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ACAD-AE-MED  July 2002

ACAD-AE-MED July 2002

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Subject:

Re: Handheld Computers

From:

[log in to unmask]

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Sat, 6 Jul 2002 17:09:20 00100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (162 lines)

Does anyone have real time experience of using the new HAS release for clinical
detail collection?
From the sales pitch at Edinburgh it looked good but how robust is it in the
real world.
It looks like the best around at present but I'm sure there is someone out there
who has tried it or others and can spill the beans.
We are looking at going towards them for our system

Andy Volans
>I use handheld computers extensively and posted the following reply last
>year regarding a discussion on paperless EDs:
>
>--------------------
>I don't think the principal of a computerised clerk-in is a problem, but the

>fact that they force the user to follow a prescribed route and style is.
>Current medical software is not "intuitive" enough for medical staff.  Too

>often it is designed around the software's needs or the number crunchers'
>wants (ie event codes) and not the users needs.  Lateral thinking on the
>part of the software designer may help here and the interface is the key.
>For instance allowing mouse-selected free text entry in multiple fields at

>once which the user can freely move around - looking much like a paper
>record on a large screen.  HTML-style interface records may be another idea,

>as they are quite intuitive.  Being able to draw diagrams on a touch screen

>and place text or parts of an ECG trace etc. anywhere on the "page" is also

>important.
>
>There is a lot of work going on at the moment to find better ways for
>professional to interface with computers.  Think back to the punched card
>interface before VDUs or the DOS interface before Apple OS / Windows. Then

>the computer interface was thought of as being like a typewriter.  Now we
>use an interface that resembles our office desk.  The future interfaces are

>hopefully going to provide a similar paradigm shift in the way we interact

>with computers.  Hopefully we will interface with the computer as though it

>were a secretary or assistant.
>
>In GP the requirements for an effective system are less.  The Torex Premier

>GP system is pretty impressive - a desktop based consulting and prescribing

>system it can synchronize all the patient data with a Windows CE palmtop via

>a cradle.  This means you can take all you patient info with you on visits

>and update it in the patients house (see my website
>http://www.coull.net/computers.html to see other ways in which palmtops can

>help in GP out of hours cover).  Still, even this is too cumbersome for a
>more chaotic clinical environment such as A+E.  I've based my entire GP
>approach around a palmtop and am very happy with the results, but all my
>attempts to use one in A+E or BASICS-type calls have not worked well.  The

>interface is just too fiddly for effective use in those environments and
>because they are clumsy to synchronize, they don't lend themselves well to

>team information sharing.
>
>Up and coming Bluetooth technology may solve this.  Bluetooth
>(http://www.bluetooth.com/) is a wireless protocol that allows multiple
>computers to network automatically in the background with each other when
>they come in range of another device.  The idea is that you tell your
>palmtop that you have, say, an appointment at a set address at a set time
>and you also select a recipe for your evening meal.  The palmtop tells your

>alarm clock the time to get you up and tells the water heater when to switch

>on in anticipation of this.  When you go to your car it then tells your car

>GPS where you are going.  When you come home the oven is pre-heating because

>it told the oven when to switch on, and there is a delivery waiting for you

>because the bar-code-reading fridge realized you needed more ingredients
>based on the recipe the palmtop had told it you chose.
>
>Applied to healthcare this may make EHRs much more practical with each
>member of staff using palmtop devices for all patient events AT THE POINT OF

>CONTACT.  These devices all communicate silently and automatically with
>central hub computers in the department and/or with the devices of other
>members of staff and/or other department's computers.  I suspect this may be

>the key breakthrough technology for hospital EHRs.  This may make your A+E

>staff look a bit like the cast of Space 1999 (lets hope they don't make us

>wear the flares).
>
>However, all this is in the future and this brings us to one of the major
>problems with IT implementation.  IT software developers are dreamers
>pushing out a new frontier.  So they get very excited and tell you what tbey

>can achieve for your department, and you then spend millions to find out
>that they were basing their promises on technology still being or to be
>developed and none of it actually works.  (I remember being told by the IT

>specialist when I was on the IT liason group in Tameside in 1993 that we
>could have palmtops with pen based bedside medical software.  Complete
>fantasy at that point, but presented as fact.)
>
>So, you should be sensible about what parts of your process you can improve

>by using current computer technology and what can be done better with paper

>and pen.  For example, do you really need an ISDN link to order the staff
>Chinese take away over the internet or would a paper/pen/telephone approach

>be better?  A more difficult question is would a palmtop internet link to
>the eBNF site http://www.bnf.org/ be better than having to distribute paper

>BNFs?  With current technology probably not, but in the near future that
>will change.
>
>> Computer systems also need to have reliability records approaching that of

>> aircraft.
>
>This is another critical point. Almost all GP practices use Windows based
>systems that are hopelessly unreliable.  Web servers almost all use Linux
>based systems because it is a much more stable system.
>
>So basically, the problem with a paperless system in A+E is...
>
>1. the hardware development is not advanced enough yet to cope with near
>patient use by teams working in a chaotic environment.
>
>2. the software interface is inadequate
>
>3. the server systems are not reliable enough to be depended on.
>
>Static business offices are much simpler and the technology to make them
>paperless has been around for a while.  GP surgeries - which are less
>chaotic in their patient contacts - are just about there, but the paperless

>clinical department will probably take a little longer.
>
>-------------------------
>
>
>Robbie Coull
>
>email: [log in to unmask]             website: http://www.coull.net
>
>=============^==============================================================

>LOCUM123.COM
>Visit the world's first automated locum service at http://www.locum123.com

>=============^==============================================================

>
>
>

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