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Physicians Cut Loose

Your family doc bustles into the examination room and without saying a word, pulls out a Palm Pilot, taps the screen and pauses to read something on it. The last time you were at this clinic, the guy was carrying around dog-eared manila folders on a clipboard.

He looks up. "So," he says, "you've had a sore throat for a few days?" Yes you have, but it was only a few minutes ago that you apprised the nurse receptionist of this fact. How the devil does he know it already?

Dr. Hightech goes on to ask you more questions and appears to be making notes on the PDA screen. After the popsicle stick on the tongue, the aaaahhhing and the rest of it, you go back out to the nurse receptionist and she smiles and hands you a prescription, neatly printed. She also hands you an itemized bill -- a very complete, detailed bill.

What's up, doc? Welcome to the medical clinic of the -- well, of the present. The medical profession, which has long been on the high-tech leading edge when it came to diagnostics and surgery, is finally beginning to automate day-to-day patient care in clinics.

MDeverywhere of Durham, NC, is one of the companies helping make it happen. Its Web-based suite of MDeverywhere software services helps hospitals and medical clinics manage patient care by having physicians use PDAs for scheduling, ordering, prescribing, note taking -- even dictation and medical reference. The company has about 1,300 physicians in 20 institutions using the services.

Until recently, MDeverywhere docs had to plug their PDAs into a cradle attached to a networked PC to synch with the clinic's back-end practice management system. Now, at least a few of them can update continuously in real time over a Wi-Fi WLAN. They don't even need a PC anymore, or a wired network for that matter.

"We absolutely believe that the world is moving towards wireless," says MDeverywhere vice president of marketing Dan Pollard. "There are policy considerations and infrastructure costs for these organizations, so moving to wireless is something that may take time for some. But when they're ready to start leveraging wireless, we'll be ready too."

The company is in the process of implementing its first pilot Wi-Fi-based wireless installations at some existing customer sites. The main target market will be clinics and hospitals that already have WLANs installed. MDeverywhere won't get involved in implementing WLANs. It is also lab-testing Bluetooth for smaller clinics.

The pre-wireless MDeverywhere service has been in use since 2000. The company sells it as an ASP service, but also has a turnkey onsite server-based offering.

"Most customers have chosen the ASP deployment model," Pollard says. "From their point of view it's much more effective in terms of maintenance and cost of deployment. We're the ones managing the databases and backups and the server hardware. It makes for a very robust service."

The MDeverywhere software sits between the clinic's or hospital's existing practice management system and the physicians' PDAs, mediating and managing the communication between them over secure Internet connections. MDeverywhere can integrate with virtually any practice management system using standardized integration tools or custom integration.

Scheduling information and the patient records associated with a clinician's schedule or hospital rounds move from practice management system to PDA. When a physician starts rounds, they'll only have to look at the PDA screen to know who they'll be seeing.

Doctors use forms-based client applications on the PDAs to record everything during the interaction with the patient, to take notes and place orders for prescriptions, tests and diagnostics. That information passes from the PDA to practice management system during synching sessions.

"Users can run synchronizations as frequently as they need," Pollard explains. "Some run a couple of times a day, others every five minutes."

MDeverywhere has claimed returns on investment of as much as 300 percent per year. When it's easy and convenient for docs to record all the charges against a patient's record, and they're continually prompted to do so, they actually do it. Result: clinics capture more charges and therefore more revenue from patients and insurance companies.

Because the physician is recording charges with an easy-to-use forms-based application, there is no need for support staff to transcribe often messy -- and incomplete -- notes. This saves support staff time and it also ensures higher accuracy, which results in fewer denials of charges by insurance companies.

"It works just fine without wireless," Pollard notes. "But it's easier in some important ways with wireless."

For starters, wireless will make it easier to deploy and easier for doctors to use. Institutions won't have to disrupt clinical areas to deploy wired networks. They also won't have to try and shoe-horn PCs into cramped clinical spaces. With wireless, PCs are bypassed and the PDAs synch directly with MDeverywhere servers -- without physicians having to do anything

"It's also a benefit in certain work flows -- in walk-in clinics, for example, where if a patient comes into the clinic [without an appointment], they won't be on the physician's handheld. This allows us to get that patient on to the device immediately."

Wireless will definitely improve MDeverywhere's business case when approaching some new customers, Pollard says. "At a high level, a number of organizations already view wireless as a key strategic initiative," he points out. "Our being able to use their wireless infrastructure allows us to fit in better."

For new customers that have mature and widespread WLAN implementations, there will be "significant cost savings" because they won't have to buy, configure and install PCs and wired networking infrastructure.

For those customers, and they're mostly larger organizations, Wi-Fi is clearly the technology of choice, but for smaller clinics, Bluetooth may be a more cost-effective wireless solution, Pollard says. For one thing, Bluetooth is a more readily available wireless option in lower-end PDAs such as some of the Palm products.

While more and more cost-effect wireless options are coming -- including tiny Secure Digital (SD) Wi-Fi cards that fit in the latest generation of PDAs -- client hardware is one of the hold-backs for this technology. Some existing customers, for example, have already invested in PDAs that cannot add Wi-Fi or Bluetooth connectivity at all.

For these and other reasons, MDeverywhere expects it will take a few years for wireless to become the rule rather than the exception, even among its existing customer base. Today, a quarter or perhaps a third of those existing customers are seriously considering wireless, Pollard says. For the rest, it will take more time.

Of course, with only 20 client organizations up and running, MDeverywhere's market universe for wired or wireless service remains enormous.