State of the Art?
Russell Cucina, MD, MS, a hospitalist at the University of California-San Francisco Medical Center, San Francisco, is also the associate medical director for information technology at UCSF.
Dr. Cucina quips that a good example of a state-of-the-art, stand-alone patient data management system offering rapid data entry, long battery life, and high mobility is the paper index card, the longtime standard for making rounding notes.
“Plenty of doctors, including me, use it every day,” he says. But growing numbers of hospitalists also use PDAs, smartphones, and laptops to access information and support applications. Among the plethora of reference applications readily available to physicians by PDA or laptop are UpToDate, Epocrates, the Pocket Sanford Guide to Anti-Microbial Therapy, and Merck Medicus.
“I use many different resources as a hospitalist,” Dr. Cucina says. “I Google all the time.” Hospitalists still have opportunities to innovate, although increasingly their “home-grown” solutions will compete with multinational technology conglomerates entering the medical market.
The use of technology and equipment also varies depending on whether the hospitalist is employed by the hospital or part of an independent medical group.
Another factor is whether that hospital is academic, community-based, or part of a system like the Veterans Affairs or a staff-model HMO such as Kaiser Permanente. But all hospitalists are used to working on the run, Dr. Cucina says. And in their daily jobs, workflow is everything.
Tech in Use
“I use medical technology on the job to a moderate degree,” reports Latha Sivaprasad, MD, a hospitalist at Beth Israel Medical Center in New York City. “This is my sixth year working as a hospitalist, and for the first five years I didn’t use a specific device. Now I have a Palm-based program with MD Everywhere, Epocrates, UpToDate, and the ability to do billing. The hospital’s tech support staff trained us on the new system and how to use the PDA for tasks like developing rounding lists, accessing our colleagues’ lists and creating system-based memos.”
Dr. Sivaprasad also has GPS in her car, a cell phone, and a laptop at home. “We probably aren’t using medical technology as much as we could,” she says. “Many physicians still write prescriptions by hand. I’ve never used voice-recognition software. In a previous hospital, we used the hospital’s transcription service for dictated notes.”
Karim Godamunne, MD, MBA, a hospitalist with Eagle Hospital Physicians and a practice medical director at South Fulton Medical Center in Atlanta, uses a PDA at work for billing.
“I don’t use the PDA intensively,’’ he says. “I’d like to see our hospital create a wireless network like the one I have at home. Our sister hospital has wireless.” He notes, however, that there are computer workstations for him to use at his hospital.
Dr. Godamunne’s group has a practice coordinator who faxes discharge summaries to attending physicians.
“Fax is kind of what they expect these days,” he says. “I’m not sure e-mail would be as reliable for the community we serve. I’d be concerned that the attendings wouldn’t read their e-mails.” He says he sometimes gives written notes to patients at discharge with instructions to hand the note to their physician on their next office visit.
Michelle Pezzani, MD, is part of a 10-member hospital medicine group that practices at El Camino Hospital in Mountain View, Calif., in the heart of Silicon Valley. The hospital tries to stay on the cutting edge with technology, and its hospitalists were given Microsoft XP Tablet laptops a few years ago. “I access the Web two to four times a day at work,” Dr. Pezzani says. “It helps keep us current. The great thing about the laptop is I also take it home with me, and I can use it to check or reorder labs from home. We’re all connected to the hospital’s Intranet from home.”