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Wireless Helping to Save Lives
Wireless Helping to Save Lives

The ability to carry five or more volumes of reference information around in their pocket, and interfaces that are easier to use than flipping pages in a book, will make PDAs a norm for medical workers everywhere. The advantages are just as apparent in other fields with workers who are mobile for periods of time without regular access to a desktop PC.

Wireless tools for mobile medical workers are seeing widespread use. They are being utilized by military medical workers in the Gulf, in remote communities in Africa, and also closer to home. Wireless medical tools can make high-quality information available to those in locations with poor medical infrastructure, where access to up-to-date information can be critical.

When asked to cover a story for WBT about wireless saving lives in war zones I was intrigued for a number of reasons. First, I wondered whether there could be a more forceful benefit to invest in a new technology than the potential for saving a human life. Second, I wanted to know how this use of technology would relate back to medical workers in more traditional environments. And third, I wondered whether these tools would replace existing support materials, or like so many new services, would simply be a short-term fad.

Clear Benefits of Combining Wireless and Medicine
When approaching wireless enterprise projects, value is often created by improving processes using technology. Wireless devices and applications can help to automate processes that are typically manual or offline due to the mobility of the workers. Industries that are typically heavy on systems and IT to support workers are good targets for mobile enterprise. In many workplace settings, wireless applications are often most beneficial to those who are mobile for periods of time without regular access to a desktop PC.

Many medical and health-care workers are mobile as a standard part of their daily routine. Within hospitals, doctors and nurses spend a large part of their day at the bedside of patients or in the operating room. And there are those in the industry who work with patients in their homes or while being transported. It is also an industry where the stakes are high if the wrong information is referred to or passed on - creating high value for investments in electronic processes. I wonder how many wrong prescriptions and treatments result from a doctor's poor handwriting.

It's not surprising that there are quite a number of technology vendors who have developed wireless solutions targeted at the medical industry - from Bluetooth-enabled machines in hospitals (removing the hazards and limitations of wires) to the focus of this story, which is productivity-enhancing and enabling tools.

Analyzing the Processes of a Medical Worker
Doctors and other medical workers rely upon standard reference materials when they are confronted with cases that are not routine, and also require access to up-to-date information such as medical alerts and drug news. The Asian SARS crisis has demonstrated the need for medical information systems that rapidly update critical information to doctors and medical workers - and also allow the reporting of information back to authorities. In addition to this access to broadcast information, doctors require access to information that is specific to the particular patient they are treating - such as medical history and current prescriptions.

Creating wireless tools for mobile medical workers is not about creating new information. In some ways it's a process improvement project - how to make existing information more accessible and smarter. To create process improvements, the first step is to detail the workflow that is relevant to the user. In the case of treating a patient, a medical worker will typically follow a three-stage process - think-refer-act. Think through the problem based on the symptoms displayed, the patient's medical history, and any other valid information such as current medical alerts. Refer to general and specific information available to correctly diagnose the condition, identify possible treatments, determine the interaction between different drugs, and choose a course of action. Act upon this decision, specify a course of treatment, write a prescription, order a lab test, and capture the transaction information to charge the patient.

Wireless Medical Reference Tools
Building upon this process paradigm, Skyscape, a Massachusetts-based software development company has been a pioneer in the production of medical reference material for wireless devices. Working with the traditional publishers of medical reference guides, they have created new ways of using and combining this information to the benefit of wireless medical users.

The basis of Skyscape's products is the digitization of information from medical reference texts, drug guides, and publications that list interactions between drugs. This is then stored in a central system that also builds smart linkages between information in the different publications. The user interface at the front end is perhaps the most important element. It must reflect the needs of the user, be cognitively designed so that it is quick to get to the information required, and where possible, link to other relevant information to speed up the think-refer-act process.

R J Mathew, VP business development at Skyscape, explains that medical reference information, as the basis for a whole operating environment, can provide practical benefits for mobile medical workers. "For a start, it's time-consuming and cumbersome to cross-reference between different titles, and certainly if you are a mobile medical worker, carrying reference books and binders around is often not practical."

Skyscape publishes a range of medical texts and journals within its applications, selling them to individuals or groups by subscription. Their medical reference software on PDAs is being used by physicians, surgeons, anesthesiologists, and nurses with the U.S. military everywhere, but also by mobile medical workers in the U.S.

Bill Cyr works as a medic with Boston MedFlight - a not-for-profit organization that manages critical-care transport in the eastern Massachussetts area. They are not a large organization; about 35 medical crew and 12 pilots operate 2 helicopters, a jet, and ground ambulances transporting patients between hospitals and from the scene of accidents.

On these missions, space and weight restrictions limit the reference material that can be carried. Previously during missions, medics had to prepare ahead of time by researching and carrying essential information in binders. In emergency or unplanned situations, they would use radio to contact the base station with specific questions.

With the introduction of PDA-based reference tools, the crew can carry all the necessary information it needs, and it weighs significantly less than the binders they used to carry. While there are benefits, there are also practical issues in introducing new technologies. Some workers naturally adapt to using handhelds more readily than others. Even the requirement to synchronize devices to receive the latest updates proves difficult to enforce. But Bill is convinced of the benefits, and confirms the ultimate test of value for wireless applications - could you live without it? "Not a chance."

These types of medical reference tools are being used extensively by military medical workers in the Middle East and other regions. Speaking with some of the field staff in the U.S. Air Force and Navy, they report similar benefits to MedFlight. They too stress that with having to pack light with no room for bulky textbooks, they rely on PDA-based medical software. Most PDAs have been purchased by individuals, but as news of their success spreads to other medical workers in the field, it is likely that they will become standard issue.

Evolving to Encompass More Processes
Skyscape is evolving its products as devices and platforms become more sophisticated - enabling them to meet more of the needs of medical workers. For instance, as devices are more readily connected to the Internet, it will become more practical to refer to live information, including up-to-date medical and drug news that can be cross-referenced with the basic reference information. Individual patient records can also be accessed in real time, allowing more accurate decision making in emergency situations. And with the inclusion of digital, still, and video cameras, possibilities for expert remote diagnosis or more accurate record keeping become available.

Reference Tools for Other Mobile Workers
There are numerous opportunities to use the same types of systems described in this article to meet the needs of other mobile workers. Industries such as engineering require access to reference materials and documentation while in the field. Insurance claims assessors could also benefit from standard references and tools. WBT editor Bill Ray tells me that he has been waiting for a digital copy of TCP/IP Network Administration for years - perhaps so he can take support calls while on the golf course?

Wireless Changes the Way People Work
Referring back to my initial three questions, the only remaining question is whether medical reference tools on mobile devices are here to stay or merely a fad. Based on the testimonials of users, it seems that in certain situations, solutions such as Skyscape are clearly a better option than bulky printed materials.

Remote medical workers aren't the only ones who can benefit from the initial reference tools. Other providers, such as, MercuryMD, have shown through their hospital implementations that wireless tools for medical workers can save doctors between 30 and 90 minutes a day on their standard hospital rounds. And back-office work is also reduced, given the electronic input of information and the reduction in errors.

Taking a process improvement approach will mean that once medical workers rely upon the reference tools available, their work behavior will have changed. This provides the opportunity to extend the value of wireless medical tools by enabling more support of a worker's job tasks. Taking into account the integrated action features such as writing prescriptions and accessing a patient's medical records, this is not simply a reference tool, but an improvement on traditional ways of doing things.

Another success factor for companies like Skyscape is to overcome the barriers in human nature that stop the adoption of new ways of doing things. To ensure that wireless medical references are here to stay, Skyscape is ensuring that its tools are a requirement for students by stitching up distribution deals with medical schools. Like most other things, once the kids figure out that they can carry five or more volumes around in their pocket, and the interfaces are easier to use than flipping pages in a book, then it will slowly become a norm for medical workers everywhere.

In addition to these process-related improvements, there is also another category of benefits - availability of information. In less developed countries, illness and disease are often not controlled due to a lack of information. The spread of SARS outside of China has largely been attributed to a lack of information and failure to act quickly. In more managed medical systems, taking information from the field and processing it allows faster identification of new disease outbreaks and action to be taken sooner to limit the consequences. When all medical workers are able to report patients' symptoms electronically, and medical authorities are able to quickly analyze information and send alerts to doctors, it may be possible to limit these types of major spreads of disease.

About Andrew Martyn
Andrew Martyn is director of business
development for WorldManuals.

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