Remote Access to Clinical Data Using Personal Digital Assistants PDAs

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Remote Access to Clinical Data Using Personal
Digital Assistants (PDAs)
APIII 2001 Breakout B2 October 5, 2001 945
AM

• Dennis Cheng, President
• Cerebros Medical Systems, LLC
• Kuo Cheng, CEO, Clinical Laboratories, Inc.

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Contact Information
This presentation can be downloaded
from http//www.clinical.com/Apiii Dennis
Cheng, President Cerebros Medical Systems,
LLC 781 Keystone Industrial Park Dunmore, PA
18512 570-340-0236 dcheng_at_cerebros.com Kuo
Cheng, CEO Clinical Laboratories, Inc. 901
Keystone Industrial Park Throop, PA
18512 570-346-1759 kcheng_at_clinical.com
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Background

• Clinical Laboratories, Inc. (CLI)
• Independent Clinical Lab in NE Pennsylvania
• AP, CP, Reference Testing, Toxicology,
  Veterinary, Dairy, Foods
• 1.3 M Test volume (80 outpatient)
• 200 Employees
• Large geographic service area -
• Courier Coverage - 10 counties, 700,000
  Miles/year
• Affiliated 9-Pathologist Practice

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Background

• Cerebros Medical Systems, LLC
• Independent spin-off of the RD wing of a
  regional reference lab in NE Penn. (CLI)
• Provides consulting and application development
  to LIS vendors, and IVD manufacturers
• Provides consulting and applications to
  laboratories
• IT Product Development
• COPAS (web-based lab reporting)
• tube.tracker? (ASP specimen tracking and
  management system)
• http//www.tubetracker.com

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Development Chronology

• December 1997 began web-based programming
• July 1998 web-based reporting fully deployed
• January 2000 Palmtop results download available
  to physicians via AvantGo.com site
• July 2000 Palmtop results download available via
  HealthSync application

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Production Databases (LIS)

• Clinical Pathology
• SMS OpenLab v.25 (Sybase System XI)
• Anatomic Pathology
• Tamtron Power Path 2000 (MS SQL)
• Cytology
• Tamtron Power Path 2000 (MS SQL)
• Toxicology
• Gemini Laboratory System

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PDA Result Reporting

• Communication Methods
• PDA docking device (used by all users)
• Wireless (capable but not used)
• Communication Routes
• AvantGo.com
• In-house HealthSync server

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PDA Result Reporting (cont.)

• Clinical and anatomic pathology results
• Real-time result access and download
• Physician specific
• Physicians receive only results of patients under
  their care as
• ordering, consulting, copy to physician
• All patients within a defined time period
• Default to 1 week but individually customizable
  based on physicians workload

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Current PDA Solutions

• Web clipping from existing web-enabled
  application
• AvantGo.com channel
• Rapid development cycle
• Inexpensive
• Limited flexibility
• Native Palm applications
• HealthSync
• Greater flexibility and control
• Allows real-time transactions via wireless

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Distribution of Reporting Methods - Daily Average

• Total clients 600 daily
• Hard Copy Delivered 500 83
• Faxed 200 33
• Client Service - daily (phone) 150 25
• Internet Users 250 42
• PDA Users 22 4

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Why use PDAs

• Emerging Technology and Trend
• Mobile
• Gaining Popularity
• More Applications Being Developed
• Improved Memory Capacity

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Who Uses PDA

• Physicians already have PDAs
• All prefer using standard HotSync procedure for
  downloading
• Uses PDA in the office during patient visit

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Users Profile

• Browser-based Query
• Mainly used by physicians support staff (90 of
  all queries)
• Less than 10 of queries were initiated by
  physicians
• PDA Result Download
• Used by physicians exclusively

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Benefit to Physicians

• Time Savings
• In a busy office setting, patients are seen at
  short time intervals. PDAs are used to look up
  result during patient encounter
• When the results were available, it eliminated a
  sequence of events including looking for results,
  and then returning to patient care

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Benefit to Physicians (cont.)

• Physician users generally benefited from this
  several times a day which they feel as a
  tremendous savings to their personal time
• The feedback indicated savings of anywhere from
  30 minutes to an hour of patient face time each
  day

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Business Impact

• Maintain competitive advantage in the market
  place with Internet-based applications
• Clients want to hear about our Internet
  capability whether they intend to use it or not
• Those clients who began to use Internet for
  result query - cant live without it

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Business Impact (cont.)

• Selling Points to Physicians
• time saved is at the physician level which is the
  most valuable savings in the practice

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Business Impact (cont.)

• Economic Savings (from Web-based applications) at
  CLI
• Over 100,000 results queried through Internet per
  year translates to 4 FTEs of Client Service time
• Equal amount of time saved at the users offices
• CLI virtually eliminated remote printing and 75
  per client per month cost

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Issues and Stumbling Blocks

• Costs
• Performance
• Accessibility of Dynamic Data
• Security

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Costs

• Total cost of ownership is still high
• Hardware and software
• Supports
• Communication
• It is a supplemental application and does not
  replace the existing applications - an added cost

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Performance

• 8 MB is not enough
• Lab results account for 100K per patient which is
  small
• Many popular physician applications are pigs in
  terms of memory consumption
• Heavy burden on the server and network to
  download large database to PDA with encryption
• HotSync process is computationally intensive

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Accessibility of Dynamic Data

• The need to access dynamic and real-time data is
  obvious
• The barriers are still here
• Cost of ownership
• 300 modem
• Lack of mobile services
• 45 per month access fee
• too many dead zones
• Modems and services will become commodity in the
  future and be priced as such

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Security

• Palmtop is the weakest link in corporate security
• State Department prohibits certain officials
  using Palmtop at work
• Native Palm OS is inherently vulnerable to
  numerous exploitations
• Existing solutions
• locked palm - Movian
• locked conduits - VPN, Certicom

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Conclusions

• PDA application is a supplemental solution
• PDA applications are personal and have direct
  impact on physician users