By Stephen Robitaille - 02/19/02

For physicians in U.S. hospitals, each day contains a seemingly interminable array of roadblocks≈lost medical charts, specialists who can't be contacted, test results from orthopedics that somehow wound up in the urology clinic. And that's before anyone even gets started on the paperwork for billing.

But researchers are moving ever closer to a computerized magic wand for medicine, a single software package that can place a hospital's entire informational output into a handheld computer. This new generation of networked computers holds the promise of improved communications, lowered medical errors, substantial cost savings, and streamlined efficiency in medical operations.

At UCLA Medical Center, for example, the neurosurgery department is in the final testing phase of a program that at the press of a button allows surgeons at a patient's bedside to call up medical charts, examine all images from x-rays, MRIs, and CT scans, place orders≈which include checks for potential drug errors≈enter patient exam findings, and communicate with medical colleagues, hospital staff, and family members via email or fax.

The Care Quest program, which is scheduled to be ready for commercial markets in May, also allows physicians to conduct remote checks on patients from anywhere in the hospital≈or the country. They can get readings from any bedside monitoring equipment to which the patient is connected, and view the patient through wireless Web cameras, in addition to tapping into the hospital information system.

And it can even deliver billing information to an insurer. Oh, and it does all this in compliance with the Health Insurance Portability and Accountability Act, the omnibus 1996 federal law which mandated strict new rules for privacy and security of patient medical records.

"Physicians are the ultimate mobile professionals. They go from the operating room, to their office, to clinic, to other hospitals," said Dr. Neil Martin, chief of the Division of Neurosurgery at UCLA Medical Center and a co-developer of the Care Quest program. "The information I require to understand what is going on with a patient is multi-dimensional. I need text, images, etc., and those data are currently all over the hospital. There is a need for multi-combination communications.

"Care Quest doesn't examine the patient, doesn't do surgery, but it gives you all the tools to make the decisions and gives you the ability to monitor your patients either at bedside or remotely," said Martin.

The program is currently being tested in the medical center's neurosurgery department. Future expansion plans call for installation in the organ transplant, pediatrics intensive care, and anesthesiology departments, as well as the Veterans Administration hospital in West Los Angeles, in which substantial numbers of UCLA-affiliated physicians also practice, said Martin.

Care Quest is a wireless system, said Valeriy Nenov, Ph.D., an associate professor of neurosurgery at UCLA and a co-developer of the program.

Within the medical center buildings, there is a local area network, or LAN, with transmitters every 200 feet inside the building to transmit information. For remote access, physicians connect to the system via standard commercial cellular phone networks.

This means no synchronizing of handheld units to a server, and an uninterrupted stream of current patient information, Nenov said. The program also is compatible with most handheld computers and personal digital assistants.

Care Quest program has a number of viable competitors whose products are already on the market, Nenov said. But what sets Care Quest apart, said Nenov, is that while its competitors' products provide some of the same services as Care Quest, such as online prescriptions or test results, none of them provides the full range of services that the UCLA program delivers.

"We were able to integrate data from a variety of sources≈labs, information system, all electronic medical records, radiology, nuclear medicine≈and we were able to display images and manipulate them on the handheld," said Nenov. "We also have full access to all bedside patient monitors, so we get real-time readouts."

Though the screens of handheld devices are small, the images of test results such as x-rays and MRIs are nonetheless clear and readable, said Martin. A physician will see a series of thumbnail-sized images from the scans and can choose which ones to blow up. Then, those images can be manipulated further, so physicians can examine particular areas of interest to them.

"We also use them as data input devices, so nurses can put in a stroke scale or anything, and it is flexible enough that we can add new data on the fly," said Nenov. "Doctors can input data after they do rounds. In our case, it goes directly into the medical record. And there is the capability, not widely used yet, for billing to insurers."

For programs such as Care Quest, "capability not widely used yet" is a common lament. The health care industry, which invests only about 4 percent of its budget nationally on information technology, has long been viewed as lagging behind other sectors in its use of such technology to improve efficiency and save money.

For example, the program's ability to fax information is important because relatively few medical groups≈whose doctors refer patients to hospitals like UCLA≈use email in their communications, said Martin.

Dr. Mark Leavitt, founder of Medscape, the medical services Web site, said in a Washington, D.C. policy briefing last June that there are several barriers to physician uptake of information technology systems. Leavitt said that cost is a big deterrent, as installation and training can cost a medical group $30,000 per physician. This is a hefty price tag in California, where more than half of all medical groups do not meet state fiscal solvency standards.

Doctors who go online for business services often receive criticism from health plans and other doctors, said Leavitt, who also cited doctors' attitudes toward technology as preventing them from embracing new products.

And insurers, who regularly appear in news stories when they get into legal trouble with state regulators for tardy payments to providers, markedly improve their performance when utilizing online billing systems. But those systems currently account for only a modest portion of their overall billing programs.

For example, an April 2001 study by the Medical Society of New Jersey found that Aetna U.S. Healthcare in that state paid 81 percent of electronically submitted claims within 30 days, but paid less than half of all paper claims within 40 days≈but overall, only submitted 38 percent of its claims electronically.

Online programs, say proponents, can help cut through these kinds of logjams. It's just a matter of time.

"This is the new wave, basically," said Nenov. "Wireless handhelds are propagating rapidly and coming into flower in hospitals, in terms of improving work flow, reducing medical errors, and a whole list of items."