Contact: Mark Ebell, Family Practice, (517) 353-0772, Ext. 448 or Tom Oswald, Media Communications, (517) 355-2281
HAND-HELD COMPUTERS HELP MANAGE INFORMATION; MAKE "BETTER DOCS"
EAST LANSING, Mich. - Imagine a device that improves the quality of health care, helps keep health care costs down, improves efficiency, AND fits in the palm of your hand.
Such a device does exist in the form of a hand-held computer and it is being put to use at Michigan State University.
Weighing in at hardly a pound and easily fitting in the palm of a hand, it can be used for managing more information than one can imagine, including summaries of the latest published papers, medical calculators, basic drug information, systematic reviews of the best available evidence, and treatment guidelines. The little computers can even tell a doctor what medications the local insurance companies will cover.
"Doctors have ever-increasing demands placed on them, to not only improve the quality of care, but to improve the efficiency of care, to keep costs down, and to see more patients more quickly," said Mark Ebell, MSU associate professor of family practice. "Central to that is being more efficient about how we manage information. When you think of managing information, you think of computers."
Using a grant from the state of Michigan, through MSU's Institute for Managed Care, the university has purchased 100 of the computers. Not only will they be used in the clinics, but Ebell and colleagues will use them as teaching tools, as well as conduct a research project to investigate the future of such technologies.
The computers are equipped with "InfoRetriever," a software package developed by Ebell and several colleagues that allows doctors to tap a keyboard and get an answer. It gives them quick and easy access to the best available evidence on a topic, without having to wade through a lot of unimportant, unrelated, or poorly designed research.
"To be really useful, information should be relevant to your patient population, should use outcomes that patients should care about, and should have the potential to change practice. We call that kind of information POEM - patient oriented evidence that matters."
For example, a patient comes in with a sore throat, and a doctor has to determine whether or not he or she has a strep infection. Ordering a throat culture takes three days and the rapid strep tests are inappropriate for patients with a very low or very high risk of strep. The physician can feed all of the pertinent information into the computer, which will then help him or her determine the patients' risk of strep.
"Instead of having to remember all of this, instead of having to find the published paper, it's all right there at the fingertips," Ebell said. "It makes it very easy to apply the results of research and individualize care to a patient's needs."
The software also includes practice guidelines, developed by groups of physicians who have carefully reviewed the medical literature to develop a suggested approach to a common medical problem. Not a cookbook, these guidelines help physicians identify tests and treatments that are proven to work.
The computer also can help a physician determine which medication is best for a certain condition. If the doctor thinks an antibiotic is in order, all he or she needs to do is select the class of antibiotics in the computer program.
"It will then show a list of antibiotics sorted by relative cost, basic prescribing information, and whether they are on the insurance company's formulary," Ebell said.
In addition to their clinical applications, the hand-helds also are part of a research project. Every time the software is used, it will create a database entry that will indicate when and how it was used.
"We want to use this to help us better understand what information physicians need at the point of care," he said. "We'll keep track of what they find most useful, see how different people use it, and so on."
These days, computers in the doctor's office are not rare - they are usually used for billing and keeping patient records. Where they are rare is in the treatment room, but, according to Ebell, that will soon be changing.
"If I can be more efficient in the way I manage patient information and how I access high-quality answers to my questions, then I'll be a better doc," he said. "Hopefully, that will also give me more time to spend talking to my patients about what is really important to them."
One-hundred of the units have been purchased. About 80 will be used by residents - second- and third-year resident physicians in the Lansing area.
The "InfoRetriever" software was developed by Ebell; Henry Barry, MSU associate professor of family practice; David Slawson, associate professor of family medicine at the University of Virginia; and Allen Shaughnessy, director of research, Harrisburg Family Practice Residency.
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