22 AE Winter 2011

pharmacists, and medical recordsstaff, not to mention patients andtheir families, and they need to beavailable 24/7. More than anyoneelse, physicians need anytime/any-where access to information.

News flash 2: The information sys-tems deployed in most hospitals,

News flash 1: Physiciansare a mobile work force.This information surpris-es many practice admin-istrators. Physicians work

in a variety of environments andinteract with a number of otherhealthcare workers, including nurses,administrators, billing personnel,

Implementing Mobile Technologies in Your Practice

Running the Practice Information Technology

Frank McDonough

clinics, and physicians’ offices werenot designed to support physicianworkflow, but rather were built toautomate specific functions such asprocessing laboratory results, dis-pensing medications, or implement-ing billing.

As a result, physicians oftenmust access multiple systems in the

“ Mobile computing may just be the bestpatient care tool since the stethoscope.”

Gregory A. Ator, MD

AE Winter 2011 23

same hospital or clinic to get theinformation they need and caneasily spend 15 minutes each daysimply logging on. It is no wonderthat they are not rapidly adoptingIT.

Here are some points to con-sider regarding implementingmobile technology applications inyour practice and improvingpatient healthcare delivery.

Clinical WorkflowWhen implementing EMR technol-ogy, remember that mobile tech-nology enables systems to bedesigned from the physician’spoint of view as well as that of theoffice staff. Mobile technologyapplications can provide access toclinical information on all of aphysician’s patients and supportsmany of the key tasks in a physi-cian’s workflow. For example, injust minutes a physician can checka patient’s lab results, dictate anote, write a prescription, andenter charges for a patientencounter.

These applications improvepatient safety because they ensurethat a provider is making decisionsbased on the most recent results.They also include automatedchecks for drug–drug anddrug–allergy interactions and elim-inate repetitive error-prone admin-istrative tasks. Furthermore, theyallow physicians to spend a greaterportion of their day providingcare.

The key to improvements inthe physician’s clinical workflowextends beyond the point of care.With the right technology applica-tions, physicians can access up-to-the-minute information onpatients when they are in anotherfacility, in their offices, or even attheir kids’ soccer games. Whenphysicians receive a patient-relatedcall from a hospital or theiranswering service, they don’t have

to ask a nurse to read results froma chart, possibly missing criticalinformation. Instead, they accessall the information that is availablejust as if they were in the hospital,but via a mobile device.

Providing mobile technologyto physicians creates significantdownstream impacts on otherhealthcare workers, especially nurs-es. When physicians have mobileaccess to clinical results, theyspend less time asking nurses tohunt for charts, print specificresults, or read results over thephone. By automating physicians’workflow, a clinic can also improvestaff productivity and allow staff tospend more time providing directpatient care, without any changeto the administrative workflow.

Dictation WorkflowDocumenting an encounter viadictation is a process that hasexisted since the advent of thetape recorder. On the surface, itseems simple: See a patient, dictatea note, have someone transcribe it,and add the note to the patient’smedical record. With off-site and,in some cases, off-shore transcrip-tion, physicians are being asked toenter identifying information intothe transcription system, enteringas many as 40 numbers, includingpatient identifiers, before they candictate. When an incorrect medicalrecord number is entered, hospitalsmust match the transcribed notesto the correct patient. This con-sumes resources, causes delays ingetting notes into patients’ charts,and creates another point ofpotential error in the care deliveryprocess.

Using mobile dictation, physi-cians must no longer enter longstrings of numbers before dictat-ing. They can simply tap on apatient’s name, click “dictation,”and start talking. The system sendsall necessary patient identifiers

along with the voice file to be tran-scribed. Medical records staff nolonger have the problem of match-ing transcribed notes to correctpatient files.

Billing WorkflowMobile charge capture applicationseliminate billing inefficiencies byallowing physicians to entercharges for their services as theyare delivered. The charge informa-tion is validated at the time ofentry, so that it is guaranteed to be“clean” when passed to the billingstaff. In addition, studies haveshown that when physicians incor-porate the charge capture as part oftheir patient-encounter workflow,they capture more accurate andcomplete diagnoses. On paper, aphysician might scribble “glauco-ma,” but with an automated andmobile charge capture system, hecan easily choose a more specificcode and is more likely to add sec-ondary and tertiary diagnoses.

The biggest benefit to usingcapture technology is that whenthe physician enters the charge, itis uploaded directly to the clinicalbilling system, not stuffed in a labcoat or bag. Bills cannot be lost ordelayed. Simply processing billsmore quickly through electroniccharge capture can free up amonth or more of cash that is tiedup in lag days. The cycles requiredto recheck or obtain missing infor-mation from the physician areeliminated. Billing operations runmore smoothly, physicians savetime, billing clerks save time, andcash collections increase.

MedicationPrescription WorkflowPatient safety and cost savingsalone are compelling reasons toadopt e-prescribing, but its impacton improvements in physician,pharmacy, and hospital workflows

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24 AE Winter 2011

not be charged a large copayment.The need for faxing, phoning, andcallback cycles to physicians is virtu-ally eliminated, streamlining thepharmacy’s delivery of the mostappropriate medications to patients.

While e-prescribing is typicallythought of as beneficial in an outpa-tient setting, it can deliver a benefitin the clinical environment as well.Upon a patient’s admission, the e-prescribing application allowsproviders to access the patient’s med-ication history. This helps cliniciansavoid missed diagnoses, ensures thatpatients remain on their mainte-nance medications during the inpa-tient stay, and avoids potential drug

cannot be ignored. With mobiletechnology, physicians can write pre-scriptions on mobile devices and for-ward them directly to pharmacies. Aspart of this process, each prescriptionis checked for drug–drug anddrug–allergy interactions and formu-lary compliance. A big advantage ofthis process is that the e-prescribingapplication can provide the physi-cian with a complete list of all med-ications the patient uses.

Thus, patients can visit the phar-macy knowing that the medicationthey receive will not adversely inter-act with their other medications andthat the medication is on their insur-ance’s formulary so that they will

Running the Practice Information Technology

interactions. At discharge, the e-pre-scription application can quicklytake the list of inpatient medicationsand convert them to prescriptionsbased on the outpatient formularyand send them to a pharmacy.

Integration forWorkflow ContinuityNo matter how good a mobile appli-cation is, if it can’t access informa-tion in the existing systems of anorganization where a physician prac-tices, it won’t be useful. Most of theworkflow benefits described requireaccess to multiple information sys-tems. At a practical level, this alsorequires mobile applications them-selves to be integrated with eachother so they share a common pointof access into the existing informa-tion infrastructure.

This application integrationstreamlines the physician experience,allowing a physician to select apatient and then see results, writeprescriptions, dictate a note andenter a charge—without having toselect the patient again or log on toanother application.

Mobile computing promisestremendous benefits. Physicians savetime, patients save time, nurses savetime, medical errors are reduced, andthe administrative efficiency of thehealth delivery system is increased.As Gregory A. Ator, MD, a user ofmobile computing and the formerchief medical information officer atKansas University Hospital, said,“Mobile computing may just be thebest patient care tool since thestethoscope.” AE

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American Society American Society of Ophthalmic of Ophthalmic Administrators Administrators

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Frank E. McDonough (703-383-5717; fmcdonough@ascrs.org) is the informationsystems director forASCRS•ASOA. McDonoughhas 20 years of IT experience,the last 11 for scientific andmedical industry groups in theWashington, DC area.