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Technology, Information & Handhelds

Technology, Information & Handhelds. Stephen Lapinsky. Mount Sinai Hospital & University of Toronto Toronto. Data overload - patient information. One ICU patient generates up to 236 variable categories Morris, Crit Care Clin 1999, 15:523 Humans capable of managing

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Technology, Information & Handhelds

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  1. Technology, Information & Handhelds Stephen Lapinsky Mount Sinai Hospital & University of Toronto Toronto

  2. Data overload - patient information 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

  3. Data overload - reference information • Textbooks • Journal articles • Review articles • Association Guidelines • Hospital protocols • Pharmaceutical company information • Electronic Medical literature

  4. Data overload - communicating info

  5. Information Access in Critical Care • Evaluation of New Technologies in Medicine

  6. 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: physician nurse

  7. 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

  8. Handheld Computers

  9. Roles for Handheld computers • access to patient information • tracking patient symptoms, signs • access to medical reference information • tracking educational experience • research data entry • scheduling, contacts • non-synchronous communication

  10. Roles for Handheld computersDemonstration

  11. 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 Care

  12. 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 Care

  13. Methods • Data entry & transfer: • on admission • update on rounds • IR beaming between staff • Reports • Daily report • Discharge summary • IR beam to HP Laserjet 6P

  14. Evaluation of Palm Computers in Critical Care Results • 6 month study period: June - November 1999 • 24 palm handheld users (84 user-months): • 3 Focus group meetings at 2 month intervals

  15. Physical attributes of Palm IIIx Patient Management database Medical reference database Suggestions: hardware & software Suggestions: process Evaluation of Palm Computers in Critical Care Results

  16. 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 Care

  17. Comparison of paper & electronic databases Methods Study 2 • Paper database: Critical Care Handbook of the Massachussetts General Hospital

  18. Comparison of paper & electronic databases Methods • Paper database: Critical Care Handbook of the Massachussetts General Hospital • Palm database: Electronic version of the Mass Gen handbook Mount Sinai ICU handbook Searchable database Treatment guidelines

  19. Comparison 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 difference But: Palm could carry 5x the data

  20. 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 Care

  21. Surgical Procedure Logging System • 69 General Surgery residents • Data entry on Palm • Internet download of procedure data

  22. Surgical Procedure Logging System Reports Allow evaluation of - individual trainees - teachers - hospitals - trainee years - etc

  23. ICU Procedure Logging System

  24. 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 Care

  25. Comparison of Handheld Pharmacopoeias Results: Essential parameters: - Physicians identified 9 - Pharmacists identified 14 Content: A2Z 9/9 13/14 Functionality Cost Updates • Comparison of features & content • Pharmacopoeias • Mobile Micromedex • Epocrates qRx • Dr. Drugs • A2Z Drugs • Lexi-Drugs • Moby Drugs & Interactions • PDR

  26. 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 Care

  27. Dr. S. Lapinsky Dr. T. Stewart Dr. R. Wax Dr. S. Fischer Dr. B. Kashin Dr. H. Clasky Dr. T. Rogovein Dr. D. McRitchie

  28. INFORMATION DATABASE • content determined by user’s needs • evidence-based management guidelines • regularly updated according to feedback Internet Synchronisation 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: content, format

  29. Evaluation • Does the handheld resource work? - videotaped "think aloud" analysis of the technology in action • Do community intensivists find the content and technology helpful? - Surveys downloaded to users’ handhelds - Moderated focus group meetings • 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

  30. Acknowledgments Current studies supported by:

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