Mobile Information and Coordination for Health Care

James J. Cimino, Elizabeth S. Chen, Lawrence K. McKnight, Peter D. Stetson,

Jianbo Lei, Eneida A. Mendonça

Department of Biomedical InformaticsColumbia University

New York, New York, USA

Opportunities for Error

Coordination

DecisionMaking

DecisionMaking

DecisionMaking

HealthInformation

ClinicalAlerting

?

???

PatientData

Opportunities for Error

Coordination

DecisionMaking

DecisionMaking

DecisionMaking

PatientData

HealthInformation

ClinicalAlerting

?

???

Mobil Access to Information

Coordination

DecisionMaking

DecisionMaking

DecisionMaking

PatientData

HealthInformation

ClinicalAlerting

Coordination

Study of Information Needs - Methods

• Surveys

• Focus groups

• Observational studies

• Nurses and physicians studied

Study of Information Needs - Results

• Mobile access to patient data

• Coordination of care

• Interactions and alerts

• Health information resources

• Mobile access to patient data

• Coordination of care

• Interactions and alerts

• Health information resources

• Mobile access to patient data: PatCIS

• Coordination of care: Virtual Whiteboard

• Interactions and alerts: Event Monitoring

• Health information resources: Infobuttons

Study of Information Needs - Solutions

Mobile Access to Patient Data: PatCIS

• WebCIS: desktop-based access to patient data

• Web browser on phone/Palm Pilot combination

• Different screen layout

• Slower access

• New security problems

PatCIS Architecture

Coordination of Care: Virtual Whiteboard

• Database of users and schedules

• Clinicians’ patient lists in WebCIS

• Web server application manages messages among team members

Interactions and Alerts: Event Monitoring

• Rule-based monitoring system• Waits for trigger events• Evaluates logic to determine warnings• Medical Logic Modules (Arden Syntax)• Web-based, insitution independence: Vigilens• “Push” is possible with Palm Phones• Not yet developed for integrated with PalmCIS

Health Information Resources: Infobuttons

• Links between clinical data and on-line resources

• PubMed searches

• Microbiology results and Medline

• Culture sensitivity tests and Micromedex

Wireless Palm-based Error Reduction

Coordination

DecisionMaking

DecisionMaking

DecisionMaking

PatientData

HealthInformation

ClinicalAlerting

Coordination

Infobuttons Vigilens

VirtualWhiteboard

PatCIS

Discussion

• Poor information access uninformed decisions

• Ineffective communication poor care coordination

• Wireless, hand-held technology can help

• Technical problems solved

• Security problems solved

• Evaluation is the next step

Conclusion

Wireless hand-held communication and access to information work.

But do they work well?

Acknowledgments

• National Aeronautics and Space Administration (NASA)

• Health Resources and Services Administration (HRSA)

• New York Presbyterian Hospital (NYPH)

• Suzanne Bakken (SB, PhD)