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Tackle Technology

Dennis Deruelle, MD, a hospitalist at University Community Hospital in Tampa, Fla., once needed reliable medical information in a hurry while treating a young woman admitted to the hospital with cellulitis.

The woman was later diagnosed with methicillin-resistant staphylococcus aureus (MRSA). After Dr. Deruelle administered prochlorperazine (Compa­zine), she had a severe dystonic reaction.

“She was going rigid right before my eyes,” Dr. Deruelle says. There was no instantly accessible hospital clearinghouse of medical information, although he had called the pharmacy department and was waiting for a call back. So he opened his laptop and turned to an aid available to anyone with a computer and Internet access: Google. “I immediately looked up information on reactions to Compazine and the correct dose for counteracting it. I administered the dose, and within minutes [the patient] was getting better.”

How Hospitalists Use Technology

Hospitalists have plenty of ways to use communications technology, such as PDAs or laptops, to make their daily practices more efficient.

  • Communicating with attending physicians, both formal admission/discharge summaries and briefer discharge notes or daily progress notes with immediately relevant information, entered on personal computing devices and delivered to the physician’s office fax machine the same day;
  • Communicating within the hospitalist practice regarding practice business and scheduling but also for daily sign-outs and hand-offs to evening or on-call shifts;
  • Handling routine daily business, including personal organizers, schedules, to-do lists, rounding notes, current patient rosters, and other “personal clipboard” data such as lab results for active patients;
  • Managing billing functions, including billing codes, charge captures, and audits for completeness and accuracy;
  • Using reference applications, including a variety of electronic medical textbooks, pharmacopoeias, and other informational databases and Web resources that can be accessed on a PDA or over the Internet;
  • Using decision support alerts;
  • Interfacing with the hospital’s electronic health record, computerized physician order entry, and other information systems. As quality and outcomes measurement requirements grow, PDAs and laptops will be used for reporting the data;
  • Using calculator functions, including important medical value calculations supported by software applications; and
  • Text messaging, a quick way to get a simple question into the hands of a colleague when a prompt reply is needed.—LB

Dr. Deruelle is not alone among physicians in answering medical questions with Google. (See The Hospitalist, July 2007, p. 33.)

He has been interested in medical applications of computer technology for years and serves on SHM’s advisory committee on technology. He receives tech support from his employer, IPC-The Hospitalist Company, based in North Hollywood, Calif. IPC offers its physicians a Web-accessible network called IPC Link—a “virtual office” to help with billing, medical decision support, reference software, continuing medical education, and even blogs written by company CEO Adam Singer, MD.

But Dr. Deruelle has also developed his own applications, including an off-the-shelf voice recognition software loaded onto his company-supplied, 2.5-lb. Tablet PC. He uses it to dictate brief notes to give attending physicians a heads-up about patients being discharged. These notes are uploaded to the company’s network, which automatically generates a fax to the attending within minutes.

The formal discharge summary, produced by the hospital’s medical transcription department, may take 48 hours to arrive.

Dr. Deruelle has wireless Internet access at four of the five hospitals he visits as a hospitalist practice leader.

“As soon as I walk in the door I’m ‘hot,’ ” he says. At the fifth hospital, he uses workstation computers to connect with IPC Link.

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