Technology, Information & Handhelds

Stephen Lapinsky

Mount Sinai Hospital & University of Toronto

Toronto

One ICU patient generates up to 236 variable categories

Morris, Crit Care Clin 1999, 15:523

Humans capable of managing 5 to 9 variables adequately

Miller, Psychol Rev 1956, 63:81

Data overload - Data overload - patient informationpatient information

Textbooks

Journal articles

Review articles

Association Guidelines

Hospital protocols

Pharmaceutical company information

Electronic Medical literature

Data overload - Data overload - reference informationreference information

Data overload -Data overload - communicating info communicating info

Evaluation of New Technologies in

Medicine

Information Access in Critical CareInformation Access in Critical Care

Automated Paging Alert System

Software agent scans hospital database

Filters: eg. Location = ICU Hgb < 70 g/L or 20% drop

Generates automated page Ongoing evaluation:

- time to intervention- satisfaction:

physiciannurse

Digital Wireless Area Network IEEE 802.11b Wireless LAN at

11 Mb/s

Wireless cart allowing bedside access to: hospital system (eg. labs) PACS radiology images Internet searches Order entry Teaching

Potential for: video transmission wireless handhelds wearable computers

Handheld Computers

Roles for Handheld computersRoles for Handheld computers• access to patient informationaccess to patient information

• tracking patient symptoms, signstracking patient symptoms, signs • access to medical reference informationaccess to medical reference information

• tracking educational experiencetracking educational experience

• research data entryresearch data entry

• scheduling, contactsscheduling, contacts

• non-synchronous communicationnon-synchronous communication

Roles for Handheld computersRoles for Handheld computersDDemonstration

Evaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical Care

Study 1: Qualitative evaluation of handheld computers in the ICU

Study 2: Comparison between “paper” and electronic medical reference database

Study 3: Evaluation of Surgical Procedure logging using handheld devices

Study 4: Evaluation of handheld Pharmacopoeias

Study 5: Ontario Critical Care Information Network

Evaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical Care

Study 1:Study 1: Qualitative evaluation of handheld Qualitative evaluation of handheld computers in the ICUcomputers in the ICU

Study 2: Comparison between “paper” and electronic medical reference database

Study 3: Evaluation of Surgical Procedure logging using handheld devices

Study 4: Evaluation of handheld Pharmacopoeias

Study 5: Ontario Critical Care Information Network

Data entry & transfer: on admission update on rounds IR beaming between staff

Reports Daily report Discharge summary IR beam to HP Laserjet 6P

Methods

Results

Evaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical Care

6 month study period: June - November 1999

24 palm handheld users (84 user-months):

3 Focus group meetings at 2 month intervals

2

34

15Attendings

Medical trainees

Resp therapists

Other (pharmacist, nurseeducator, research fellow)

Results

Evaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical Care

Physical attributes of Palm IIIx

Patient Management database

Medical reference database

Suggestions: hardware & software

Suggestions: process

Evaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical Care

Study 1: Qualitative evaluation of handheld computers in the ICU

Study 2:Study 2: Comparison between “paper” and electronicComparison between “paper” and electronic medical reference databasemedical reference database

Study 3: Evaluation of Surgical Procedure logging using handheld devices

Study 4: Evaluation of handheld Pharmacopoeias

Study 5: Ontario Critical Care Information Network

Methods

Paper database:Critical Care Handbook of the

Massachussetts General Hospital

Study 2

Comparison of paper & electronic databasesComparison of paper & electronic databasesComparison of paper & electronic databasesComparison of paper & electronic databases

Methods

Paper database: Critical Care Handbook of the

Massachussetts General Hospital

Palm database:Electronic version of the Mass Gen handbookMount Sinai ICU handbookSearchable databaseTreatment guidelines

Comparison of paper & electronic databasesComparison of paper & electronic databasesComparison of paper & electronic databasesComparison of paper & electronic databases

Methods

Crossover study:3 weeks control (paper), 3 weeks handheld

Subjective assessment:Survey, interview

Objective assessment: Test clinical ICU scenarios, time-constrained

Standardized on a separate group of trainees

Results:No significant differenceBut: Palm could carry 5x the data

Comparison of paper & electronic databasesComparison of paper & electronic databasesComparison of paper & electronic databasesComparison of paper & electronic databases

Evaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical Care

Study 1: Qualitative evaluation of handheld computers in the ICU

Study 2: Comparison between “paper” and electronic medical reference database

Study 3:Study 3: Evaluation of Surgical Procedure logging Evaluation of Surgical Procedure logging using handheld devicesusing handheld devices

Study 4: Evaluation of handheld Pharmacopoeias

Study 5: Ontario Critical Care Information Network

Surgical Procedure Logging SystemSurgical Procedure Logging SystemSurgical Procedure Logging SystemSurgical Procedure Logging System

69 General Surgery residentsData entry on PalmInternet download of procedure data

ReportsReports

Allow evaluation of

- individual trainees

- teachers

- hospitals

- trainee years

- etc

Surgical Procedure Logging SystemSurgical Procedure Logging SystemSurgical Procedure Logging SystemSurgical Procedure Logging System

ICU Procedure Logging SystemICU Procedure Logging SystemICU Procedure Logging SystemICU Procedure Logging System

Evaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical Care

Study 1: Qualitative evaluation of handheld computers in the ICU

Study 2: Comparison between “paper” and electronic medical reference database

Study 3: Evaluation of Surgical Procedure logging using handheld devices

Study 4:Study 4: Evaluation of handheld Pharmacopoeias Evaluation of handheld Pharmacopoeias

Study 5: Ontario Critical Care Information Network

Comparison of features & contentComparison of features & content PharmacopoeiasPharmacopoeias

Mobile Micromedex Epocrates qRx Dr. Drugs A2Z Drugs Lexi-Drugs Moby Drugs & Interactions PDR

Comparison of Handheld PharmacopoeiasComparison of Handheld PharmacopoeiasComparison of Handheld PharmacopoeiasComparison of Handheld Pharmacopoeias

Results:

Essential parameters:

- Physicians identified 9

- Pharmacists identified 14

Content:

A2Z 9/9 13/14

FunctionalityCostUpdates

Evaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical CareEvaluation of Palm Computers in Critical Care

Study 1: Qualitative evaluation of handheld computers in the ICU

Study 2: Comparison between “paper” and electronic medical reference database

Study 3: Evaluation of Surgical Procedure logging using handheld devices

Study 4: Evaluation of handheld Pharmacopoeias

Study 5:Study 5: Ontario Critical Care Information Network Ontario Critical Care Information Network

Dr. B. KashinDr. H. Clasky

Dr. T. RogoveinDr. D. McRitchie

Dr. S. LapinskyDr. T. StewartDr. R. WaxDr. S. Fischer

INFORMATION DATABASE

• content determined by user’s needs

• evidence-based management guidelines

• regularly updated according to feedback

InternetSynchronisation

from office, home, ICU

Palm Handheld Reference Resource

• mobile, point-of-care access to medical information

• optimal formatting to facilitate rapid data retrieval

• hyperlinked text, tables, images, calculators

online feedback re: online feedback re: content, formatcontent, format

Does the handheld resource work?Does the handheld resource work?

- videotaped "think aloud" analysis of the technology in action

Do community intensivists find the Do community intensivists find the content and technology helpful?content and technology helpful?

- Surveys downloaded to users’ handhelds- Moderated focus group meetings

Does the network improve resource use?Does the network improve resource use?

- Clinician performance pre/post with a computer-controlled human simulator

- Comparison of ICU mortality, duration of mechanical ventilation and length of stay, patient transfers

Evaluation

Acknowledgments

Current studies supported by: