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06.09.26

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  • 1. Principles of mobile medical computing Mohammad Al-Ubaydli me@mo.md
  • 2. Principles of mobile medical computing ● Introductions ● Mobile computing basics ● Advantages of the medium ● Databases ● Ensuring security ● Scholarship: how to win $1000 Learn these two URLs: ● www.nlm.nih.gov/mobile ● www.handheldsfordoctors.com/scholarship
  • 3. Introductions How many of you... ● own a PDA? ● have beamed? ● want to start a PDA project?
  • 4. Mobile computing basics ● Personal Digital Assistants – Handheld computer: a small mobile device that is part of your computing toolbox – Forget Palm, Pocket PC – Forget PDA and smartphone ● Just think about the possibilities of a mobile clinical computer
  • 5. Great for personal use ● For the first time, IT departments are behind the clinicians in adoption – Schedule, of course – Personal notes – Personal textbooks ● Personal Digital Educators ● NLM mobile, e.g. quot;Clinical Methodsquot; * Personal digital educators. Cimino et al. N Engl J Med. 2005 Mar 3;352(9):860-2.
  • 6. Why it is here to stay ● Handheld computers become smartphones, and every clinician is already carrying a phone – Aziz et al (PMID 16109177) gave smartphones to surgeons and improved responsiveness to nurses ● No charge left behind – Moulton et al (PMID 16385275) gave handheld computers to trauma surgeons and increases charge capture
  • 7. Advantages of handheld computers ● Perhaps the best computer ever designed for clinicians – Mobility – Synchronization – Beaming
  • 8. What would you wish you could do? ● Pt 50 year old, Native American female c/o cough and chest pain. – Productive cough for 3/7 but chest pain 1/24 ago. ● PMH – HTN (quot;capsule, half green, half blue-greenquot;). – TB while pregnant but ? Rx and duration. – Liver biopsy ? quot;hemachromatosisquot; at other hospital. – Allergy to Bufferin. ● PE: well-developed, well-nourished female in moderate respiratory distress. – Vital: pulse 90, RR 22, 100.3 F, BP 150/100. – Rales and rhonchi in the left upper chest. – Tender, palpable liver edge.
  • 9. What would you wish you could do? ● Labs – Chem7 (serum): Glucose 100 (70-105) – Chem7 (plasma): Glucose 150 (75-110) – CBC: Hgb 15 (12.0-15.8), Hct 45 (42.4-48.0), WBC 11,000 (3,540-9,060), platelets 145,000 (165,000- 415,000) – Fingerstick blood sugar was 80 – Urinalysis showed protein of 1+ and glucose of 0 – Blood culture was positive for MRSA – ECG - NSR, 74BPM, Axis -30 degrees, ST segment 2mm elevated and T-waves down in I, L, V5 and V6 – CXR: Left upper lobe infiltrate, LVH
  • 10. What would you wish you could do? ● Tx: – Nitroglycerin sublingual tablet with relief of pain – ceftriaxone for pneumonia – admitted to the CCU for monitoring. – then enteric-coated aspirin. ● Nurse found that the patient was caring for elderly father – concerned that she would no longer be able to manage caring for herself and him. – Consider antidepressant and a social work consult. ● Medical student concerned about MRSA in pt with pneumonia and recent MI. – Literature search.
  • 11. Databases There are many ways of storing your data ● Memo Pad / Notes ● Spreadsheets ● Simple databases ● Bespoke databases
  • 12. Memo Pad / Notes ● Fast and simple ● But... limited
  • 13. Spreadsheets ● Excel To Go or Pocket Excel ● Easy and great for calculations ● But problems with security, error checking, synchronization and relational data.
  • 14. Databases ● Everything is a database – quite right too! ● Software like HanDBase makes it easy to get started – eg surgical logbook ● Bespoke databases – Allow advanced user interface – Expensive and require computer expertise
  • 15. Security
  • 16. Five steps to analyse security systems 1.What assets are you trying to protect? 2.What are the risks to those assets? 3.How well does the security solution mitigate those risks? 4.What other risks does the security solution cause? “Beyond Fear”, Bruce 5.What costs and trade-offs Schneier. Springer. does the security solution impose?
  • 17. Scenario 1 ● One handheld computer storing – appointments (clinics and personal) – addresses (ward phone numbers, computer passwords) – tasks (including name of the patient) – memos (lecture notes, patient summaries) ● Fives steps: 1. What assets are you trying to protect? 2. What are the risks to those assets? 3. How well does the security solution mitigate those risks? 4. What other risks does the security solution cause? 5. What costs and trade-offs does the security solution impose
  • 18. Scenario 1 ● One handheld computer storing – appointments (clinics and personal) – addresses (ward phone numbers, computer passwords) – tasks (including name of the patient) – memos (lecture notes, patient summaries) ● Encryption
  • 19. Scenario 2 ● One handheld computer storing – appointments (clinics and personal) – addresses (ward phone numbers, computer passwords) – tasks (including name of the patient) – memos (lecture notes, patient summaries) ● Synchronise with: – home PC – work PC – secretary's PC
  • 20. Scenario 3 ● One handheld computer storing – appointments (clinics and personal) – addresses (ward phone numbers, computer passwords) – tasks (including name of the patient) – memos (lecture notes, patient summaries) ● Synchronise with: – MAU / SAU PCs – sever PC – other PDAs – ? home PCs
  • 21. Scenario 3 ● One handheld computer storing – appointments (clinics and personal) – addresses (ward phone numbers, computer passwords) – tasks (including name of the patient) – memos (lecture notes, patient summaries) ● Synchronise with: – MAU / SAU PCs – sever PC – other PDAs – ? home PCs
  • 22. The Ali Abdulla Al-Ubaydli Scholarships for Mobile Medical Computing
  • 23. The Ali Abdulla Al-Ubaydli Scholarships for Mobile Medical Computing The five selected winners will each receive: ● $1,000 Scholarship. ● Mentoring and one-on-one tutorials with me. ● Publication of your work in the Mobile Medical Computing Reviews journal ● Press campaigns by Epocrates and me. ● One year free subscription to Epocrates Essentials all- in-one mobile reference to drugs, diseases and diagnostics.
  • 24. Principles of mobile medical computing Mohammad Al-Ubaydli me@mo.md