1. Mobilising the Clinician
December 7-8, 2006
Dr. Mohammad Al-Ubaydli
The Advisory Board Company

2. Principles of
mobile medical computing
●
Introductions and mobile computing terms
●
The NHS spends money mobilising clinicians
− PDA pagers – mobility and accountability
− SMS appointments – control and convenience
− SMS results –privacy and public health
●
Evidence-based mobility

3. Introductions
How many are in...
− Clinician practice?
− IT / informatics?
− Management?

4. Mobile computing terms
●
Personal Digital Assistants
− Handheld computer: a computer small enough to
hold in your hand
− Smartphone: a handheld computer that can make
telephone calls

5. Advantages of handheld computers
●
Perhaps the best computer ever designed for
clinicians
− Mobility
− Synchronization
− Beaming

6. Why handheld computers here to stay
●
Handheld computers become smartphones,
and every clinician is already carrying a phone
− Aziz et al (PMID 16109177) gave smartphones to
surgeons and improved responsiveness to nurses
●
No charge left behind
− Moulton et al (PMID 16385275) gave handheld
computers to trauma surgeons and increases
charge capture

7. Use and Perceived Benefits of Handheld
Computer-based Clinical References
●
PMID 16929041
− Probably the largest study to date of handheld reference
usage, with 1501 MD participants (42% response rate)
− One of the few that looked at actual handheld device
usage data, not just self-reported survey responses
− Epocrates Rx was used 6.3 times/day, and MDs believed Rx
improved care quality and safety 5.6 times over 4 wks
− MDs who used Rx more than 10 times/day (25%) believed
patient care was improved 8.3 times over 4wks
− Epocrates Dx was used 8.4 times over 4 wks, and was
believed to improve patient care 4.2 times
− Epocrates ID used 4 times over 4 wks, and was believed to
improve patient care 4.1 times during that period

8. The opportunity before us…
300
250
Other
Units (millions)
200 Linux
150 Microsoft
100 RIM
Palm OS
50
Symbian
0
2003 2004 2005 2006 2007 2008 2009 2010
Est. Est. Est. Fcst. Fcst. Fcst. Fcst. Fcst.
Source: In-Stat, 9/06

9. The opportunity before us…
●
How long until a doctor realises they can use
the BNF on their mobile phone…
●
… and how long before they start putting
clinical data on it?

10. …and the risks

11. PDA pagers
mobility and accountability
●
Magic words: European Working Time Directive
●
Software now freely available for any NHS
hospital from www.ibleep.net
●
Setup
− PC on every ward for the nurses
− Central PC for night team operator
− Wireless PDA for each doctor
− Nurse contacts operator. Operator contacts
doctor. Everyone can see what everyone is doing.
●
Auditing allows adjustment of workflow

12. PDA pagers
What the nurses see
●
Can give the
doctor detailed
information
including
observations
●
Can see what
doctor is doing
about message

13. PDA pagers
What the operator sees
●
Notice the detailed logging of each call

14. PDA pagers
What the doctor sees
●
Alert thrown through
browser to PDA with
vibration and sound

15. PDA pagers
Auditing allows adjustment of workflow
●
80,000 live calls on system over last 2 years
− Can drill by ward, speciality, priority of work, MD, pt
ethnicity, pt age.
●
Actionable results
− Switched ENT SHO from 1 in 6 rotation to 1 in 13
cross-covering with general surgical SHOs
− At Start, 17 doctors at night. Now 12 sometimes 13
− 50% of cannulations handled by assistants
− Shifted warfarin prescriptions back to daytime staff
●
£115,000 savings, mainly in rota changes

16. SMS appointments
control and convenience
●
Magic words: Demand management
●
Setup (pilot to begin in January 2007)
− Patient sends SMS requesting appointment
− Receives SMS list of up to 3 slots for the next 48
hours, or a message saying there are no slots
− Replies to SMS with preferred slot
− Appointment booked with no need for phone staff
or appointment reminder
●
Software developed for Royal Free Hospital by
www.templatehealthsystems.co.uk

17. SMS appointments
Funding
●
Began with capital grant bid at strategic health
authority level
− Cost of software development
− Touch screen booking in waiting rooms
− Early SMS operating costs
●
Department of Health pilot site for demand
management
− Training for staff member
− Salary for the employee as they supervise project

18. SMS results
privacy and public health
●
Magic words: 48-hour waiting target
●
Setup (currently in pilot phase)
− Patient accesses website to enter GU symptoms
− Software triages case urgency of appointment
− Test results sent as SMS to patient
●
Software developed by Chelsea & Westminster
Hospital and Mikkom www.mikkom.com

19. SMS results
Funding
●
Conceived by Dr. Anatole Menon-Johansson
(SpR) and Dr. Ann Sullivan (Consultant)
●
Hospital senior management provided seed
funding for software development by Mikkom
●
NHS Innovation Award runner up

20. Map of Medicine Mobile Pilot Study
www.mobilemapofmedicine.com
• Magic words:
“Informing healthcare”
• PDA efforts in UK
inspired by deployment
of the UK map of
medicine on PDAs in
Kenya

21. Isabel Healthcare
• Foundation setup after
tragedy with the patient
Isabel
• Provide differential
diagnosis pediatric
decision support system
• Natural language queries
• PDA version optimised
for the small screen

22. Heartlands uses RFID for patient ID
●
Ensure patients are correctly identified before
they received surgery at The Heart of England
NHS Foundation Trust
●
Smart wristbands are linked to PDAs which
clinician's use to call up electronic patient
records that include a digital picture of the
patient
●
Safe Surgery Systems claim the system can
also save hospitals time and money, leading
to an extra 1-2 cases per list can be performed

23. The challenge
− At the start of 2006 there were over 600 papers in PubMed™ that dealt
with handheld computers. Many lessons have accumulated in the
clinical literature but we need to understand and assimilate these
lessons. The challenge is to provide these lessons as peer-reviewed and
unbiased summaries based on scientific fact, not marketing hype.
The Scholarships
− Five exceptional students from around the world will be selected each
year to review selected literature and make summary reports that will be
published in the Mobile Medical Computing Reviews journal. The
Scholarship winners will be mentored and trained by Dr. Mohammad Al-
Ubaydli, author of four books, including “Handheld Computers for
Doctors”.
●
The results
− Once complete, the reviews will be published and freely available
through the website of the new journal
Mobile Medical Computing Reviews. Each student will be able to quote
their own reviews in their list of publications.

24. Evidence-based mobility
●
International Scholarship
− Applicants from the USA, Mexico, Puerto Rico, UK,
Portugal, Romania, Croatia, Egypt, Israel, India,
China, Philippines and Australia.
− http://www.handheldsfordoctors.com/scholarship/
●
Peer-reviewed review journal
− http://www.handheldsfordoctors.com/research/

25. The winners
Joshua McAllister, USA Dr. Adesina Iluyemi, Ghana
Medical Student at PhD candidate at
University of Texas University of Portsmouth
Emily MacDonald, UK Dr. Yunan Chen, China
Medical Student at PhD candidate at
University of Cambridge Drexel University
Dr. Devashish Saini, India
Resuscitation Sciences Fellow at
University of Alabama at Birmingham

26. Mobilising the Clinician
December 7-8, 2006
Slides and handout available at
www.handheldsfordoctors.com
Contact details
IT Insights
The Advisory Board Company
alubaydm@advisory.com
+1 202 2665425
me@mo.md
Dr. Mohammad Al-Ubaydli
The Advisory Board Company