Convergence of technologies
Mobile devices put a computer in your pocket
By Jay D. Mabrey, MD
Medicine is going mobile. Gone are the days when ones trusty PDA (personal digital assistant) was nothing more than a fancy DayTimer. In addition to addresses and appointments, todays PDAs can send and receive e-mail, download stock quotes and sports scores, and function as a cell phone or pager, all in the space of a deck of cards.
The real advantage to the orthopaedic surgeon on the move is that all of this can take place wirelessly through a variety of protocols. Cedars-Sinai Medical Center in Los Angeles, is an early adopter of wireless handheld technology and requires that their students use PDAs on rounds and in patient care. These wireless handheld devices provide clinicians with a physician directory lookup, paging and wireless access to email, secure access to confidential patient information, and wireless order processing for books and articles from the medical library.
Within the past few months several companies have introduced cell phones with built-in Palm-powered PDAs. Samsungs SPH i300 uses a 256- color touch sensitive screen to double as both keypad and digital interface for this $500 device. Handspring, another Palm-based company has just introduced the Treo 180 ($400), which includes a QWERTY keyboard for fast and accurate data entry. Both devices allow one to surf the web on the run, but since the maximum connection speed is 14.4Kbps, full-blown web browsing is slow. Phone-based modems run at 56Kbps (theoretically).
Fortunately, we wont have to wait long for more speed, a newer technology known as Bluetooth will offer Internet access at around 384Kbps, although it may only be within a range of 100 feet from a dedicated base. It will be able to communicate via short-range radio with other PDAs within range as well as printers. Both Palm and Pocket PC devices are now coming on line with Bluetooth built right in. For those with older devices there are Bluetooth expansion cards. The latest entry into the Bluetooth arena is the Compaq iPAQ Pocket PC H3870 that also carries 64 MB RAM and 32 MB ROM.
Convergence also means that we are closer than ever to placing a desktop computer into our coat pockets. The IBM Metapad weighs only 9 ounces and measures just three by five inches wide and three-quarters of an inch thick, yet it contains an 800 MHz processor, 128 MB RAM, a 10 GB hard drive, and a 3D graphics chip with 8 MB RAM. The device is readily converted into a super PDA by slipping a touch sensitive color screen over it, or it acts as a desktop machine when it is plugged into a module that connects to a standard 17-inch flat panel display and keyboard. Although not available to consumers, the technology demonstrates just how much power can be packed into a very small space.
Computer programs are also becoming more powerful in the handheld market. Downsized, but fully functional web browsers are available for the latest Pocket PC devices along with portable versions of such desktop stalwarts as Word, Excel, and Outlook. Combined with ever increasing memory capacity and faster central processors, hand held devices are capable of presenting animated slide shows using PowerPoint. They can even display standard video files on their compact color screens. And with Bluetooth technology, all of this can be done remotely from anywhere in the auditorium.
Emerging software solutions for orthopaedic surgeons on the move include patient tracking programs, surgical case scheduling, and billing and coding software. Many of these are available on a trial basis or for purchase through such websites as www.ePhysician.com and www.ePocrates.com.
The AAOS also offers software products on www.aaos.org for mobile computing such as CodeX 2002, that allows you to navigate, translate and integrate CPT, ICD-9, Global Service Data, CCI edits, and RVUs. There is also Essentials of Musculoskeletal Care Quick Tips in PDA Format that allows residents and primary care colleagues to take Essentials Quick Tips on rounds, to patient consultations or wherever they go.
Future developments in mobile hand held computing will integrate the devices into larger systems allowing access to patient records and lab results off site and may even include access to radiographic images and video as well. Built-in speech recognition will transcribe and then transmit clinic and floor notes to the patients central electronic medical record as well as generate and transmit the appropriately coded bill to Medicare for immediate payment.
Jay D. Mabrey, MD, is Associate Professor of Orthopaedics, University of Texas Health Science Center at San Antonio and Director, Total Joint Service. He is also the Chair, Committee on Electronic Media Education.