http://www.microsoft.com/BackOffice/reading/stanford.htm (PC Press Internet CD, 03/1996)By Erica Schroeder
The Pain Management Service at Stanford University Medical Center is putting pen-based PCs in the hands of its 20 doctors to create a faster, more efficient way of dealing with patients.
Treating more than 20,000 patients a year, the Pain Management Service expects the pen-based systems and related workflow applications to save more than $1 million this year while reducing by 60 percent the amount of time doctors spend dealing with paperwork.
"The kinds of changes in productivity are pretty phenomenal," said Dr. William Brose, manager of the program and director of the Pain Management Service, in Palo Alto, Calif. "Reduced time is a real savings for the physicians."
The hospital commissioned Digital Medical Systems Inc., of San Francisco, to build a Windows-based application that generates forms for different tasks, such as scheduling, examinations, authorizations, and billing, and reports on each encounter with a patient. This system automatically routes forms between doctors and nurses, and forwards data to insurance companies and patients.
The doctors are equipped with 50mhz 486DX2 pen tablets from Toshiba America Information Systems Inc., with 20M bytes of RAM and 110M-byte hard drives. The back end of the system is based on an SQL Server database running on a Windows NT server from AST Research Inc. The 4.5-pound Pcs, which can run about 2.5 hours on a battery charge, are linked to the server over a Proxim Inc. wireless network that provides real-time access to patient records.
"In order to collect the data, we needed to have a tool that worked at the point of interaction between the doctor and patient," Brose said.
The key to the success of the $100,000 system is replacing the paper-based system on which doctors relied with an electronic version of those forms, so medical personnel would only have to undergo limited training to learn the application. The system generates all forms and reports using Microsoft Word and Access. The forms are attached to Microsoft Mail messages, which are transmitted over the wireless LAN to the NT Server
"The physicians can be working it within a minute, and they'll understand it because it's just like what they used to use," said Brose.
For Stanford, adopting mobile PCs eliminated a lot of early user resistance to the technology shift.
"Initially, we set the thing up with desktop Pcs, but the physicians didn't like it because it was extra work--they had to re-enter data into the PC after seeing a patient," said Brose.
"Now, during the course of their patient care, they enter information they'd normally enter on a chart into an electronic form, and the server generates a report documenting the encounter and the information," said Brose.
Having this information stored quickly in an electronic format also benefits patients. "We have automated the order entry, so we now can get a prescription sent to the pharmacy of the patient's choice, and the paperwork for prescriptions or X-rays all occurs as a by-product of entering the data," Brose said. "So now the physicians are quite willing to enter the data because it makes their job easier."
However, while the number of hours spent creating and managing paperwork has been significantly reduced for doctors, the clinic's IS staff is now undermanned. And that demand on IS resources is likely to increase even more as the hospital moves to expand the system throughout its operations, while bringing all of its patient records on-line.
"We haven't done it yet," said Brose, "but maybe next quarter we'll destroy our file room because it's become obsolete."
Problem: The Pain Management Service at Stanford University Medical Center treats more than 20,000 patients a year. Dealing with insurance and other paperwork cuts into time spent treating patients.
Solution: The clinic installed a Windows-based mobile-computing solution running on pen-based PC clients linked to an NT Server, which stores reports and automatically routes forms.
Payoff: The clinic cut down on the time spent dealing with paperwork by more than 60 percent and gets forms to insurance companies faster.
What's Next: The program is being evaluated by other departments in the hospital and might be expanded to include all patients at the hospital.
