Mobile software syncs savings with efficiency

"How do you provide information to highly mobile clinicians most effectively, particularly at the bedside?" asks Dr. Michael Blackman, chief of general internal medicine at Berkshire Medical Center, a 300-bed hospital in Pittsfield, Mass. That, he says, was the question that brought Berkshire to PatientKeeper.

The application, which runs on both Palm and Windows Mobile PDAs and smart phones, can provide the entire electronic patient record, including medical images if desired, literally in the clinician's hand.

Berkshire Medical Center already had its integrated electronic patient record running on PCs at nursing stations in the hallways. But increasingly the device at the end of the network is not a desktop or laptop computer but rather what is often termed a "pervasive device," basically a computing gadget that is designed to be carried on the person and used anywhere.

In this case, says Blackman, "PatientKeeper allows us to push that information out to relatively inexpensive devices that clinicians can carry easily with them, to the bedside and wherever they may go through the day." This is particularly useful at bedsides but also can provide a clinician with instant access to a patient's information if he is called at his office, home or even car.


One of the attractions of such devices is their relatively low cost per unit, which makes them easier to cost-justify. What sold the business case for PatientKeeper at Berkshire Medical was not improved patient care. "Presenting the information at the bedside is good for patient care and patient safety, but it doesn't pay for the device and software," says Blackman. "Charge capture does."

Medical bills are based on procedures ordered by clinicians. For insurance purposes, each procedure must be identified with a complex code. Hospitals traditionally equip doctors with decks of forms printed on 3-by-5 cards. Theoretically, every time a doctor orders a procedure, he fills out a card giving the patient's name and billing number, the procedure's name and charge code number and other relevant information. At the end of the week, each doctor is supposed to send all the completed codes to accounting, where they are hand-entered into the hospital's billing system. This has proved to be a very error-prone system -- doctors sometimes forget to fill out cards, they may put in the wrong billing code, they may lose cards, and at the other end of the process data entry clerks also can make errors, particularly in the codes.

A decade ago, PatientKeeper started as a simple automation of this system on PDAs. The doctor could check off the patient's name and the procedure's description on a PDA, which then would automatically fill in the billing codes and other information, making charge capture much easier, quicker and less error-prone.

Individual doctors can create their own short lists of procedures they use, avoiding errors such as coding something as an adult procedure for a patient under 18. At the end of the day's rounds, the doctor puts his PDA on a synchronization cradle, pushes a button, and all the information is uploaded directly to the facility's billing system, eliminating data entry.

Doctors are more likely to use it at the bedside because the check-off lists and automatic code look-up makes it much easier and quicker than filling in cards manually. And instead of receiving piles of cards to process at the end of the month, billing gets information daily. Not only do hospitals capture a more complete and accurate record of what is being done -- increasing their overall income and decreasing charge rejections by private insurers and Medicare/Medicaid -- it improves cash flow by allowing faster billing.

Security concerns

Security is another issue with mobile devices on the network. PatientKeeper can work live over a Wi-Fi network or cellular connection in a smart phone. However, Blackman says, "At present our wireless network doesn't support live access to our PDAs, but we are working toward that level of access." Therefore, for the present the doctors at Berkshire Medical capture updates and send out charge information by syncing their devices through cradles attached to the wired network at nursing stations.

Doctors typically do an Active Sync of their Windows Mobile PDAs first thing in the morning. "Currently we bring over the latest patient list for the doctor, labs, medical image reports, allergies, the current medications list for each patient and demographic data," Blackman says. Although PatientKeeper is capable of handling medical images as well, Berkshire Medical elected not to import them onto the PDAs. "We have a live PACS (Picture Archiving and Communications System) on the network that delivers full-screen medical images to PCs through the hospital," Blackman says. By comparison "on the PDA these images would be very small and not really useful." Except for charge capture, doctors do not enter information into PatientKeeper directly. Instead they enter their notes into the main patient record on a networked PC.

While PatientKeeper is not revolutionary, Blackman says it has made his life easier in several ways. "It is very easy to use, and except for a few technophobes everybody here likes it. I find it particularly helpful when someone else has been rounding for me over a weekend. When I sync my PDA on Monday morning I can immediately see all the physician encounters with my patients. I also find it very handy when I am on call over a weekend, since it gives me the information on my patients in my pocket."

Copyright © 2006 IDG Communications, Inc.

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