Mobile Devices Fast Becoming as Indispensable as the Stethoscope for Family Practice Doctors

The new Johns Hopkins Antibiotic Guide puts the expert advice from the universitys School of Medicine a click away on Pocket PCs and other Windows CE devices.

REDMOND, Wash., April 2, 2001 — In Dr. Joseph Hazens busy family-care practice, occurrences of osteomyelitis are about as common as an empty waiting room. But when a recent patients symptoms matched those of the rare bone infection, the solution was in the bag — or, rather, in the Cincinnati physicians pocket.

In the past, when Hazen needed to double check a diagnosis or determine the correct regime of medications, he had to leave his patient for five to 10 minutes to consult hardbound medical guides or other physicians, adding to the patients anxiousness and stealing time from the next patient.

Now, Hazen stays by the patients side, pulls out his Microsoft Pocket PC with PocketScript software and consults an online antibiotic guide created by the Johns Hopkins University School of Medicine in Baltimore. The school is releasing a new version of its antibiotic guide today that is compatible with Pocket PCs, allowing doctors to receive the most up-to-date medical information from a medical authority in the palm of their hand.

Hazen was able to find the correct treatment for the patient with osteomyelitis within a few seconds. Then, he clicked onto another screen on his mobile device, created an electronic prescription and sent the order via wireless e-mail to the patients pharmacy.

“My Pocket PC and the PocketScript applications are changing the way I do my job like no other tool Ive ever used,”
Hazen said.
“Not only am I doing my job faster; Im doing it better.”

Hazen is one of a growing number of doctors who are reversing their professions traditional reluctance to use new gizmos and gadgets by embracing handheld and mobile devices. While critics dismissed early versions of similar devices as glorified schedules and address books, the current generation allows doctors and other professionals to perform many of their daily tasks faster and more efficiently — on a PC small and mobile enough to fit in a pocket.

Microsoft credits the introduction of Windows CE, the operating system inside Pocket PCs and Handheld PCs, for helping change perceptions and increase acceptance of these devices. The software maker is not alone. Doctors such as Hazen are trading in their old personal digital assistants (PDAs) and other reference devices for Pocket PCs — and they notice an increasing number of their colleagues doing the same. In addition, Cincinnati-based PocketScript and other makers of handheld medical applications and online services are using Microsoft technology to get the power and features they cant find in other mobile operating systems.

Johns Hopkins is the latest.
“We have a shared vision with Johns Hopkins,”
said Steve Chin, Microsofts worldwide pharmaceutical industry manager.
“We both want to find ways to use technology to promote and improve healthcare. By giving doctors powerful tools and access to powerful resources at the point of care, we are clearly going to make a big difference for doctors and patients.”

Handhelds Win Acceptance Among Doctors

Many doctors have been reluctant to integrate new technology into their practices. They worry that new devices will take too long to learn how to use, reduce their time with patients or increase their costs.

Although he has used computers for patient billing for more than 10 years, Dr. Daniel Sway, a family practitioner for 28 years in Cincinnati, has rejected some technology because he thought it might distance him from his patients or detract from the care he provides.
“Sometimes I wonder if doctors who use these new devices are treating themselves rather than their patients,”
he said.

Sway doesnt feel the same way about the PocketScript Pocket PC he began using last year. It took him 15 minutes to learn to use, and he now takes it with him every time he sees a patient. He flips it open and pulls up the patients records for reference as he enters the exam room.

“My patients are impressed,”
he said,
“because they know they are getting a better quality of medicine.”

Sway and the practices other doctors also use mobile devices to create and send more than 100 prescriptions a day electronically to pharmacies. When its time for refills, staff members electronically resend the prescriptions, based on the guidelines of the original prescription, substantially reducing time spent arranging these orders.

“I dont think doctors will write prescriptions or do many other mundane written tasks much longer. There are too many advantages to using these devices,”
he said.

Mine allows me to practice a more efficient and safer kind of medicine that really does serve me and my patients.

“Its like my stethoscope,”
Sway added.
“It sees every patient with me.”

A recent report by the San Francisco-based financial-analyst firm WR Hambrecht + Co. found approximately 15 percent of physicians in the United States roughly 90,000 — use handheld devices to store phone numbers, look up drug information and perform other reference tasks. By 2004, the number of doctors should jump to 20 percent, and, the report predicts, they will be using their handhelds for electronic prescriptions and to order lab tests and results.

PocketScript: Exclusively on Microsoft-Powered Handhelds

Application providers such as PocketScript develop the services that are luring doctors to mobile devices. The Ohio-based company uses a patented compression technology that allows doctors to access and send information wirelessly on their devices. The radio signals can transmit more than 60,000 patient records in a single second from a secure server within their offices. The medical information necessary to generate prescriptions is stored on a separate server maintained by PocketScript.

Doctors enter information using a small keyboard or stylus — or they can speak into Pocket PCs. PocketScripts compression technology transmits the message, compares it to information in its database and transmits the matching medical and other terms back to the server in the doctors office in less than one second. The server, which employs Microsoft SQL Server technology, then transmits the information to the nearby mobile device. In some cases, doctors must choose from several matching terms or patient names. This verification process prevents them from entering incorrect information onto a prescription or reviewing the wrong patients records, said Steve Burns, chief executive officer and co-founder of PocketScript.

PocketScript also offers other safety measures — its servers double check the antibiotics a doctor selects to ensure they wont interact with those a patient is already taking, and that the doctor is prescribing the brand and formula of medication covered by the patients health insurance.

This extra set of
is important, doctors say, because of the constant influx of new drugs and ever-increasing rules of health maintenance organizations.
“When you have a practice like ours, with seven to 10 different insurance formularies for drugs, it becomes impossible to keep them all straight,”
Hazen said.
“This way, patients get the best formula possible and they know it is covered by their insurance.”

PocketScripts applications run exclusively on Pocket PCs and other Windows CE devices. The company tried to adapt its services to other mobile operating systems, but found these other systems couldnt handle the complex processes and speed requirements necessary.

“Other operating systems arent robust enough to handle the applications we provide,”
Burns said.
“We just couldnt make them perform in the timeframe we needed. If we werent worried about speed, we could use other systems. But speed and accuracy are all important to doctors.”

Johns Hopkins Guide Offers Expert Medical Guidance

Up-to-date, reliable information also is vital. Thats what the new Johns Hopkins Antibiotic Guide provides doctors on their desktops, laptops — and now their mobile devices. A partnership with PocketScript and another service provider, Allscripts, now puts the expert advice from the universitys School of Medicine a click away on Pocket PCs and other Windows CE devices. The guide is located at .

The guide — the first noncommercial online reference of its kind — contains modules with information on more than 160 drugs and more than 140 diseases, including roughly 95 percent of infectious diseases regularly treated by primary-care physicians. Johns Hopkins medical staff creates the modules, compiling and condensing the treatment regimens recommended by multiple expert sources, including Johns Hopkins and the United States governments Centers for Disease Control and Prevention.

Unlike the hardbound drug-dosing guides many doctors carry in their smock pockets, the Johns Hopkins online guide provides diagnostic guidelines for diseases, reference materials, a question-and-answer forum with Johns Hopkins staff, and articles on current medical issues.

The modules in the guide are reviewed and updated monthly.
“Information in any textbook is out of date by the time it is published,”
said Dr. John Bartlett, professor and chairman of the Division of Infectious Diseases at Johns Hopkins. He also championed the idea of the guide and is a contributor.

Dr. Eric Weidmann, a family practitioner in Austin, Texas who uses a PocketScript Pocket PC, appreciates how the site gives multiple regimens of care and the most up-to-date information on new drugs, something he cant find in traditional desk references.
“This kind of information,”
he said,
“is what closes down the gap and brings answers, clarity and confidence right down to the physician that lives three blocks from your house.”

Johns Hopkins expects to add graphical treatment information and online medical links, along with treatment and diagnostic information on additional diseases, including oral and dental infections, gynecological conditions and diseases used as biologic weapons.

“We are hoping what we are doing now is just a baby step,”
said Sharon McAvinue, director of the online guides parent initiative, Point-of-Care, Information Technology (POC-IT). She expects Microsoft will play a continuing role in the development of the project.

Although the Johns Hopkins guide is accessible on other mobile devices, the version available on Pocket PCs and other Windows CE devices contains more and more detailed information. Doctors can keep multiple windows of information active at the same time. Windows CE devices also have higher screen resolution, more memory and faster processing speed, Microsofts Chin said.

“All of these things allow Johns Hopkins to present more information and do it faster,”
he said.

Chin predicted that Pocket PC and Windows CE technology, along with services such as the Johns Hopkins guide, will produce significant reductions in medical errors and reduced medical costs because doctors can make more informed decisions faster. These technologies also will allow doctors and patients anywhere in the world to capitalize on Microsofts .NET vision, he said.

“Now, a doctor in Africa has access to the same information as a doctor at Johns Hopkins in Maryland,”
Chin said.
“This is exactly what .NET is all about. Microsoft wants to enable people — whether they are doctors, engineers, homemakers or consumers — to get the information they need any time, any place and on any device.”

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