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PubMedDate not supplied

E-prescribing in clinical practice.

E-prescribing is coming of age. It promises to reduce medication errors and adverse reactions from incompatible drug combinations. This article provides an overview of the factors that have driven greater adoption of e-prescribing, principally the promulgation of HIPAA regulations and the Medicare Modernization Act of 2004. It discusses the financial considerations that have delayed the greater use of existing methodology, addresses current government and industry initiatives, and defines some of the standards that have been set forth to date.

Ambulatory Care Information Systems↗
PubMed2005

Wireless by design.

Three separate and dramatically different organizations made the decision to shed hard wires--and, in some cases, paper. All are at various stages in their wireless evolution, and all have been challenged to get their arms around a range of devices, individual work styles, implementations and platforms.

Computers, Handheld↗
PubMed2004

User perspective of DITIS: virtual collaborative teams for home-healthcare.

DITIS supports home-care by offering wireless health care services for chronic illnesses. The main service is the dynamic creation, management and co-ordination of virtual collaborative healthcare teams for the continuous treatment of the patient at home, independently of the physical location of the team's members (or the patient). For each patient a flexible (dynamic) virtual medical team is provided, made up from visiting home-care nurses, doctors, and other health care professionals, responsible for each case. This virtual team is able to provide dedicated, personalized and private service to the home residing patient on a need based and timely fashion, under the direction of the treating specialist, without the necessity to move the patient from his home, thus making better use of the scarce and expensive medical professionals and scarce hospital beds, irrespective of geographic or organisational barriers. DITIS uses a number of state of the art technologies which are seamlessly put together, such as collaboration and personalization via mobile agents, access to medical data from anywhere and any time via a variety of mobile devices and a variety of protocols (i.e., WAP, HTML) and continuous connectivity via new communication technologies such as ADSL and GPRS, and soon UMTS. All the technologies are selected for platform independence.

Chronic Disease↗
PubMed2004

Web access to data in a mobile ECG monitoring system.

Cardiovascular diseases and, in particular, diseases related to arrhythmias are a problem that affects a significant percentage of the population, being one of the major causes of death in Europe. New advances in the fields of PDAs, mobile phones, wireless communications and vital parameter sensors have permitted the development of revolutionary medical monitoring systems, which strikingly improve the lifestyle of patients. However, not all those monitoring systems provide patients with real assistance - anywhere and at any time. We have developed a system that goes a step further than the previous approaches, being designed to capture, record and, as a distinctive feature, locally analyze the ECG signals in a PDA carried by the patient. In that sense, the system has a decision support module based on decision tree methods that can detect, with high precision, any arrhythmias that the user may be suffering. Alarms can then be activated in time to alert a medical center in order to provide the proper medical assistance. One of our aims when building the system has been to optimize limited and expensive resources like PDA memory size and wireless communication costs. Moreover, accessibility is also an important feature of the system that has been achieved by the development of web services to query the data computed in the PDA. In this way, authorized personnel (physicians and relatives) can easily obtain access to that data.

Computer Systems↗
PubMed2004

Development of teleconsultations systems for e-health.

Two prototype telemedicine systems have been developed: 1) a wireless system for status assessment of cardiology patients (WSCP), 2) a system for medical image management and teleconsultations (IMTS). The former system enables the patient to record an ECG on a personal digital assistant (PDA), view it and send it via a wireless connection. The doctor on duty is then able to view the received ECG and make appropriate decisions, also to apply for consultation by sending the received ECG to the PDA of a cardiology expert. The system logs all performed operations. The hardware used in the system consists of personal computers (PCs), PDAs, analog-digital converters, ECG sensors and GPRS modems. Software consists of programs for patients, doctors on duty, cardiology experts and administration, along with a central database. The second system is intended to be used by professional doctors for management of collected images and for teleconsultations via videoconferencing in order to obtain a second opinion. The system provides an integrated environment eliminating the need to jump between many applications. By using the system, doctors are able to acquire images from analog and digital cameras, process and enhance them, as well as upload them to local or remote databases. Doctors are also able to design custom database forms. The teleconsultation part of the system supports video and audio over ISDN and TCP-IP, using both a hardware codec (Zydacron Z360) and a software codec (based on MS Netmeeting). Images are sent from one client to another using the standard protocol T.120. Images become synchronized immediately upon reception by another client.

Computers, Handheld↗
PubMed2004

Health0: a new health and lifestyle management paradigm.

The paper describes Health0: an innovative healthcare and lifestyle management wearable system that aims to bring an individual focused approach to healthcare. A modular architecture is proposed that combines a Linux-based PDA with a distributed wireless sensor-network and innovative bandage-sized (2.5 cm2) sensor hardware. Real-world scenarios that can use the Health0 system are discussed.

Biomedical Technology↗
PubMed2005

Challenges in presenting high dimensional data to aid in triage in the DARPA virtual soldier project.

One of the goals of the DARPA Virtual Soldier Project is to aid the field medic in the triage of a casualty. In Phase I, we are currently collecting 12 baseline experimental physiological variables and a cardiac gated Computed Tomography (CT) imagery for use in an prototyping a futuristic electronic medical record, the "Holomer". We are using physiological models and Kalman filtering to aid in diagnosis and predict outcomes in relation to cardiac injury. The physiological modeling introduces another few hundred variables. Reducing the complexity of the above into easy-to-read text to aid in the triage by the field medic is the challenge with multiple display solutions. A description of the possible techniques follows.

Computer Simulation↗
PubMed2004

The PDA and the oral maxillofacial surgeon.

The personal digital assistant (PDA) offers clinicians the ability to enter and manage clinical information at the point of care. The first part of this series examined the oral medicine and surgery resources available on the Internet. This article discusses the possibilities of PDA technology, in conjunction with the Internet, for oral maxillofacial surgeons to enhance their clinical practice.

Computers, Handheld↗
PubMed2004

A new model for home care for COPD.

A new model for home care of COPD patients is investigated, as a part of a coordinated provision model across levels of care. In the Spanish pilot of the e-Vital project, relevant vital signs for COPD are closely monitored and used for early detection of deterioration in the state of the patient and all prompt treatment. This can also reduce the need for in-person check-ups and re-admission to hospital. Later analysis aims to determine whether the system has significant economic impact, and whether it will provide more convenience for patients and healthcare professionals. The present trial focuses on the impact of community based nurses visiting each patient in the home as a part of this shared care. The visits are part of the regular follow-up for patients with chronic conditions who belong to any of the home care programs currently available in our institution. In each one of these visits, the nurse performs a number of tasks in order to assess patient status. Vital signs are collected and may be transmitted to the data monitor centre automatically using 2.5-3G technology. Sensors communicate through a Body Area Network (BAN) with a PDA configured to display the data and transfer it to the server using GPRS. Patients can be trained to use the equipment on their own. Results so far are encouraging. In the previous phase, a similar set-up without monitoring facilities at the patient's home showed improvements in several clinical indicators (ER visits, SGRQ, Quality of life, LOS and costs) for a home hospitalisation program and in a prevention of exacerbation program. The current set-up aims at increasing such benefits and further extending the target population.

Aged↗
PubMed2005

Technology. IT's inside you.

The technology czar at one of the nation's most cutting-edge hospitals and medical schools wants to get an implantable identification chip, but not for the reasons you may think.

Boston↗
PubMedDate not supplied

Using PDAs during the internal medicine clerkship.

In 2000, an Institute of Medicine Report stated that there are 99,000 deaths in hospitals each year due to medical errors. Many options have been tried to improve systems and practice patterns, but they have proven to be too cumbersome to be workable and were not accepted by physicians. We conducted a study of 19 third-year medical students (12 males, 7 females) at the West Virginia University School of Medicine, Charleston Division, during their eight-week clerkship in 2002 to determine whether providing them patient information at bedside with Personal Digital Assistants (PDAs) would be valuable. In addition, we also wanted to see if the students would accept the use of these devices and better capture data on patient procedures. The Palm M 500 model was used in the study and every unit was preloaded with Epocrates, Epocrates ID, 5 Minute Clinical Consult, Harrison's and Patient Keeper Version 2.3. The medical students were given 15 minutes of instruction in the use and care of the PDAs, and they were required to input any procedures they performed or observed for patients into Patient Keeper 2.3. A pre-clerkship survey and a post clerkship survey with a five-point rating scale revealed the students had a very wide acceptance of the PDAs for the input and access of medical information. As these devices become cheaper, more powerful, more feature-packed, and as software in the PDA format becomes even more medically oriented, these devices will become much more common in hospitals. PDAs offer a valuable means of reducing medical errors and further modernizing medical record keeping.

Adult↗
PubMed2005

Safe and effective drug therapy in older adults.

The last two decades have witnessed the introduction of major advances in drug therapy for many chronic diseases. Despite an increasing number of therapeutic choices, basic challenges remain when using new drugs in the elderly. It isessential: (1) to consider whether a new drug is truly safer, more effective or worth the extra expense compared to established medications, (2) to monitor patients for drug related toxicities, and (3) to avoid polypharmacy and the prescribing cascade.

Aged↗
PubMed2005

[Development of a portable ECG and blood pressure monitor based on personal digital assistant (PDA)].

OBJECTIVE: To develop a portable multifunctional electrocardiograph (ECG) and blood pressure monitor with its convenience to use. METHOD: It consisted of the electrocardiograph and blood pressure monitor module, microprocessor module and a personal digital assistant (PDA), to implement the functions of ECG/blood pressure signal automatic monitoring and remote data transferring to the hospital. RESULT: Under the control of the microprocessor, the monitor module can achieve the ECG signal, the blood pressure signal and transmit the data to the PDA. The program runs in PDA, integrating the capabilities of data waveform browsing and remote data transfering. CONCLUSION: The monitor meets the design requirements and has a good future for application.

Blood Pressure Monitoring, Ambulatory↗