Can Wireless Technology in Healthcare Help Cure Some of Today’s Challenges?
Dr. William Bria III is one of a unique breed of medical specialists who is both a physician and a Chief Medical Information Officer (CMIO) at Shriners Hospitals for Children. He is a pulmonary/critical care physician, adjunct clinical associate professor at the University of Michigan and the University of South Florida and a 20 year veteran of medical informatics. As the President of AMDIS, the Association of Medical Directors of Information Systems (www.amdis.org), Dr. Bria believes strongly in the integration of medical knowledge with information technology. He sees wireless technology in healthcare as part of the prescription for solving some of the system’s current ailments – not only delivering better information to patients and clinicians, but driving new healthcare services.
BlackBerry Connection® (BC): What is AMDIS and what role does it play in the medical community?
Dr. William Bria (WB): AMDIS is the Association of Medical Directors of Information Systems and started in the early 1990s. At that time, it was physicians that were interested in IT and had some experience in mainframe systems. We just wanted to share tips and tricks. That role has evolved and now we’re an organization for the networking, fellowship, promotion and education of the Chief Medical Information Officer (CMIO). We recognize the physician leader for IT as a necessary position inside a system or hospital. The CMIO is truly a physician executive in every way.
BC: There’s a perception that the healthcare system in America is broken – is it?
WB: One of the problems physicians like to point out is the financial situation of healthcare today. The cost and accessibility of healthcare in America today is moving in opposite directions. We are paying more for healthcare than most of the developed world and have more uninsured Americans than ever before. The cost of care is increasing and our way of reimbursing that care in America is seriously flawed. To put a fine point on it: the idea that even though we spend more money than almost any other country in the world on healthcare, we’re spending more now and our fellow Americans are enjoying it less.
With our emergency rooms constantly filled, patient (and physician) access to vital healthcare information regularly frustrated, it should come as no surprise that there is a growing concern that not only are we paying more for care, but the safety and patient-centeredness of the system is becoming unacceptable for most Americans. Large businesses such as WalMart and Intel are actually taking matters into their own hands and creating a massive health records database for their employees.
On a more personal note, access to one’s own healthcare information continues to be a maddening ‘Easter Egg hunt’; calling each physician’s office, each hospital, each medical records department, etc. Our society is finally getting fed up with having easier access to their financial and business life over the Web than access to their own health data. Physicians are patients too, and this lesson is lost on none of us.
BC: What do you see as the challenges with the way healthcare information is being shared and handled?
WB: In this information age, if you walk into a store in Bangkok, Thailand, they will know from your Visa card what your credit rating is and how much you can buy. If you walk into an emergency room in a hospital across the street from the one you usually visit, they’ll have no idea who you are. You will be seen by physicians that don’t know any of your background. If you couldn’t express your history to them, and no one else was around from your family, you would be in deep trouble. Tolerating that in this day and age, of computers and networks, is really intolerable.
BC: Did Hurricane Katrina help make people aware that there was a serious problem with electronic health records?
WB: Katrina taught us a little bit. It brought up so many questions about how the availability of information becomes more important in a local tragedy. I think Katrina showed that if electronic records were used, you wouldn’t lose all the information and safety of your care.
The actual frustration is the inability to hand-off effectively. I was the Co-Director of the Intensive Care Unit in Michigan for more than 15 years. When a patient was transferred from another hospital, you received a lot of information that you didn’t need. The thing you really needed might come two days later. In an intensive care unit, that could make the difference between efficiently not replicating what had already been done, and moving on from there diagnostically.
In networking, they always talk about the last mile. That’s the difficult part of getting from the miles of fibre optic cabling underground to the last mile – the home. The last mile for healthcare is the electronic health record.
BC: Is wireless technology welcomed as a way to make changes in healthcare management?
WB: Email is certainly ubiquitous, and people use it for all the applications you can imagine: transfer of patients, consultation online, you name it. At one point, people tried to cram an entire electronic medical record onto a handheld device. What’s now evolving is the idea of accessing an electronic medical record through an even richer experience like a portal. Say one clinician wants to alert a doctor that a patient was given a new prescription. They can point them to the right place to look up the records on a portal. That capability makes it so much easier to have the rich context that you need for medical communications.
At the same time they can quickly get into databases like Lexi-Comp® for drugs or PubMed for medical articles. This is a big difference from the old days when you kept a copy of the Washington Manual of Medical Therapeutics in your lab coat, or The Harriet Lane Handbook if you were in pediatrics.
Wireless technologies have become part of everyday life in America. The cellular revolution has moved so quickly that cellphones have moved from novelty to fetish to necessity in less than a decade. Internet integration with cellphones is well on its way and with it, expectation of just in time, easy to use information navigation on a cellular convergence device. Now that entertainment (texting, email, music and video) are also becoming commonplace on our pocket devices, it is no surprise that healthcare information access is following suit. Again business applications have lead the way, but as Google® and other major search engine companies have told us, health concerns have now outpaced all other information requests on the World Wide Web.
BC: Why can wireless technologies now be used so freely – don’t they interfere with medical equipment in hospitals?
WB: One of the barriers to using wireless technology was really the perception of safety in healthcare settings. People felt they would somehow interfere with monitoring equipment or with pacemakers. There have been bans and a lot of confusing information about the cell phone, cellular technology and of course other associated wireless technologies being used inside the hospital. A report was recently published about the safety of using cellular technology. The Mayo Clinic Proceedings in March 2007 puts a lot of the worries about interference with medical equipment to rest. And I have to say that some of the reason wireless devices are more commonly accepted is many physicians wouldn’t agree to give them up in a hospital setting.
BC: Are wireless devices used for remotely monitoring the health of patients?
WB: Asthma and Diabetes patients now have specialized wireless communication devices so a patient can be in regular contact with a nurse or physician from their homes. It takes away their need to keep coming in and out of a busy clinic, or worse, an emergency room.
In Boston, they’re testing a wireless surrogate for the old-fashioned physician sitting by your side. In an emergency room, where there may be hundreds of people milling about, the patient is monitored continuously. It’s basically a fanny pack that contains a device that continuously monitors your oxygen saturation with a little probe on the finger. If oxygen levels or pulse rates go out of range, an alarm goes off and somebody automatically comes to your room.
In Los Angeles, they’re using a wireless alerting system for the Intensive Care Unit. On the basis of preset rules, the system notifies the physician of urine output dropping, blood pressure changes, gas exchange, oxygenation and so on. It basically allows the remote management of intensive care patients, using small portable wireless devices.
BC: What kinds of strengths does the BlackBerry® smartphone offer in medical settings?
WB: The BlackBerry solution’s forte is the idea of push email. Before, doctors looked at email when sitting at their desks at 7:00 in the morning and again at 5:30 at night. With BlackBerry® smartphones, that entire landscape changed. Healthcare is 7x24, and having a communications device that is intelligent and delivers email to you as you are on the move, opens up far more choices.
The usability of the BlackBerry smartphone interface – with its email capabilities, the growing facility, speed and quality of the web connectivity – means more physicians see their value. They want one device that offers voice communication, Internet connectivity, and email access wherever they work.
BC: What do you see as the future of wireless use in improving the delivery of healthcare?
WB: We have definitely grown in our understanding of what to do with portable devices. Today, a doctor can be reached by different people in different ways. His trusted colleagues might call him, nurses that need an answer might send an email or the lab might alert him about test results. If the doctor has a way of getting those requests and triaging them when it’s a convenient moment, it’s very helpful.
Using wireless devices is a real thing in healthcare. The idea of convergence in these forms of communications makes a tremendous amount of sense; convergence in the home, convergence in patient monitoring systems, and convergence in the continuous infusion of medicines for a number of different chronic conditions. It’s all happening.
BC: Could you give some examples of the use of wireless technology that excite you?
The most exciting wireless technologies to me are: 1. Innovative device interfaces enhancing web and other application use, 2. Portal applications in healthcare that rather than trying to cram an entire EMR [electronic medical record] into a tiny screen, abstract key information for the user and, most importantly 3. Clinical decision support systems in available EHRs [electronic health records] that are enabling increased opportunity for better and safer care.
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