.FLYINGHEAD HANDHELD HEALTH
.TITLE How mobile physician order entry can help healthcare providers reduce costs
.AUTHOR Christine Harland Williams
.OTHER
.SUMMARY Today, leading authorities in healthcare agree that CPOE (Computerized Physician Order Entry) and mobile technologies such as handheld devices are two information technology trends that will significantly impact the healthcare industry’s future. This article, by Christine Harland Williams show how mobile physician order entry systems based on PDAs can help healthcare provides reduce costs.
Today, leading authorities in healthcare agree that CPOE (Computerized Physician Order Entry) and mobile technologies such as handheld devices are two information technology trends that will significantly impact the healthcare industry’s future.
Pressure on the healthcare industry to widely implement CPOE systems is coming from many areas, including publicity about the number of deaths at U.S. hospitals each year that are caused by medical errors, industry organizations voicing concern for improved patient safety, the increase in state legislation aimed at reducing the incidence of medical errors, and the need for hospitals to reduce liability costs by reducing medical errors. Despite this pressure, after over 30 years of CPOE availability, only 3 percent of hospitals have successfully implemented enterprise-wide CPOE systems according to the 2002 Back Beats Survey conducted by Healthcare Informatics.
In contrast to CPOE, handheld devices and other mobile technologies have followed a significantly steeper adoption curve in healthcare. With the penetration of handheld devices growing along with the demand for CPOE, the obvious conceptual integration is to implement full CPOE functionality on handheld devices. Today, IT vendors, hospitals, and clinicians are trying to merge these two trends into "CPOE on a handheld." They expect to have full functionality on all platforms: computer workstations, rolling laptops, tablet PCs, and handheld devices.
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.H1 Debating the Future of CPOE
MercuryMD, a private, healthcare-focused software company that provides hospitals with mobile technology solutions, believes that the widespread adoption of CPOE and mobile technology in healthcare will come about only through the adoption of a new category of systems it calls "mobile physician order entry," or MPOE.
The company argues that adoption of MPOE systems will be driven by easy-to-use, intelligently limited, high-yield functions that do not merely mimic comprehensive CPOE systems onto smaller devices, but are different from CPOE in form, function, and implementation. By recognizing the importance of MPOE as a distinct product category, MercuryMD believes that hospitals can implement MPOE systems to accomplish different goals depending on the stage of their overall "order entry" strategy.
"CPOE systems are complex and require substantial user training for appropriate use. Even with all the CPOE-relevant benefits of computer workstations, like large screens, keyboards, fast processing power, mice, comfortable chairs, and time-intensive training initiatives, the adoption rate for CPOE is quite low," explains Alan Ying, CEO at MercuryMD. "It seems unreasonable to expect sudden, enthusiastic industry adoption by replacing CPOE-friendly computer workstations with the tiny screens, slower processing power, and reduced connectivity of mobile devices, while maintaining all the complexities of full-function CPOE system. Yet this is exactly what the industry is growing to expect and demand."
.H1 Lessons from history
Ying supports his perspective on MPOE by taking a closer look at historic efforts to mobilize other systems, which show that successful mobilization of comprehensive, stationary systems resulted from intentionally limiting the functionality of the systems on portable implementations. For example, efforts to mobilize stereos and telephones lead to the development of the Walkman and cell phones, which initially had intentionally limited functionality.
Sony introduced its first-generation Walkman in 1979. At that time, the status quo was the large audio system with lots of knobs and dials, but the Walkman allowed only the tape cassette "play" function. The success of this approach is self-evident, as the portable music player — now integrating various technologies and based often on MP3 technology — is ubiquitous because of its focus on high-yield functions, ease-of-use, and mobility.
Motorola introduced its first cell phone in 1983. At that time, the status quo was the PBX-style business phone system with dozens of functions and features, yet cell phones could only place and receive calls. From 960,007 users in 1985 to 5.2 million in 1990 to over 100 million expected in 20008, focused and high-yield functions within an easy-to-use mobile form factor have resulted in widespread adoption.
.H1 Beta test of industry’s first MPOE product begins
The growth of portable stereos and cell phones over the last 30 years demonstrate that migration of only the most vital functions from stationary, full-featured systems to smaller devices is the recipe for successful mobile products. Applying this strategy to its MPOE system, MercuryMD recently began beta testing its Mobile Physician Order Entry product, ActivOrders, at a MEDITECH site. The MEDITECH site will be the first to use handhelds with MPOE functionality to improve physician workflow and speed claims submissions.
Handheld-based e-signature of transcribed reports is the first of several key functionalities comprising the ActivOrders product. The e-signature functionality of ActivOrders allows a physician to use a handheld device to electronically approve a preliminary transcribed report and have that approval go back into the hospital information system. By doing this in real-time — from their handheld devices — during patient encounters instead of manually signing accumulated charts in the medical records department after patients have been discharged, physicians save time and hospitals reduce the time required to submit reimbursement claims.
The complete ActivOrders product will also include functionality allowing physicians to place high yield lab orders, co-sign preliminary orders, and view status of all orders, from their handheld device. By limiting the functionality of its ActivOrders product to four high-yield functions, MercuryMD hopes to enable hospitals to implement MPOE far more quickly and easily than they could implement a comprehensive "CPOE on a handheld" system. Ying expects his MPOE system will optimize the benefit hospitals can gain from the convergence of CPOE and mobile technology.
"MPOE is critically important to hospitals as they seek cost-effective IT solutions that physicians will adopt to make progress towards fully computerized physician order entry," claims Ying. "As the healthcare industry’s emphasis on mobility and error reduction intensifies, we feel confident that MPOE will become indispensable as both a stand-alone solution and a complementary system in hospitals’ order entry strategies."
The company expects complete ActivOrders functionality to be available by the end of the year to its customers utilizing MEDITECH, McKesson, Siemens, IDX, and other hospital information systems.
.H1 Simple interface and mobility are critical for the adoption of MPOE
Given that simplicity is the key to handheld use in any hospital environment, physicians are not likely to click through 15 screens on a 2" PDA display to make one precise order.
According to Gartner Healthcare VP and Research Director Kenneth Kleinberg, progress towards enabling the use of mobile handheld devices for even basic order entry will require a focus on intuitive completion of frequent orders and on context-sensitive menus. Ultimately, users will judge ease-of-use success by demonstrating adoption while standing at the patient’s bedside, walking down corridors, or while sipping coffee in the lounge.
With the significant penetration of various portable devices and connectivity solutions, the healthcare user market has clearly — and preferentially — adopted some mobile technologies. Leveraging highly adopted mobile technologies will facilitate integration of CPOE into this user market. One of the clear winners in clinician user adoption is the PDA.
.H1 MPOE is a practical alternative to complex, expensive CPOE systems
Based on recent studies performed by the California Healthcare Foundation, the American Hospital Association, the Leapfrog Group, and the Institute for Clinical Systems Improvement, the average cost to implement a CPOE system is $4.4 million in up-front fees with $500,000 in annual expenses.
This is the average cost that a 200-bed single hospital would have to incur, not a large, multi-facility healthcare organization, for whom the cost would be far, far more. Considering this cost profile and the surprisingly low average hospital profit margins of 2%, CPOE systems remain largely out of reach for many organizations. With such conditions, the only option for the vast majority of hospitals, unfortunately, is to attempt to have everything … or, often more likely, to have nothing.
But hospitals that understand the value of MPOE can soon leverage mobile data delivery systems, which consistently demonstrate a high user adoption rate and enhance clinical workflow while costing an average of $250,000 in up-front fees with $50,000 in annual expenses, a fraction of the CPOE cost model.
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By appropriately adding MPOE functionality to a solidly adopted handheld technology, such as mobile data delivery, hospitals can achieve the majority of essential benefits in a comprehensive CPOE system at a fraction of the cost.
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.H1 Product availability and resources
For more information on ActivOrders, visit http://www.mercurymd.com.
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.BIO Christine Harland Williams is President of Harland Communications and tracks handheld solutions used in the enterprise. She can be reached at http://www.harlandwebs.com.
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