But the physicians don't get this information from their Palm Pilots alone. Instead, the small, hand-held device contains a wireless modem that taps into Cedars-Sinai's secure web server, accessing customized software that is continuously updated to give them the latest information on everything from a patient's blood pressure to a full medical consultation.
"Using the Palm Pilot to access this information is really the icing on the cake," says Michael Shabot, M.D., Director of Surgical Intensive Care at Cedars-Sinai Medical Center and Medical Director of Enterprise Information Services. "The hard part was setting up and implementing a system that gave our physicians and caregivers an efficient way to get patient information."
The system now in place at Cedars-Sinai, began in 1998 with the development of Web/VS (stands for Web Viewing System) by Ray Duncan, M.D., Director of Architecture and Technology in Information Systems at Cedars-Sinai. Web/VS is a software program that enables physicians and caregivers to access patient data from a personal computer at home or in the office via the medical center's secure web server. The system is now widely used by hospital caregivers and eliminates the inconvenience of waiting for paper reports that might be delayed or in use by other physicians.
"Web/VS eliminates thousands of pages of cumulative laboratory reports and essentially moves us one step closer to a paperless medical record," said Paul B. Hackmeyer, M.D., Chief of Staff at Cedars-Sinai Medical Center.
Not long after Web/VS was launched, Cedars-Sinai introduced Palm/VS. The system was designed for Palm Pilots and capitalized on improvements in wireless technology that made it possible to access the World Wide Web by adapting Web content for smaller screen sizes and the limited input capabilities of these hand-held devices.
"To date, there are nearly a thousand physicians at Cedars-Sinai who regularly access Web/VS to retrieve patient information, and an increasing percentage use their Palm Pilots too," said Dr. Shabot.
The information available in either Web or Palm/VS includes consultations, surgical results and emergency room reports as well as hourly information on heart rate, blood pressure, ventilator settings and blood gases for ICU patients. Other information includes an Operating Room schedule and Census Report, which allows physicians to view the Medical Center's patient census information.
To ensure patient confidentiality, Cedars-Sinai physicians must obtain a digital certificate, which is provided by Cedars-Sinai's secure web server and contains encrypted information about the physician and his or her account. Once physicians have logged in, the server tracks all entries or attempted entries into Palm or Web/VS and provides daily audit reports for entries into "sensitive" patient accounts or test results.
Once the physician's credentials have been verified, Palm/VS automatically displays the user's "Patient List" in a menu. The user can then pick a patient and jump directly to the results screen, or can search for patient by name, medical record number, or nursing unit. After selecting a patient, all clinical lab results for the last three days are automatically displayed, with abnormal results indicated by an asterisk. If preferred, the user can use a pop-up calendar control to select results for a different day or can request any number of flow sheets that trend selected lab results over time. Users can also view lists that include reports, summaries of emergency department visits and vital signs. A searchable staff directory allows the user to quickly send e-mail to any attending physician or caregiver.
Because the design of Palm/VS is limited by the bandwidth of the wireless networking connection and the small screen size of the Palm Pilot, physicians cannot access the same amount of data available to them on Web/VS.
"Although there are limits to accessing patient information on the Palm Pilot, wireless access to the web gives us one more tool to provide the best in patient care," said Dr. Shabot.
Cedars-Sinai Medical Center is one of the largest non-profit academic medical centers in the Western United States. For the fifth straight two-year period, Cedars-Sinai has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthrough biomedical research and superlative medical education. The Medical Center ranks among the top seven non-university hospitals in the nation for its research activities.
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