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  1. 1. Mobilising the Clinician December 7-8, 2006 Dr. Mohammad Al-Ubaydli The Advisory Board Company
  2. 2. Principles of mobile medical computing ● Introductions and mobile computing terms ● The NHS spends money mobilising clinicians − PDA pagers – mobility and accountability − SMS appointments – control and convenience − SMS results –privacy and public health ● Evidence-based mobility
  3. 3. Introductions How many are in... − Clinician practice? − IT / informatics? − Management?
  4. 4. Mobile computing terms ● Personal Digital Assistants − Handheld computer: a computer small enough to hold in your hand − Smartphone: a handheld computer that can make telephone calls
  5. 5. Advantages of handheld computers ● Perhaps the best computer ever designed for clinicians − Mobility − Synchronization − Beaming
  6. 6. Why handheld computers 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. 7. Use and Perceived Benefits of Handheld Computer-based Clinical References ● PMID 16929041 − Probably the largest study to date of handheld reference usage, with 1501 MD participants (42% response rate) − One of the few that looked at actual handheld device usage data, not just self-reported survey responses − Epocrates Rx was used 6.3 times/day, and MDs believed Rx improved care quality and safety 5.6 times over 4 wks − MDs who used Rx more than 10 times/day (25%) believed patient care was improved 8.3 times over 4wks − Epocrates Dx was used 8.4 times over 4 wks, and was believed to improve patient care 4.2 times − Epocrates ID used 4 times over 4 wks, and was believed to improve patient care 4.1 times during that period
  8. 8. The opportunity before us… 300 250 Other Units (millions) 200 Linux 150 Microsoft 100 RIM Palm OS 50 Symbian 0 2003 2004 2005 2006 2007 2008 2009 2010 Est. Est. Est. Fcst. Fcst. Fcst. Fcst. Fcst. Source: In-Stat, 9/06
  9. 9. The opportunity before us… ● How long until a doctor realises they can use the BNF on their mobile phone… ● … and how long before they start putting clinical data on it?
  10. 10. …and the risks
  11. 11. PDA pagers mobility and accountability ● Magic words: European Working Time Directive ● Software now freely available for any NHS hospital from www.ibleep.net ● Setup − PC on every ward for the nurses − Central PC for night team operator − Wireless PDA for each doctor − Nurse contacts operator. Operator contacts doctor. Everyone can see what everyone is doing. ● Auditing allows adjustment of workflow
  12. 12. PDA pagers What the nurses see ● Can give the doctor detailed information including observations ● Can see what doctor is doing about message
  13. 13. PDA pagers What the operator sees ● Notice the detailed logging of each call
  14. 14. PDA pagers What the doctor sees ● Alert thrown through browser to PDA with vibration and sound
  15. 15. PDA pagers Auditing allows adjustment of workflow ● 80,000 live calls on system over last 2 years − Can drill by ward, speciality, priority of work, MD, pt ethnicity, pt age. ● Actionable results − Switched ENT SHO from 1 in 6 rotation to 1 in 13 cross-covering with general surgical SHOs − At Start, 17 doctors at night. Now 12 sometimes 13 − 50% of cannulations handled by assistants − Shifted warfarin prescriptions back to daytime staff ● £115,000 savings, mainly in rota changes
  16. 16. SMS appointments control and convenience ● Magic words: Demand management ● Setup (pilot to begin in January 2007) − Patient sends SMS requesting appointment − Receives SMS list of up to 3 slots for the next 48 hours, or a message saying there are no slots − Replies to SMS with preferred slot − Appointment booked with no need for phone staff or appointment reminder ● Software developed for Royal Free Hospital by www.templatehealthsystems.co.uk
  17. 17. SMS appointments Funding ● Began with capital grant bid at strategic health authority level − Cost of software development − Touch screen booking in waiting rooms − Early SMS operating costs ● Department of Health pilot site for demand management − Training for staff member − Salary for the employee as they supervise project
  18. 18. SMS results privacy and public health ● Magic words: 48-hour waiting target ● Setup (currently in pilot phase) − Patient accesses website to enter GU symptoms − Software triages case urgency of appointment − Test results sent as SMS to patient ● Software developed by Chelsea & Westminster Hospital and Mikkom www.mikkom.com
  19. 19. SMS results Funding ● Conceived by Dr. Anatole Menon-Johansson (SpR) and Dr. Ann Sullivan (Consultant) ● Hospital senior management provided seed funding for software development by Mikkom ● NHS Innovation Award runner up
  20. 20. Map of Medicine Mobile Pilot Study www.mobilemapofmedicine.com • Magic words: “Informing healthcare” • PDA efforts in UK inspired by deployment of the UK map of medicine on PDAs in Kenya
  21. 21. Isabel Healthcare • Foundation setup after tragedy with the patient Isabel • Provide differential diagnosis pediatric decision support system • Natural language queries • PDA version optimised for the small screen
  22. 22. Heartlands uses RFID for patient ID ● Ensure patients are correctly identified before they received surgery at The Heart of England NHS Foundation Trust ● Smart wristbands are linked to PDAs which clinician's use to call up electronic patient records that include a digital picture of the patient ● Safe Surgery Systems claim the system can also save hospitals time and money, leading to an extra 1-2 cases per list can be performed
  23. 23. The challenge − At the start of 2006 there were over 600 papers in PubMed™ that dealt with handheld computers. Many lessons have accumulated in the clinical literature but we need to understand and assimilate these lessons. The challenge is to provide these lessons as peer-reviewed and unbiased summaries based on scientific fact, not marketing hype. The Scholarships − Five exceptional students from around the world will be selected each year to review selected literature and make summary reports that will be published in the Mobile Medical Computing Reviews journal. The Scholarship winners will be mentored and trained by Dr. Mohammad Al- Ubaydli, author of four books, including “Handheld Computers for Doctors”. ● The results − Once complete, the reviews will be published and freely available through the website of the new journal Mobile Medical Computing Reviews. Each student will be able to quote their own reviews in their list of publications.
  24. 24. Evidence-based mobility ● International Scholarship − Applicants from the USA, Mexico, Puerto Rico, UK, Portugal, Romania, Croatia, Egypt, Israel, India, China, Philippines and Australia. − http://www.handheldsfordoctors.com/scholarship/ ● Peer-reviewed review journal − http://www.handheldsfordoctors.com/research/
  25. 25. The winners Joshua McAllister, USA Dr. Adesina Iluyemi, Ghana Medical Student at PhD candidate at University of Texas University of Portsmouth Emily MacDonald, UK Dr. Yunan Chen, China Medical Student at PhD candidate at University of Cambridge Drexel University Dr. Devashish Saini, India Resuscitation Sciences Fellow at University of Alabama at Birmingham
  26. 26. Mobilising the Clinician December 7-8, 2006 Slides and handout available at www.handheldsfordoctors.com Contact details IT Insights The Advisory Board Company alubaydm@advisory.com +1 202 2665425 me@mo.md Dr. Mohammad Al-Ubaydli The Advisory Board Company