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FW: Article for tech section of obgyn.net
From: Edward Zabrek, M.D. (zstork@compuserve.com)
Wed, 8 Dec 1999 21:37:40 -0600
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Ed
M.D.’s in the next millennium with Windows CE
By Edward M. Zabrek, M.D.
As a physician, I seek out Windows CE programs that will enhance my ability to manage my patient load and assist me in being a better doctor.*** Over the past 5 years I have tested and used a number of Windows CE medical software applications. Dramatic improvements are rapidly evolving in this field.
With the recent legislation signed by Clinton on December 7, 1999, physicians, hospitals and all other health care providers are going to be under increased pressure to perform in a safe and accurate manner. This almost seems like an oxymoron. What provider does not want to act in such a manner? Unfortunately, the demands and complexity of our professions sometimes preclude perfection, and unfortunate errors do occur. I firmly believe that Windows CE devices and medical programs developed to work on them can increase patient safety, and give all healthcare providers an effective tool by which they can manage their patients.
The rest of this article is summary of my experiences with some of the currently available medical software for Windows CE PC Companions (Handheld PCs, H/PC Pros, and Palm-Sized PCs). I’ll take a look at medical and drug reference program, and insurance coding application, and a complete electronic medical record (EMR) product. Although developed by different companies, these programs work well together and provide healthcare professionals with a very powerful medical tool.
e/MD˛ -The Portable Coding Solution (H/PC only)
The U.S. government requires physicians to include standard “E&M” codes for procedures when billing patients and insurance companies. These are designed to provide consistency to documentation and billing procedures. They also add a lot of time to the administrative process. e/MD˛ (http://www.emd2.com) is a Windows CE application developed by Rensimer Enterprises, Ltd. e/MD˛ walks a physician through a series of screens where the physician enters the basic details about a procedure. Then e/MD˛ “intelligently builds” the billing code on the spot.
I have used this program over the past 5 years, and I have not found any program currently available (for any operating system) that does what e/MD˛ will do. It helps me provide more accurate billing records and claims to insurance companies, while ensuring more complete and accurate patient medical charts or records which conform to service charges. The application is flexible, allowing me to quickly search for just the right diagnosis, make changes or corrections on the fly, and to add written comments for future reference. The records generated can be transferred easily. The patient rounds screen allows the physician to view a snapshot of his service and complete charges. Once the data has been entered a charge code is calculated and displayed at the top of the screen. Diagnoses can be searched use the ICD-9CM search engine.
I use e/MD˛ on a daily basis (see my complete review on page 23 of the Jan/Feb 99 issue of Handheld PC Magazine). e/MD˛ uses 5-6 Megs of internal memory. In fact, most of the medical applications I use are memory intensive and you can quickly use up a big chunk of your on board RAM with a single medical program. To help with this I have expanded the internal memory of my HP Jornada 680 Handheld PC Pro from 16 to 32 Mb with an upgrade kit available from HP http://www.hp.com/jornada/accessories/680/ram_upgrade.html). The problem with e/MD˛ and some other data-intensive programs is that you have to store the program in RAM. e/MD˛ is currently working on a fix that will let you load the program onto a PC or CompactFlash card.
e/MD˛ runs on and H/PCs or H/PC Pro with 16MB and a screen size of 640x240. The operating system must be Windows CE 2.0 or greater. The software cost is $250 per physician license. (A real bargain!) This includes handheld PC management software that resides and a standard PC. Support is available at a cost of $50 per month for unlimited telephone support or $30 per quarter hour.
e/MD2® Portable Coding Software
(Review from Handheld PC Magazine January,1999)
Based on a Health and Human Services audit of the medical industry in 1996, which alleged over $23 billion per year in over billing by medical professionals, the Health Care Finance Administration (HCFA) released documentation guidelines for medical record keeping in 1997. These were intended to provide structure and consistency to the industry's chaotic documentation/billing system, partially by specifying standardized service codes ("CPT" or "E&M" codes). They also added an estimated 140 to 200 minutes a day per 20 patient visits to document patient visits with the appropriate codes, leading many medical professionals to suspect that the cure was worse than the original disease. Fortunately, I discovered a program for my H/PC, called e/MD2. It has become an invaluable tool that guides me through the labyrinth of red tape that was required of all practicing physicians by these regulations.
The e/MD2 Portable Coding Software was developed for the Windows CE Handheld PC by Rensimer Enterprises, Ltd., of Houston, Texas (http://www.emd2.com). It guides the practitioner through a series of steps that helps make sure he or she is in compliance with the new federal healthcare regulations. This is important because innocent errors of omission, or a lack of proper knowledge of these new laws could lead to charges of fraudulent billing practices that could result in fines of $10,000.00 per infraction, and even jail time for the unsuspecting doctor.
How e/MD2 works
Step by step, a physician or administrative assistant enters the basic details about a procedure into e/MD2. The program then "intelligently builds" a CPT or E&M service code for the procedure, based on the Documentation Guidelines for that code.
e/MD2 is extremely user-friendly. The physician selects an existing patient from the opening screen, or creates a new patient record (see Screen 3). From the patient screen, the physician can create a note, or prepare to enter a "New Evaluation and Management Charge" using E&M Documentation Guidelines.
The physician then uses a stylus on the H/PC's touch-screen interface to select a service category from a drop-down menu based on the AMA's manual. From there the physician taps the bullet points from the '97 Documentation Guidelines within the three elements that comprise a charge code: History, Exam, and Medical Decision-Making (see Screen 4). Instantly, the program calculates the appropriate code for that patient encounter. When completed, the code and its time and date of entry can be viewed on the H/PC's screen, listing the entire patient service.
The program flows logically through a patient encounter. Clinical notes can be quickly jotted through handwriting recognition software. Both the Clinical Note and the Patient Note functionality can be accessed at any point in the program. Once the patient encounter is complete e/MD2 generates a CPT billing code which can later be uploaded to the computer base station at the office for quick, error-free charges.
Although it's not necessary for a physician to know an individual charge code while he or she is with a patient, the codes help to accurately track medical services given. This would make it easier for the medical profession to spot trends and correct problems in patient care.
If a program such as e/MD2 were universally adopted, physicians, medical, government and insurance organizations would have a means for performing meaningful outcomes analysis, standardization of medical care practices, and ultimately improving the quality of medical care.
More information is available at the e/MD2 Web site at http://www.emd2.com.
Statement from the Manufacturer:
e/MD˛ is a Windows CE application developed by Rensimer Enterprises, Ltd. with the help of NanoSoft Corporation, a Microsoft Certified Solution Provider Partner in Houston, Tx. The new Windows CE-based application makes it easy for doctors to enter the elements of their work using a stylus on a touch-screen of a Handheld PC to derive diagnosis codes for creating billing codes on the spot. The application takes advantage of the familiar Windows interface to eliminate the learning curve for computer-wary physicians.
Benefits · The e/MD˛ application can eliminate coding paperwork by up to 90 percent, saving thousands of dollars a year in clerical expenses. · The higher accuracy rates resulting from e/MD˛ mean doctors can provide more accurate billing records and claims to insurance companies, while ensuring more complete and accurate patient medical charts or records which conform to service charges. The flexibility of the application allows doctors to quickly search for just the right diagnosis, make changes or corrections on the fly, and to add written comments for future reference or for other physicians who may handle the same case. · The robust hardware capabilities of devices using the Windows CE operating system give physicians the resources they need to keep detailed records during the course of a busy day. These records can then be easily and quickly transferred using Windows CE synchronization to "base station" PCs for processing, storage, and electronic transfer between physicians.
Cost · The software cost is $250 per physician license. This includes handheld PC management software that resides an a standard PC. Support is available at a cost of $50 per month for unlimited telephone support or $30 per quarter hour.
Hardware e/MD˛ runs on HPCs with 16MB (program requires about 5MB of memory) and a screen size of 640x240. The operating system must be Windows CE 2.0 or greater. The HPC management software can run on Windows 95,98, or NT.
The patient rounds screen allows the physician to view a snapshot of his service and complete charges.
The charges are derived for the physician as he checks off the items covered during his examination. All data entry is touch screen.
Once the data has been entered a charge code is calculated and displayed at the top of the screen. Diagnoses can be searched use the ICD-9CM search engine.
PocketChart by Physix (H/PC only)
e/MD˛ does not create a patient chart note or electronic medical record (EMR), nor does it create a prescription printout. The best program that I have seen for this is PocketChart by Physix (http://www.physix.com).
PocketChart offers a full-featured electronic medical record for Handheld PCs and H/PC Pros. ***(Hitachi developed an H/PC Pro, tablet device specifically to work with PocketChart. I still prefer to use my HP Jornada 680 with this program)*** The software allows physicians to collect vital patient data and access medical information at the point of care with seamless integration to the desktop (see Screens 3 & 4). PocketChart includes a formulary of more than 1,200 medications, updated short-description E/M codes and ICD-9 billing code chapters, and 11 single organ exam templates. Healthcare providers can capture and access every element of critical patient information at the point-of-care, and output legible clinical notes and prescriptions.
PocketChart can use a large amount of memory depending of the number of specialty modules you install. These modules can be installed on a CF or PCMCIA card, thereby freeing up you valuable internal ram for applications that cannot use this option. PocketChart can support optimal decision making at the point-of-care, wherever that happens to be. The final documentation can be printed directly to your printer or uploaded to your desktop computer for printing later.
PocketChart links with several of the major desktop office management programs, but it is one of the few Windows CE programs to do so. Most of the vendors I interviewed are making this issue a high priority for future releases of their software.
The package includes templates, software, care plan and template editor. Add $149 for annual support and upgrade. ***PocketChart sells for $2,346 and can be used with an H/PC or H/PC Pro. A demo version and more information is available from PHYSIX Inc; http://www.physix.com; E-mail: sales@physix.com; Phone: 800-749-2585 or 713-797-1199
Keep Patient Records on an H/PC with pocketCHART (Article from Handheld PC Magazine January, 1999)
Physicians spend as much as 40% of their time producing routine notes and keeping up with the ever increasing demand for paperwork from the government and insurance providers. All things considered, the development of computerized "Electronic Medical Record" (EMR) systems was inevitable.
Such a system would have to be easy to use and highly portable. Laptop computers have been tried, but they are too cumbersome and their batteries simply do not last long enough to be truly useful to a physician.
EMR solution: H/PCs and pocketCHART
Handheld PCs fit easily in a physician's pocket. Their battery life is long enough for most uses, and spare batteries are easy to carry along. The built-in software provides a Contacts database and Calendar for appointments, as well as Pocket Word for memos. Add to these basic features a program called pocketCHART and you have a personal organizer and full-featured electronic medical record keeper in one package.
pocketCHART by PHYSIX (http://www.physix.com) lets a physician with an H/PC produce comprehensive and legible patient notes with relatively little effort. The Handheld PC has a small keyboard and typing in a lot of text is no fun. Fortunately, pocketCHART uses template-generated notes to speed data entry. They are implemented as user-defined pop-ups, which allow the physician simply to click on the screen to pick items (which are then added to the growing note).
Once entered, virtually all information is available to be "adopted" in other notes at other times. Physicians end up repeating themselves quite a bit in patient notes. The ability to quickly find and reproduce previously enter information is a big time saver. Further, certain information is automatically adopted into summaries displayed at various places in the program.
pocketCHART comes with several types of pre-programmed blank forms you can call up and fill out for individual cases. These include History & Physical, Clinic Follow Up, SOAP, Quick SOAP, Addendum, Discharge Summary, and Referral letter. These represent most of the documents a physician needs to create. In version 1.5 of pocketCHART, the structure of these notes is not user-modifiable. However, future releases will allow the physician to write his or her own note structure.
A Quick look at pocketCHART
pocketCHART's main screen lets you access patient information and create new records (see Screen 1). The large open box in the middle of the screen displays a list of the patients.You can display all, or part of your patient list.
The rest of pocketCHART's features are organized in "tabs." The "Profile" tab (see Screen 2) provides a summary of the patient's medical record. The information is automatically gathered from the notes and prescriptions entered elsewhere. pocketCHART presents the most important data on a single screen.
The government requires physicians to code the diagnoses they make and the procedures. The pocketCHART Codes Tab lets the physician access a reference list of ICD-9 and CPT codes, organized by category to make it easier to find the correct code. Picking codes is the slowest part of using pocketCHART. This is not really a criticism of pocketCHART, but of the code systems themselves.
pocketCHART's "Rx" Tab lets the physician create and print out a prescription. The Prescription Editor helps the physician create the prescription. It is linked to a drug lookup form called the Pharmaceutical Browser, which lets you look up medications along with brief prescribing information. pocketCHART lets you select a template for the way the prescription will look when printed out. After completing the prescription, you tap a "Print" button, which saves the prescription to a .TXT, .PWD, or .RTF file for later downloading and printing.
pocketCHART's Patient Chart Tab (see Screen 3) is the heart of the program. This screen lets you write a new note or view an old one. Every time a physician meets with a patient, the physician creates a "note" that describes the interaction. Because the structure of the note can be complex, pocketCHART splits the screen to make navigation within a note more intuitive. The left pane provides a list of the different sections of the note. Tap on an item in that list and the right pane shows the actual text being created for that part of the note.
Taping on the "Select Template" button pops a template for that section of the note. These templates are almost completely user-defined and can be up to three levels deep. For example, if a patient complained of pain in the left elbow the physician would first tap "pain," then tap "elbow," and finally tap "left." >From these three
taps, pocketCHART would enter a sentence which read: "The patient also complained of pain in the left elbow".While many templates come with the program, PHYSIX provides a desktop utility called the Template Editor which allows a user to create his own templates. Writing templates is a meticulous and complex process which takes a great deal of time to do well.
Room to improve
pocketCHART provides physicians with a very useable EMR system. However, pocketCHART stores all of its data in the H/PC's internal memory. This problem is alleviated somewhat in the newer H/PCs with greater internal memory, but pocketCHART really needs to be able to store and access patient data in memory cards. PHYSIX also needs to engineer an easy way to move selected records to and from a desktop PC.
[According to PHYSIX, Inc., a forthcoming product called CE Desktop Link will allow pocketCHART to store patient demographic and billing information on a desktop PC. Uploaded information will be deleted from the H/PC's limited memory, and can be downloaded again when needed. Clinical notes, however, cannot be transferred and still must be printed out and stored in a physical chart.]
I encountered a couple other minor problems. On several occasions sections of notes I had entered disappeared completely or showed up in other parts of the note. Also, it seemed that my H/PC locked up more often when in pocketCHART than when not.
Even with these problems, I consider pocketCHART on the handheld PC to be the most useable EMR system I have yet encountered. I have purchased several of these type of programs and written two myself, and I can tell you that it is not easy to cram all that data into a limited environment. That the team at PHYSIX could accomplish this is a testament to their prowess.
Will it work on Palm-sized PC’s?
The majority of physicians I have spoken with prefer the smaller form factor of the Palm-size PC and Palm Pilot. Unfortunately, e/MD˛ and PocketCHART were developed for the Handheld PC and have not yet been re-designed for the Palm-size PC. Fortunately, other programs are available for the Palm-size PC.
PEPID 2000 (H/PC & P/PC)
One program, available for both H/PCs and Palm-size PCs, is PEPID 2000 (http://www.pepid.com). PEPID is an incredibly potent “browser-based” medical reference program. PEPID gives healthcare providers a library of essentials for virtually all medical and drug problems (including drug interactions). It includes complete monographs for over 1,000 commonly prescribed drugs and vitamins, and on your P/PC, this powerhouse of data will fit in your top lab coat pocket.
PEPID 2000 is well organized by specialty, and easy to navigate using the “Index” word search, or through the hypertext “Table of Contents”. Once you have completed your search, the body of the document contains further references with hypertext that are quickly and easily accessed (see Screens 5 & 6).
If you plan on using it on a P/PC, you must install a browser on your device. PEPID recommends Pocket Browser, a $20.00 shareware program created by Conduits (http://www.conduits.com/ce/browser). I must agree. This is an easily customizable program that works extremely well with this application.
PEPID was written by over 40 physicians and is designed for Emergency & Primary Care Physicians, Residents, Interns and Students. Suggested retail price is $295.00. For more information contact PEPID Inc; http://www.pepid.com; E-mail: info@pepid.com; Phone: 888-321-STAT
PocketCode (P/PC only)
For billing and accurate coding on your P/PC, I recommend PocketCode by Dynamedix (http://www.dynamedix.com). As with PocketCode is portable coding tool for healthcare providers. As with e/MD˛ PocketCode is designed to eliminate coding errors and reduce the denial rate of claims at the point of patient encounter, resulting in improved practice profitability, efficiency and compliance with federal and local coding regulations.
PocketCode works extremely well on the small form factor of the P/PC. It uses about 350K of internal RAM, with the majority of (database) information loading to an external CF card. PocketCode synchronizes with a desktop PC version of the program (both versions included in the package). I have used this program on a Cassiopeia E-105 and a Compaq Aero 2180 and works flawlessly on both devices. Be sure to follow the manual very closely when setting up PocketCode on your P/PC. It is not as straightforward as it may appear. If you have difficulties, Dynamedix has an excellent, friendly technical support department. They will be there for you (during their regular business hours) and get you and keep you up and running.
Both PEPID 2000 and PocketCode can be installed on an external PC or CompactFlash card. I am currently using the Cassiopeia E-105 Palm-size PC with 32 Mb of internal RAM. The brilliant color screen of the Casio E-105 is ideal for a weary-eyed doctor like myself. (Note: PocketCode is currently partnered with Casio, and is co-marketing the Cassiopeia E-100/105 with Dynamedix.)
I use a 340 Mb IBM Microdrive Compact Flash II plus (CF+) card for file storage on my Palm-size PC. I use a 440 Mb SanDisk Type II PC Card and a 96 Mb SanDisk Compact Flash Card with my HP Jornada 680 Handheld PC Pro. With all of this external storage memory I feel I’m in pretty good shape. But you can never have too much file storage space. SanDisk will be shipping 300 Mb CF card and 1.2 Gb (1,200 Mb) Type II PC Card next year.
Bringing Windows CE to the healthcare forefront
Over the past year, there has been a dramatic maturation of hardware and software programs available for both Handheld PC’s and Palm Sized PC’s. Recent software enhancements have made the smaller P/PC more functional than ever before. Future developments by Learnout and Hauspie and Microsoft will give your P/PC speech-to-text capability. Medical photographic images (as well as family pix) can be shared using Sierra Imaging’s CE Image 2000 (http://www.sierraimaging.com). And you can even leave your digital camera at home with the Digital Camera Card Casio is marketing for it’s E-105 Palm-size PC. These incredible current and future abilities are destined to topple the Palm Pilot’s dominance in the Palm PC wars and bring Windows CE to forefront of Medical Informatics and patient management.
Other healthcare products and services for Windows CE
The following software and hardware products and services round out the Windows CE medical roundup list. I have not had an opportunity to review or evaluate these programs.
AllScripts ( http://www.allscripts.com/) Medication management software that provides physicians with current information on approved formularies, potential drug interactions and drug utilization at the point of prescribing, thereby reducing the need for time consuming follow-up, increasing quality and reducing costs associated with providing prescription benefits.
Practical Portable ( http://www.masterchart.com/) Offers a range of medical software that allow the mobile clinician to access clinical information and to perform key tasks related to patient care. Works with a range of Palm-size PCs.
Patient Care Technologies Inc. (http://www.ptct.com/) provides a point-of-care solution for home care clinicians based on Windows CE. Clinicians carry a CE device right into the home and use it as care is delivered to document their work.
PPARIS (http://www.parkstonemed.com) The Physician Prescription and Referral Information Server (PPARIS) system serves a variety of participants in the healthcare industry, including physicians, patients, insurance companies, pharmaceutical companies, and pharmacy benefit managers. The information is provided to the physician in the form of 'modules' that run on a Palm-sized PC and interface with Microsoft SQL Server 7.0.
WiiN-PAD (http://www.dg.com/) a wireless, pen-entry Handheld PC computer tailored for doctors, nurses, administrators, and other healthcare professionals. The WiiN-PAD handheld computer complements Data General's healthcare solutions by providing a robust client device for mobile computing.
DoseAssist (http://www.SimkinRx.com) Based on Simkin's drug therapy and dosing software, DoseAssist comes standard with Renal Dosing and Once-Daily Aminoglycoside Dosing modules. Optional dosing modules include Heparin Weight-Based Dosing and Antibiotic Kinetic Dosing.
MediHPC (http://www.cam.com/windowsce.html) a Meditech host systems for Windows CE H/PCs that features full Data General 5220/5222 and Esprit 105C/125C emulation. Users can copy and paste between host sessions and Windows CE documents.
Medical products from K2 Consultants (http://www.skyscape.com/k2new/nindex.html). The following products are available from K2 Consultants, Inc. They are good and useful products, but be forewarned! Tech support (even through e-mail) has been extremely difficult to get. Archimedes -The Intelligent Calculator -- A indispensable medical calculator with nearly 70 pre-programmed, structured formulas covering a wide range of topics in medicine, accounting and finance. Griffith's 5-Minute Clinical Consult -- A quick reference to any number of over 1000 diseases. Includes basics, diagnosis, follow-up, medications and treatment options. A must-have for both obscure and common diseases. Lexi-Comp's Drug Information Handbook -- A complete database of over 5200 drugs with both generic and brand names. The information for each drug is complete with important information on use, dosage, contraindications, interactions, pregnancy implications, nursing instructions, therapeutic category, etc. Outlines in Clinical Medicine -- A comprehensive and up-to-date medical reference over 700 separate outlines covering general internal medicine and related fields. Includes succinct coverage of medical topics including diagnostics and therapeutics.
*** end ***
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