Dr' Mohammad AlUbaydli

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Mobilising the Clinician December 7-8, 2006

• Dr. Mohammad Al-Ubaydli
• The Advisory Board Company

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Principles ofmobile medical computing

• Introductions and mobile computing terms
• The NHS spends money mobilising clinicians
• PDA pagers mobility and accountability
• SMS appointments control and convenience
• SMS results privacy and public health
• Evidence-based mobility

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Introductions

• How many are in...
• Clinician practice?
• IT / informatics?
• Management?

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Mobile computing terms

• Personal Digital Assistants
• Handheld computer a computer small enough to
  hold in your hand
• Smartphone a handheld computer that can make
  telephone calls

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Advantages of handheld computers

• Perhaps the best computer ever designed for
  clinicians
• Mobility
• Synchronization
• Beaming

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Why handheld computers here to stay

• Handheld computers become smartphones, and every
  clinician is already carrying a phone
• Aziz et al (PMID 16109177) gave smartphones to
  surgeons and improved responsiveness to nurses
• No charge left behind
• Moulton et al (PMID 16385275) gave handheld
  computers to trauma surgeons and increases charge
  capture

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Use and Perceived Benefits of Handheld
Computer-based Clinical References

• PMID 16929041
• Probably the largest study to date of handheld
  reference usage, with 1501 MD participants (42
  response rate)
• One of the few that looked at actual handheld
  device usage data, not just self-reported survey
  responses
• Epocrates Rx was used 6.3 times/day, and MDs
  believed Rx improved care quality and safety 5.6
  times over 4 wks
• MDs who used Rx more than 10 times/day (25)
  believed patient care was improved 8.3 times over
  4wks
• Epocrates Dx was used 8.4 times over 4 wks, and
  was believed to improve patient care 4.2 times
• Epocrates ID used 4 times over 4 wks, and was
  believed to improve patient care 4.1 times during
  that period

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The opportunity before us
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The opportunity before us

• How long until a doctor realises they can use the
  BNF on their mobile phone

• and how long before they start putting clinical
  data on it?

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and the risks
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PDA pagersmobility and accountability

• Magic words European Working Time Directive
• Software now freely available for any NHS
  hospital from www.ibleep.net
• Setup
• PC on every ward for the nurses
• Central PC for night team operator
• Wireless PDA for each doctor
• Nurse contacts operator. Operator contacts
  doctor. Everyone can see what everyone is doing.
• Auditing allows adjustment of workflow

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PDA pagersWhat the nurses see

• Can give the doctor detailed information
  including observations
• Can see what doctor is doing about message

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PDA pagersWhat the operator sees

• Notice the detailed logging of each call

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PDA pagers What the doctor sees

• Alert thrown through browser to PDA with
  vibration and sound

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PDA pagers Auditing allows adjustment of workflow

• 80,000 live calls on system over last 2 years
• Can drill by ward, speciality, priority of work,
  MD, pt ethnicity, pt age.
• Actionable results
• Switched ENT SHO from 1 in 6 rotation to 1 in 13
  cross-covering with general surgical SHOs
• At Start, 17 doctors at night. Now 12 sometimes
  13
• 50 of cannulations handled by assistants
• Shifted warfarin prescriptions back to daytime
  staff
• 115,000 savings, mainly in rota changes

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SMS appointmentscontrol and convenience

• Magic words Demand management
• Setup (pilot to begin in January 2007)
• Patient sends SMS requesting appointment
• Receives SMS list of up to 3 slots for the next
  48 hours, or a message saying there are no slots
• Replies to SMS with preferred slot
• Appointment booked with no need for phone staff
  or appointment reminder
• Software developed for Royal Free Hospital by
  www.templatehealthsystems.co.uk

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SMS appointmentsFunding

• Began with capital grant bid at strategic health
  authority level
• Cost of software development
• Touch screen booking in waiting rooms
• Early SMS operating costs
• Department of Health pilot site for demand
  management
• Training for staff member
• Salary for the employee as they supervise project

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SMS resultsprivacy and public health

• Magic words 48-hour waiting target
• Setup (currently in pilot phase)
• Patient accesses website to enter GU symptoms
• Software triages case urgency of appointment
• Test results sent as SMS to patient
• Software developed by Chelsea Westminster
  Hospital and Mikkom www.mikkom.com

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SMS resultsFunding

• Conceived by Dr. Anatole Menon-Johansson (SpR)
  and Dr. Ann Sullivan (Consultant)
• Hospital senior management provided seed funding
  for software development by Mikkom
• NHS Innovation Award runner up

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Map of Medicine Mobile Pilot Studywww.mobilemapof
medicine.com

• Magic words Informing healthcare
• PDA efforts in UK inspired by deployment of the
  UK map of medicine on PDAs in Kenya

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Isabel Healthcare
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• The challenge
• At the start of 2006 there were over 600 papers
  in PubMed that dealt with handheld computers.
  Many lessons have accumulated in the clinical
  literature but we need to understand and
  assimilate these lessons. The challenge is to
  provide these lessons as peer-reviewed and
  unbiased summaries based on scientific fact, not
  marketing hype.
• The Scholarships
• Five exceptional students from around the world
  will be selected each year to review selected
  literature and make summary reports that will be
  published in the Mobile Medical Computing Reviews
  journal. The Scholarship winners will be mentored
  and trained by Dr. Mohammad Al-Ubaydli, author of
  four books, including Handheld Computers for
  Doctors.
• The results
• Once complete, the reviews will be published and
  freely available through the website of the new
  journal Mobile Medical Computing Reviews. Each
  student will be able to quote their own reviews
  in their list of publications.

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Evidence-based mobility

• International Scholarship
• Applicants from the USA, Mexico, Puerto Rico, UK,
  Portugal, Romania, Croatia, Egypt, Israel, India,
  China, Philippines and Australia.
• http//www.handheldsfordoctors.com/scholarship/
• Peer-reviewed review journal
• http//www.handheldsfordoctors.com/research/

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The winners
Dr. Adesina Iluyemi, Ghana PhD candidate
at University of Portsmouth
Joshua McAllister, USA Medical Student
at University of Texas
Emily MacDonald, UK Medical Student at University
of Cambridge
Dr. Yunan Chen, China PhD candidate at Drexel
University
Dr. Devashish Saini, India Resuscitation Sciences
Fellow at University of Alabama at Birmingham
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Mobilising the Clinician December 7-8, 2006
Slides available at www.handheldsfordoctors.com C
ontact details IT Insights The Advisory Board
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• Dr. Mohammad Al-Ubaydli
• The Advisory Board Company