, storing contact information, creating to-do lists, writing personal memos, accessing e-mail and collecting data are all routine for business PDAs, according to a Government Computing News survey.
The devices will alleviate the problem of treatment records not making it into patient files, said Maj. Timothy Rapp, chief of TATRC's information-technology engineering division.
"We want to avoid the situation that happened in Desert Storm, where we're not sure what happened to medical treatment records," he said. "Even when troops were in garrison and the aid station saw patients, the information recorded on treatment forms didn't make it back into the records."
He said a very small percentage of field medical cards are filled out, even at training exercises.
"The percentages are much lower in a real-world situation because once you're done treating the patient, you don't go back and fill out the information," Rapp said. "With a handheld, it's 20 seconds to jot down the encounter after you see the patient."
Clinicians can also improve their efficiency and patient care by using wireless PDAs, said Jessica Kenyon, a project engineer on PDAs at TATRC.
"The provider usually has to hand-write notes at the point of care, and at some point they have to be transcribed," she said. "With (wireless) PDAs, the data could be captured right then and can be sent to a medical transcriptionist or a dictation server."
Some providers have already incorporated the devices into their practices.
Maj. David Blair, a power PDA user and staff Family practice physician at Fort Sill, Okla., Medical Department Activity, said he recently started using a PDA to make clinic notes by pointing and clicking through a list of typical things found during an exam, then generating a note that can be used to update the patient's chart. He also uses his PDA to calculate due dates for obstetrical patients and gestation dates from ultrasounds and determine pediatric medication dosages.
"I can do the things that I would normally have to look up on a desktop, with the exception of Internet information, wherever and whenever I need it," Blair said. "So if I'm up on the ward or if I'm in the clinic or emergency room, I don't need to have a computer terminal everywhere I go."
Though refinements are still in the works, TATRC is showing how MDAs can help process patients quickly and give commanders useful information on in-theater health. A team from TATRC that included 1st Lt. Ed McDonough, a biomedical engineer, used a laptop and MDAs to field Global Expeditionary Medical System in a field clinical environment.
"Our goal was to take the equipment out there to see what the physicians liked and disliked and to gather requirements that can be incorporated into future efforts in support of Enduring Freedom," McDonough said.
GEMS has two components: a patient encounter module and a module that collects epidemiological data for the theater. The patient encounter module eliminates the "stubby pencil" ritual providers go through when signing in a patient, taking vital signs and completing treatment notes on the SF 600 form that ends up in the medical record.
The ultimate version of GEMS will allow the patient to sign in electronically once, at which time the information record flows to the clinicians' MDAs so they can add to or review it.
The second component tracks epidemiological trends so preventive medicine doctors can pinpoint common symptoms and ailments occurring within a theater.
"If malaria is going around and you have this information, you can catch it before it's too late," McDonough said.
In a study titled "Clinical Needs Assessment for Handheld Medical Applications," that began in December 2001, TATRC gave clinicians at Walter Reed Army Medical Center and Fort Belvoir, Va., MEDDAC MDAs loaded with "a baker's dozen" programs. The goal of the study is to find out what clinicians need MDAs to do, Sessions said.
"Without user buy-in from the beginning, MDAs are not going to be successful," Kenyon said.
The clinical needs study also examines how user friendly MDAs are, in and out of combat.
"They (clinicians) want a fast system that does the same thing as the pencil and gives them better results," McDonough said after the Kuwait trial. "Everyone liked the idea of the PDA and being able to move about, but we have a long way to go before it's actually fielded."
Users said they appreciated having medical references immediately available and the ability to write clear notes; however, they also remarked that entering information in GEMS using the stylus was too time consuming compared to handwriting it.
From the January 2003 Mercury, an Army Medical Department publication.