Doctors do it wirelessly

Doctors and nurses employed by IPC — The Hospitalist Company (IPC), now spend less time on paperwork and more time on patient care thanks to a combination of software from Oracle Corp. and handheld devices.

PC has over 300 full-time doctors throughout hospitals in the U.S. Before IPC deployed Oracle Corp.’s Database Lite — a complementary product to Oracle’s database — doctors in these disparate locations had to send billing information via snail mail to IPC’s head office in Los Angeles. Then a data entry clerk had to manually input the information into IPC’s central system, which would generate a bill to be mailed to the client, explained Pat Holmes, vice-president of technology at IPC in Los Angeles.

Now billing information is sent out electronically via the doctor’s handhelds directly to the head office. “Eighty per cent of our claims are going out electronically. That’s had a huge impact on our bottom line,” Holmes noted. Database Lite lets IPC store subsets of data on a handheld device. This means the handheld can access data autonomously without being connected to the network, explained Jacob Christfort, CTO and vice-president of mobile and wireless products at Oracle in Redwood Shores, Calif. Also, each handheld can store a different subset data, Holmes said.

Database Lite also allows for two-way replication. Throughout the day doctors synchronize data on their handhelds via a phone line, or wirelessly over Sprint’s 1xRTT network using a wireless card, to ensure they have the most current data. Data that has been modified on the handhelds will be updated on the central database and vice versa.

The latest version, Database Lite 10g was released last month. With 10g, users don’t have to synchronize to the network — it automatically synchronizes itself. In fact, synchronization is completely invisible to the end user, Christfort said. If a user is in an area where there is no wireless data service, the device will synchronize as soon as it detects a network, he added. IPC uses a solution from the older version 9i Lite.

Also, 10g lets system administrators gain control of the device and fix problems remotely. Previously, the sys admin would have had to walk the user through troubleshooting procedures or have physical access to the handheld, Christfort explained. And, if the device is lost or stolen, the sys admin can erase all the information on the handheld, he said.

The handhelds, in conjunction with Database Lite, have also reduced other paperwork and administrative tasks like making phone calls to other health care providers and sending faxes. Before IPC deployed handheld devices, doctors had to phone patients’ family doctors to inform them about hospital visits — such as why the patient was admitted, diagnoses, follow-up procedures as well as home health care. Doctors often had to fax further information to these family doctors as well as to IPC’s headquarters.

This method proved inefficient because information often got lost in the process. “Our founder found that 40 per cent of the time, when he ordered home health care it wasn’t delivered,” IPC’s Holmes said. IPC’s nurses and patient representatives follow up with patients once they are released from the hospital.

With Oracle Database Lite, information is sent electronically and automatically thus helping to increase the success of post-hospital patient care. IPC currently uses legacy Hewlett-Packard Co. Jornada 720 and 780 handheld devices but is slowly moving over to HP’s iPaq. Before IPC used Oracle’s Database Lite, it used a DOS-based text application.

IPC picked Oracle on the advice of two different consulting firms. “Synchronization with the back-end Oracle database is easy to set up and seamless,” Holmes said. “Some alternatives would have required middleware coding in a way that was unfamiliar to us.” Similar products include IBM Corp.’s DB2 Everyplace Database and Sybase Inc.’s SQL Anywhere Studio. Oracle Database Lite costs US$100 per user and requires the user to have an Oracle back-end.

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