Pen Computing Issue #5

June/July 1995
Special Feature: Pen Computers in Healthcare

Newton Medical Software

A rapidly growing number of healtcare applications are running on Apple Computer's Newton platform. The Newton, though originally conceived as a consumer electronics product, is a very attractive solution for a number of reasons:

· First, it is much smaller and lighter than conventional pen computers, weighing less than a pound, and handy enough to carry around all day. Most PC-based pen computers weigh between 2.5 and 7.0 pounds.

· Second, Newton MessagePads cost much less. Apple's newest Newton, the MessagePad 120 is just $699 including a fax modem and a software bundle.

· Third, there is a surprising variety of medical software available for the Newton, all the way from free programs you can download from commercial online services to sophisticated packages that let the Newton interact with powerful server systems.

· Fourth, a large variety of Newton communications options have come to market, ranging from fast PC Card data/fax modems, to wireless local area network adapters, wireless radio modems, infrared networks, and cellular phone adapters.

· Fifth, the Newton's batteries last for several days of typical use; there is no need to recharge the system during the day or change the batteries.

· And finally, with almost 200,000 Newtons already out there and a large and productive software developer community, the Newton is both an economical and a safe investment, particularly since Apple is targeting healthcare as one of its primary markets for the Newton platform.

Among the platform's caveats is that the Newton uses an ingenious but completely different operating system than desktop PCs and data exchange is not always trivial. The Newton's screen is somewhat small and it does not have a backlight. This can make it difficult to read in darker rooms. Even though handwriting recognition was originally supposed to make the Newton a true electronic pad, the reality is that handwriting recognition has not been perfected yet. It works for some people but not for others. This is no big issue because most new Newton programs offer picklists and do not require any handwriting. There may, for example, be lists of pharmaceuticals, physical findings, diagnoses or other commonly used information. You should know, though, that a new utility program called Graffiti from Palm Computing greatly improves the accuracy of character recognition through an easily learned slightly modified set of characters. Also, the Newton can store your writing as "digital ink" without trying to translate it into words.
There are several categories of Newton programs for physicians. They include maintaining a list of patients with associated information, creating prescriptions for printing or faxing, recording types of visits for charges, and accessing medical references. There are also very useful calculators for functions commonly used in patient care, such as computing medication doses or determining results from laboratory values.
As stated, some of these programs are just small utilities available free from online services or the Internet. Others are part of sophisticated medical systems where the Newton acts as a portable "client" to a central system. A significant number of software vendors are specializing on Newton software development and systems integration, among them such heavyweights as the "Big Six" accounting firm KPMG Peat Marwick.

Newton Healthcare Applications

· Caduceus
Primary care patient record and medical management system allowing thorough capture of all medically and legally relevant information of a patient encounter. Caduceus interfaces with Fractal Medical Solutions' Windows and Mac-based systems. Patient data is downloaded from an existing database, new data is recorded during the patient encounter using editable picklists. Afterwards, the main system is updated with this information. The system is tested at the Internal Medicine Care Suite at the UCLA Medical Center.-Fractal Medical Solutions, 330 Washington Blvd., Marina Del Rey CA 90292, 310-577-8338, fax 310-577-8339, Internet: granofm@apple.com

· GraviPAD
A data collection product primarily for obstetrician or OB nurses complementary to ReQuest Technology's prototypical CoLab multimedia patient record system and other POCitWare (point-of-care information technology) tools, but able to interface with almost any existing database system. Patient information is accessed from a circle of 11 icons that bring up categories such as well woman, transfers, newborn, referrals, postpartum, labs/scans, and risk assessment. CoLab is being tested at Bassett Healthcare in Cooperstown, NY.-ReQuest Technologies, Inc., RD#2, Box 395, West Winfield, NY 13491, 315-855-4490, Internet: requestinc@aol.com

· Hippocrates
Hippocrates from HealthCare Communications (the makers of FilePad), is an "electronic medical assistant" comparable in features with PocketDoc. It has nice features like an anatomical image library that can be annotated to record a patient's condition. Hippocrates can manage daily schedules, write prescriptions using forms, track encounters. Billing information can be uploaded into a compatible practice management system (such as HCC's MediMac). Especially useful to collect data which is then uploaded to keep patient records current. Used by Dr. Alec Goldenberg at New York University Hospital-Healthcare Communications, Lincoln, NE, 402-489-0391, Fax: 402-489-6411

· HYPER-Chart
HYPER-Chart: Physician's Electronic Patient Chart gives doctors and nurses on their rounds access to a summarized patient chart. The program has a graphical view of up to four patient parameters at the same time. For example, selection of systolic BP from the parameter list would show 10 data points reflecting hourly BP measurements. Tapping on a data point brings up information and notes about that particular point. Though the application can operate "stand-alone", the program is meant to be run with a host system from which patient information and lab results are downloaded into the Newton every morning. The package will also have facilities for prescription orders and have on-line references for physician use.-Mformation Systems Co.

· InfoMed-AQT
Effort by large Canadian health care software company InfoMed Development Corporation to branch into the use of PDAs for data collection. Pilot was conducted at Sunnybrook Health Science Centre in Toronto. INFOMED-AQT will handle order entry, patient encounter recording, workload measurement, and patient scheduling.-InfoMed Development Corporation, 1771 Comox Ave #202, Comox, BC Canada V9M 3l9, 604-339-4457, fax 604 339-7119, Internet: infomed@mindlink.bc.ca

· MD3
MD3 provides a simple database to assist residents in keeping track of short patient lists. It stores basic patient information, such as demographics, physicians, history of present illness, problem list, and medications. Patient visits are recorded and can be linked to to-do lists, tests to be performed, etc. Once in the database, all this information can be quickly examined, or printed in a sign-out sheet format. A global to-do list can also be assembled from individual patients' to-do lists, prioritized, and then copied to the notepad, where it can be printed or beamed to others.-Cornell University Medical Center

· Med-Notes
Med-Notes, the successor to John Burch's Med-Access, is a patient data collection system. Patient notes are developed in the SOAP format: Subjective, objective, assessment, and plan selections can be accessed, as well as labs and medications. Subjective, for example, allows entries for CC, HPI, PMH, medications, allergies, family history, social history, and review of systems. Section headings are added for HPI, PMH, etc., and selections are made from word lists to assemble the note. Med-Notes has a built-in selection of over 130 word lists that can be linked to 16 specific complaints, and which the user can edit and enhance.-Education Research Laboratories, Inc., 226 Bailey Ave., Suite 102, Fort Worth TX; 800-575-3754 or 817-336-5751. Internet: erli@pic.net

· Patient Care Network
Forest Software's Point-of-Care Network is a family of customizable modules which seamlessly integrate with existing patient accounting and management systems. A pilot of the system was designed for one of the country's largest HMOs, Group Health Cooperative in Washington State. Modules include diagnosis and billing, prescriptions, lab ordering and results notification, digital ink communication, referrals, clinical documentation, office management, and online reference. A fully implemented system takes advantage of wireless communication.-Forest Software, POB 12353, Aspen, CO 81612, 303-923-3572, fax 303-923-6596, Internet: forest@applelink.apple.com

· Physician Assistant
Developed by a small Vermont software company, Physician Assistant creates complete medical records while a patient is being interviewed and examined. The program can be used to track QA and UR data, produce prescriptions, referrals, instructions, and first reports. -Green Mountain Software Corp., POB 700, Colchester, VT 05446, (802) 865-2728, fax 802 658-5867, Internet: ann@ greenmtnsw.com

· Pocket Doc
Pocket Doc is a sophisticated, comprehensive encounter-based patient record system, patterned after the typical physician workflow, and designed to maintain clinical and reference information on the Newton. The program also has extensive drug reference information (800 medications), 1,300 ICD-9 reimbursement code listings (additional ICD-9 chapters are available, and CPT codes will be available soon for $20 per chapter.), and an interface that generates patient notes from a series of medical phrase menu selections in clinical templates. The program has built-in support for digital reference books, and has a custom medical dictionary to enhance recognition of medical terms. Registered users can add care plans and clinical templates by making their own or downloading them from Physix Inc.'s WWW site on the Internet. In wireless configurations, Pocket Doc can retrieve drug references and fax prescriptions to pharmacies. Pocket Doc also excels with very clever design and a number of true enhancements to the Newton's basic functionality. Physix also offers the Pocket Doc Integration Server which allows interchanging patient information from multiple Newton users to other open healthcare systems. The Pocket Doc Stand-Alone System costs $499.95.-Physix, Inc. 1720 Dryden, Suite 205, Houston TX 77030; 713-797-1199, World Wide Web, Internet: tg@physix.com

· SOAP Notes
SOAP. (subjective objective assessment and plan) Notes is a Newton interface for entering data into SOAP. Notes for Windows. It is used to rapidly form patient notes in an office setting with the help of a some 490 phrases, which can be selected and combined, as opposed to scanning in the phrases with a bar code reader in the Windows version. - SOAP Notes, Inc., Lincoln, NE, 402-434-2900; E-mail: hamilton@soapnotes.com, or eWorld

· The Consultant
The Consultant is designed for practicing anesthesiologists. It has over 400 screens of clinical information in 24 subject categories pertaining to clinical situations, intraoperative events, and complications. - The Consultant, POB 577, Shasta, CA 96087, 916 244-4323, fax 916-244-9691, Internet: 74003.2301@ compuserve.com

·Constellation Project
The Constellation Project is a pilot study at Brigham and Women's Hospital and Massachusetts General Hospital examining the utility of the Newton in active clinical use. The application consists of online reference texts including the American College of Physicians (ACP) Medical Knowledge Self-Assessment Program, the ACP Journal Club, the Electronic Monthly Prescribing Guide, an ICU/CCU Drug Reference Book, and the Brigham and Women's Medical Resident Handbook. The package also features a medical calculator useful in doing creatinine clearance calculations and other functional determinations from standard clinical measurements.

· Current Clinical Strategies
The Current Clinical Strategies series of reference texts, derived from Paul Chan's medical reference series and released by Education Research Laboratories, Inc. (ERLI), so far consists of seven titles in two series. The Medicine series ($99.95) contains Medicine, Outpatient Medicine, Critical Care Medicine, Diagnostic History and Physical Exam; the Specialty series ($79.95) covers Gynecology, Obstetrics, Pediatrics, and Surgery. The texts contain charts, references, and an ACLS protocol by which users can quickly move though a clinical situation to show appropriate treatments. The information is presented in a form that is particularly useful for house officers with some of the recommendations presented as admission orders. - Education Research Laboratories, Inc., 226 Bailey Ave., Suite 102, Fort Worth TX; 800-575-3754 or 817-336-5751. Internet: erli@pic.net

· Drug Finder
A "quick and dirty" medical reference tool for easy access to drug information by trade or generic name. Geared towards med students and interns. The database is easily customizable. Selection from a scrollable list of drugs brings up fields entitled Pharmacology, Dispense, and Notes that contain information for that specific drug. Drug Finder comes with an arbitrary list of drugs to show functionality. Other databases are available (General Medicine, Ophthalmology, Psychiatry, Over-the-Counter).-Ted Wei, Jr., MD. Available on WWW and eWorld.

· Patient's Guide to Cancer
The Guide to Cancer is a Newton book providing information on 77 types of cancer. Descriptions are in lay terms and cover stage explanations, treatment option overviews, standard and experimental treatments, and pointers to additional information. The Guide is updated monthly. Iverson also has Newton books on brain functions and chemical hazards-Iverson Software Co., POB 3, Rice lake, WI 54868, 715-236-7918, fax 715 234-6304, Internet: iversons@aol.com

· Rx on Tap
Rx on Tap is a prescription writer designed to cut down on those phone calls from pharmacists trying to decipher prescriptions. You pick commonly used prescriptions from an alphabetically indexed list. When a drug is selected the usual Rx format appears. If necessary it can be edited before printing or faxing. There is a dose calculator and space to enter more information about the drug. No longer will you have to scribble out instructions for tapering a medication over the course of weeks. This shareware ceases function after 30 days unless the user registers with Medical Microsystems and pays $50. Wireless printing to an infrared printer will soon be available for about $100.-Vernon W. Huang. WWW: http://med-amsa.bu.edu/newton.medical/newton.medical.html and commercial on-line services

· The Electronic Onion
The Electronic Onion ($69.95) is the electronic version of the Little Black Book of Primary Care Pearls and References spiral manual by Dr. Daniel K. Onion. This is an excellent quick reference for primary care information but conclusions drawn reflect Onion's own experience and interpretations of the literature. - W.W. Norton and Co., 500 Fifth Ave., New York, N.Y. 10110; 800-223-4830

· MediCalc
Medicalc calculates values pertinent to patient care using recognized algorithms. It can save you time in the hospital and contains screens for calculating anion gap and osmolality, body surface area, absolute neutrophil count, and a handy calculator for doses of pediatric, emergency and intravenous medications. The medication lists­p;which can be edited and augmented­p;contain brief information about each drug. Version 2.0 with the ability to add more formulas and clinical pearls is soon to be released.-Vernon W. Huang. WWW: http://med-amsa.bu. edu/newton.medical/newton.medical.html and commercial on-line services

· ScutMaster
ScutMaster is an attempt at implementing a calculator for performing common, tedious medical calculations such as the FENA and Renal Failure Index, estimated creatinine clearance, the A-a gradient, expected acid-base compensations, and the corrected QT interval. ScutMaster also shows the assumptions and formulas used in the calculations.-Cornell University Medical Center. On WWW and eWorld.