When I initially set up my office, I installed a wireless network so that I could access my EMR and patient information using a wireless laptop. I found this solution to be difficult to sustain because of a number of factors - limited battery life of the laptop, difficulty in carrying the laptop around the office, needing somewhere to perch the laptop during the clinical exam and the slower access speed provided by an 802.11b network. To some degree the access speed has been dealt with in the move to 802.11g, however the former three problems have not been addressed. I next tried a Tablet PC - Slate verion - Motion Computing M1300. Many of the same problems as the laptop. It has a faster processor, but still suffers from the speed issues, the need to dock it somewhere during the clinical exam, a screen that was more reflective than I was used to, limited battery life and limited capability in terms of entering data with a pen despite the improvements in the latest version of Windows Tablet PC edition.
In the physician office, I believe the key is to have access to computers where needed. Every exam room should have a PC and every point that patient care is provided including the physician desk. Once the capability to access information becomes universal throughout the workflow setting the need to be wireless becomes less important. I would never want to use a wireless PDA as my primary access device for an EMR. It is too small, the screen is difficult to read at times and it does not display very much information. It is also unlikely that I would carry around a wireless latop or tablet PC throughout the day. I have never seen a clinician do this.
So the weapon of choice for the mobile clinician is likely the PDA. I would like a PDA to increase my efficiency and provide clinical functionality. On the efficiency side, it must help me manage my schedule dynamically - I would like to see my patient bookings for the next 4 weeks, my call schedule information and the specialists who are on call with their contact information. In addition, I would like to see general reference material such as clinical references and a drug database. I would also like to have access to a core set of patient information. Ideally, every time I synchronize the device, I would like to have a limited data set of my entire patient profile updated on the PDA in encrypted format so that I can answer clinical questions or create encounter notes when I am not in the my office. Where I see wireless functionality is in the ability to transmit prescriptions to the pharmacy directly from a PDA or to check lab results for patients in the community setting or in the hospital.
Until a year ago, I owned a BlackBerry wireless device. Despite the potential advantages of wireless e-mail, I found the messaging to be intrusive to my personal life. Not only was I always contactable, but there was an inherent expectation that I should respond quickly (because I could). I cancelled the BlackBerry and have not missed the wireless e-mail. Techology is pervasive in so much of our lives that as much as I believe in the advantages, I think we also need to retain some technology free zones and if we do allow wireless technology into those zones, we must carefully decide how we will use the technology to pull and push information.
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