The use of a PDA or handheld computer as support in the clinical setting

1. SESS
April 2008
Presented by:
Edward A Stern, RN
NothingBetter, Healthcare Team
ed.stern@nothingbetter.com

2.  Need for HIT in the ED
 Growth of PDA Use
 Why a Handheld Device
 Clinical PDA Uses
 Use beyond the clinical to get things done
 The right PDA for you
 Enterprise PDA
 Live Product Demonstration
Visit www.nothingbetter.com for a copy this presentation

3.  Edward Stern, RN
 Founder of NothingBetter Healthcare Strategies
 Clinical ED Nurse
 Consulting with ED’s on the effective utilization and
integration of clinical technologies
 EMR needs assessment and RFP development
 Workflow analysis
 Implementation support
 Training delivery and development
 Web-based training development and delivery models

4.  Adoption of health information
technology (HIT) can improve
quality and patient safety.
 Rapid growth of EMR/EHR solutions
in the ED, increase safety and
reduce LOS
 Only about a quarter of primary
care doctors in the U.S. (28%) and
Canada (23%) use EMRs
 Compared with a large majority of
primary care doctors in the
Netherlands, (98%), New Zealand
(92%), the U.K. (89%) and Australia
(79%).
[Health Affairs 25 (2006): w555-w571
(published online 2 November 2006; 10.1377/hlthaff.25.w555)] www.healthaffairs.org

5.  PCP’s Ability to offer care to patients other than
during working hours, which can prevent
unnecessary emergency room visits.
 Just 40% of U.S. primary care doctors report they are
able to offer such access; in the Netherlands the rate is
95%, and in the U.K. it is 87%.
 Access to resources for managing complex chronic
conditions at a time when more and more patients
are suffering from these conditions.
 Use of multi-disciplinary teams varied widely, from a
high of 81% in the U.K to lows of 29% to 32% in the U.S.,
Canada, Australia and New Zealand.
[Health Affairs 25 (2006): w555-w571
(published online 2 November 2006; 10.1377/hlthaff.25.w555)] www.healthaffairs.org

6.  Health Information Technology (HIT) involves
more than just the EMR solution. Handheld
PDA devices are a remarkable bedside
partner to the complete EMR solution.
Handylife.com

7.  Since the “Apple Newton” came to market
in 1993. the market continues to grow with
“Smart Phones” and “Integrated
PDA/Phones.
 Common growth of use for PDA style
devices is 25% increase each fiscal
quarter in 2008
 Growth markets where once personal data
management however modern devices can
access external data and voice networks as
well as the Internet through a wireless
connection dramatically changing the
market segment and healthcare potential.

8.  Minimize risk and error in patient care
 Faster and safer dose management
 Patient/medication confirmation (5
rights etc)
 Brigham and Women's Hospital, reports:
50% of physicians using a PDA drug
reference guide avoided one or more
serious adverse drug events per week.1
 A survey of nurses indicated that
immediate access to drug references was
the most important use of a PDA in
nursing.2
Photo compliments of Cerner Corporation
1. 2003 study and report as reported by PDA Cortex
2. 2003 study conducted by PDA Cortex on the “PDA Nurses listsev hosted by PDA Cortext

9.  Administration errors account for
38% of medication errors. (1)
 Only 2% of drug administration
errors are intercepted. (1)
 Medication errors occur in nearly
1 of every 5 doses given to
patients in the typical hospital. (2)
Images compliments of
Care Fusion®
(1) Leape LL, Bates DW, Cullen DJ et al. Systems analysis of adverse drug events. JAMA 1995;
274:35-43.
(2) Medical malpractice verdicts, settlement and statistical analysis, Jury Verdict Research. Referenced
by: Albert, T. Liability insurance crisis: Bigger awards just one factor. April 15, 2002. Available at:
http://www.ama-assn.org

10.  The
median compensation award for
medication errors was $668,000 per
award in 2000. (1)
 Through integrated Positive Patient
ID (PPID) and PDA “style” reference
tools we can immediately reduce
patient care error.
1. Barker KN, Flynn EA, Pepper GA, PhD, Bates DW, Mikeal
RL. Medication errors observed in 36 health care facilities.
Arch Intern Med 2002;162:1897-1903.

11.  The “Early Palm” Device

12.  The “Modern Palm Device”

13. • Most common
Clinical Uses
• Vast array of patient
care references and
other “nurses tools”
• Immediate access to
hospital process and,
procedure manuals

14.  Patient education resource
 Providing references to prepare
the nurse
 Providing anatomic visual aids
 Bedside real time education
 Interpretation opportunities
 Through phone features
 Through dictionaries that can
speak for you

15. • Requirement in
some nursing
schools
• Some medical
facilities are
offering payback
and/or support
programs

16.  CEU/CME
 Stand alone applications
 Web applications
 Clinical Tips and Primers
 Clinical charting solutions
 Internal Communications
 Phones integrated into the PDA
 Text message alert for entire
hospital networks (replacing
paging)

17.  Immediate patient care
data retrieval, and
charting
 While still a relatively
immature market
segment, PDAs can (and
should) be part of the
documentation process.
 Significant cost savings
and manpower hours
could result from
technologies that
expedite the
documentation process
Images compliments of Cerner Mobile

18.  PDAsare known for scheduling but
what else?
 Schedule
 Tasks
 Contacts
 The“GTD” (Getting Things Done)
movement as brought all sorts of
“back up brain” additions. For
example:
 Bug Me
 EverNote (PC & PDA)
 SugarSync (PC and PDA Web)

19.  Whatto take into consideration for personal
and professional use
 Needs – What are you going to do with it
 Operating System
 Size and Weight
 Price and Budget
 Systems integration use
 (more detailed)

20.  Consider needs and growth
 Always get a unit with expandable memory
 Consider your technology comfort and
support
 Consider integration concerns
 Do you want phone and email with it or just a
simple reference tool?

21.  Palm operating system (not device)
 Simple easy set-up and interface
 Loosing market share rapidly
 Still lots of software on the market
 Products price point starts around $100
 Price plans for phone models vary
 Some are stand-alone some integrated with phone
 Email integration is limited with “office” email
solutions
 Check out: www.palm.com or your cell provider

22.  Windows (and Smart phone)
 “Hey it’s Windows”
 Large and growing market share
 Products start at around $300
 Price plans for phone models vary – Phone units are
cheaper due to cellular plans
 Typically integrated with phones
 Email integration is seamless with office email
solutions (hey it’s Microsoft)
 Be sure you focus on the “type” of device and
versions
 Check out www.dell.com, www.hp.com, or your
cell provider

23.  Blackberry
 a.k.a “Crackberry”
 Always integrated as a phone/email device
 Rapid growth marketing but still limited medical
product line
 “Sleek” product integrations… more the
corporate tool
 Email is sweet!
 Prices vary depending on cell provider

24.  iPhone
 Very new tool on the market
 Very limited application choices for
clinical use
 Recent change in Apple business to
“open” the technology may
dramatically change availability of
applications
 Cost varies around $400 or more

25.  Consider “Broad User” site
licensing options for merged
Intranet and PDA access
 Micromedex
 Offers Intranet and limited PDA
Integration
 Pepid
 Offers comprehensive Intranet,
PDA and even Wireless secure
network options
 Offers clinical specialty content
areas

26. • Full Integration with
an EMR/HER
• Care Fusion (now a
Cardinal Company) for
patient and care
identification
• Cerner Mobile
• Reality is the
“interface” for the
device might be the
only limiting factor

27.  Hybrid Device – The “Mr Coffee of PDAs”?
 Integrated Reference, Charting device, Patient
safety tool and in hospital voice phone (e.g.
SpectraLink®, Vocera®)
+ + + = ?

29. Visit www.nothingbetter.com for this presentation