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Vol. 38, No. 18

3-4-2009
By: Adam King

OSU med students get in ‘Touch’ with new ways to deliver patient care

Med Center is a tech leader

When Andrew Thomas was an intern at OSU in 1995, he hand-wrote discharge instructions for patients — and then gave them a carbon copy.

Since 2000, however, the associate dean of Graduate Medical Education and assistant professor of internal medicine hasn’t had to whip out his pen because of the Med Center’s ongoing push to go internally paperless.

Today discharge instructions are automatically faxed to patients’ family physicians with the stroke of a key.

Thomas also can fill out a prescription through a laptop he carries with him and can either print it off wirelessly for his patient or instantly send it to a local or mail-order pharmacy through a computer interface.

“When you think how bad physicians’ handwriting is, it’s great to have it all electronic,” Thomas said.

In 2001, the Medical Center won the Davies Award, which recognized OSU for having the best US medical electronic records system. Those systems are in the midst of receiving another upgrade that should be finished by 2011, Thomas said.

What changes? First is the paperless effort, which is a success internally at the Med Center’s hospitals and is currently being extended to its outpatient physician offices and clinics. Thomas’ practice at Kenny Road made the switch last June.

“There are no paper charts any longer, and that’s the biggest change,” he said.

X-ray requests and lab test orders are no longer hand-written, either. Instead they are electronically sent to the proper destination to await the patient’s arrival. Inpatient and outpatient care are moving to a single electronic chart for each patient.

In a booming area of the industry, OSU plans to add software that will give doctors analytical decision support at the point of care.

“As I’m entering an order, do I want to do this or that, the computer will help process your thoughts,” Thomas said. “Currently, the system will warn you if a patient is allergic to a medicine you are trying to prescribe or if the patient is already on another drug which has an interaction with the new drug you want to prescribe.

“It also has a workflow engine which allows what you’re doing to be pushed to other staff in your office or automatically to another physician that they see in the hospital system. It sounds straightforward, but it’s quite complex because of the size and complexity of our medical center.”

The software, which would tap into a patient’s electronic monitors and lab results and deliver that information to a doctor’s handheld device, is expected to help physicians make faster and better decisions in real time.

The Med Center also is working on creating a single computing grid so that information can be accessed anywhere in the system. No longer will information need to be asked for and forwarded.

Clay Marsh, a professor of internal medicine, says integrating the information will allow doctors to create a coordinated and cumulative experience from working with their patients. Combined with the secure warehousing of all patients’ data in the grid, more personalized health care will be possible as well as the ability to maximize best practices in disease treatment and prevention.

“We want to offer Ohio and the world the benefit of the power we’re discovering and put that into practice in a way that benefits people. Not only are we realizing some of the potential now, but this is the platform we will use to transform the practice of medicine from disease-focused to health- and wellness-focused.”

Third-year medical students Scott Bean (left) and Justin Harper compare medical programs on their Apple devices.

There’s a vast amount of information one is required to know in order to become a doctor.

But knowing it isn’t enough; retaining it is the key to being effective.

Not even 10 years ago, doctors carried with them their “peripheral brains” — notations made in a notebook or on note cards with how they handled a certain medical situation, how drugs interacted or key phone numbers they had to have handy.

Those days are so over at the Ohio State Medical Center — ended for good the day Palm personal data assistants first were distributed to students and interns in 2001.

People in the Med Center have never been shy about keeping up with trends.

Now a new pilot program that provided an Apple iPod Touch to every first- and third-year medical student and intern in 2008 continues to push the boundaries where technology and medicine intersect.

“This is about training people for the future,” said Andrew Thomas, associate dean of Graduate Medical Education. “When people used their ‘peripheral brain,’ as soon as they wrote it down, it risked being out of date. With the iPod, the software is constantly updated by the vendors.”

In the palm of their hands, the 850 students and 650 interns and fellows can now access, in a user-friendly platform, virtually anything they would need to help a patient or make a diagnosis.

“There’s medical decision-making software, special formula calculators that help with drug dosing and other physiology, and online textbooks,” Thomas said. “The drug database is one of the key things, which can help determine complications, side effects, cost and drug-to-drug interactions. For those that utilize it and like that technology, it’s very effective for them. I’ve gotten a lot of positive comments of how they think it’s a better interface than what we have had in the past.”

There is still a percentage of students and doctors who never open the box, however, because either they’re not inclined to use it or have no need for it because of the many rolling laptops and desktops available on patient care units. Also, there are some specialties that find this technology less useful than others due to the type of work they do.

“We think it’s a tool that more and more people are using, but they are not required to use it,” Thomas said.

Third-year medical student Justin Harper spearheaded the effort to begin using the iPod Touch. He said he prefers Apple’s platform because he can access his reference materials almost as quickly and easily as he would on a laptop.

“And you don’t have to lug a laptop around, either,” said Harper, who, like 50 percent of his classmates, actually uses an iPhone, which has the same functionality as a Touch just with a phone added. “It bridges the gap in knowledge. I’m early on in my training and have a lot to learn still, but I can access whatever references I need to fill in that gap. It’s enhanced patient care because I can give them the best information and most complete care that is possible.”

Harper has been receiving e-mails from other med centers and medical faculty and students from around the country inquiring about the pilot program.

“Ohio State already has a good reputation for being a wired and technologically advanced medical center, and this program just adds to that,” Harper said. “The amount of information out there, any physician is hard-pressed to remember all that exists, especially if it crosses different specialties or fields. Having something that helps with that all the time is really useful.”

Of course, Harper said, the “cool” factor doesn’t hurt either. He admittedly puts his favorite music, movie clips and podcasts on his iPhone in addition to lectures and reference materials.

“By doing that it actually encourages people to have it with them all the time,” Harper said. “Very few people actually carried the Palm with them. It was bulky and didn’t provide as much utility. The fact people want to carry the Touch or iPhone whether they’re using them for medical applications or not, the devices are in their pockets when they do realize they need them.”

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