A Windows CE
Physician's Toolbox

Our Medical Editor spotlights 15 medical applications that save a doctor's time and simplify patient care.

by Ed Zabrek, M.D.

I'm a husband, a father, a writer, and last but not least, a physician. Needless to say my time is booked solid ­ in fact it's overbooked. Because of the importance of my first two roles, I am always looking for ways to be more efficient as a writer and a physician. This desire to be more efficient and devote more time to my family is one of the reasons I became interested in portable computers, most recently Windows CE PC Companions.

As a physician, I seek out Windows CE programs that will enhance my ability to manage my patient load and assist me in being a better doctor. Over the past 5 years I have tested and used a number of medical software applications on handhelds. Dramatic improvements are rapidly evolving in this field.

The rest of this article is a summary of my experiences with some of the currently available medical software for Windows CE PC Companions (Handheld PCs, H/PC Pros, and Palm-size PCs). I'll take a look at a medical and drug reference program, and an insurance coding application, and a complete electronic medical record (EMR) product. Although developed by different companies, these programs work well together and provide healthcare professionals with a very powerful medical tool.

e/MD~ -- The Portable Coding Solution (H/PC only)

The U.S. government requires physicians to include standard "E&M" (Evaluation and Management) codes for procedures when billing patients and insurance companies. These are designed to provide consistency to documentation and billing procedures. They also add a lot of time to the administrative process. e/MD~ (www.emd2.com) is a Windows CE application developed by Rensimer Enterprises, Ltd. e/MD~ walks a physician through a series of screens where the physician enters the basic details about a procedure (Screens 1 & 2). Then it "intelligently builds" the billing code on the spot.

Screen 1: e/MD~ walks a physician through a series of screens where the physician enters the basic details about a procedure.

Screen 2: After a physician has entered the details about a procedure e/MD~ "intelligently builds" the billing code on the spot.

I have used this program over the past 5 years, and I have not found any program currently available (for any operating system) that does what e/MD~ will do. It helps me provide more accurate billing records and claims to insurance companies, while ensuring more complete and accurate patient medical charts or records which conform to service charges. The application is flexible, allowing me to quickly search for just the right diagnosis, make changes or corrections on the fly, and to add written comments for future reference.

The records generated can be transferred easily. The "patient rounds" screen allows the physician to view a snapshot of his service and complete charges. Once the data has been entered a charge code is calculated and displayed at the top of the screen. Diagnoses can be searched using the ICD-9CM search engine.

I use e/MD~ on a daily basis (see my complete review on the Jan/Feb 99 issue of Handheld PC Magazine). e/MD~ uses 5-6 MB of internal memory. In fact, most of the medical applications I use are memory intensive and you can quickly use up a big chunk of your onboard RAM with a single medical program. To help with this I have expanded the internal memory of my HP Jornada 680 Handheld PC Pro from 16 to 32 MB with an upgrade kit available from HP (www.hp.com/jornada/accessories/680/ram_upgrade.html). The problem with e/MD~ and some other data-intensive programs is that you have to store the program in RAM. e/MD~ is currently working on a fix that will let you load the program onto a PC or CompactFlash card.

e/MD~ runs on H/PCs or H/PC Pros with 16 MB RAM and a screen size of 640x240. The operating system must be Windows CE 2.0 or greater. The software cost is $250 per physician license. (A real bargain!) This includes handheld PC management software that resides in a standard PC. Support is available at a cost of $50 per month for unlimited telephone support or $30 per quarter hour.

PocketChart by Physix (H/PC only)

e/MD~ does not create a patient chart note or electronic medical record (EMR), nor does it create a prescription printout. The best program that I have seen for this is PocketChart by Physix (www.physix.com).

PocketChart offers a full-featured electronic medical record for Handheld PCs and H/PC Pros (Hitachi developed an H/PC Pro, tablet device specifically to work with PocketChart. I still prefer to use my HP Jornada 680 with this program.). The software allows physicians to collect vital patient data and access medical information at the point of care with seamless integration to the desktop (see Screens 3 & 4). PocketChart includes a formulary of more than 1,200 medications, updated short-description E/M codes and ICD-9 billing code chapters, and 11 single organ exam templates. Healthcare providers can capture and access every element of critical patient information at the point-of-care, and output legible clinical notes and prescriptions.

Screen 3: PocketCHART's Main screen lets the physician start a new patient chart or go to the chart of an existing patient. The physician access patient information from the tabs on the right side of the display box.

Screen 4: PocketCHART's Patient Chart tab lets the physician select templates and write complex notes without typing.

PocketChart can use a large amount of memory depending on the number of specialty modules you install. These modules can be installed on a CF or PCMCIA card, thereby freeing up your valuable internal RAM for applications that cannot use this option. PocketChart can support optimal decision making at the point-of-care, wherever that happens to be. The final documentation can be printed directly to your printer or uploaded to your desktop computer for printing later.

The package includes templates, software, care plan and template editor. Add $149 for annual support and upgrade. PocketChart sells for $2,346 and can be used with an H/PC or H/PC Pro. A demo version and more information is available from PHYSIX Inc; www.physix.com; E-mail: sales@physix.com; Phone: 800-749-2585 or 713-797-1199.

Will it work on Palm-size PCs?

The majority of physicians I have spoken with prefer the smaller form factor of the Palm-size PC and Palm Pilot. Unfortunately, e/MD~ and PocketCHART were developed for the Handheld PC and have not yet been re-designed for the Palm-size PC. Fortunately, other programs are available for the Palm-size PC.

PEPID 2000 (H/PC & P/PC)

One program, available for both H/PCs and Palm-size PCs, is PEPID 2000 (www.pepid.com). PEPID is an incredibly potent "browser-based" medical reference program. PEPID gives healthcare providers a library of essentials for virtually all medical and drug problems (including drug interactions). It includes complete monographs for over 1,000 commonly prescribed drugs and vitamins, and on your P/PC, this powerhouse of data will fit in your top lab coat pocket.

PEPID 2000 is well organized by specialty, and easy to navigate using the "Index" word search, or through the hypertext "Table of Contents". Once you have completed your search, the body of the document contains further references with hypertext that are quickly and easily accessed (see Screens 5 & 6).

Screens 5 & 6: PEPID 2000 is a browser-based medical reference program that gives healthcare providers a library of essentials for virtually all medical and drug problems (including drug interactions). Navigate using the "Index" word search, or through the hypertext "Table of Contents".

If you plan on using it on a P/PC, you must install a browser on your device. PEPID recommends Pocket Browser, a $20.00 shareware program created by Conduits (www.conduits.com/ce/browser). I must agree. This is an easily customizable program that works extremely well with this application.

PEPID was written by over 40 physicians and is designed for Emergency & Primary Care Physicians, Residents, Interns and Students. Suggested retail price is $295.00. For more information contact PEPID Inc; www.pepid.com; E-mail: info@pepid.com; Phone: 888-321-STAT.

PocketCode (P/PC only)

For billing and accurate coding on your P/PC, I recommend PocketCode by Dynamedix (www.dynamedix.com). PocketCode is a portable coding tool for healthcare providers. As with e/MD~, PocketCode is designed to eliminate coding errors and reduce the denial rate of claims at the point of patient encounter, resulting in improved practice profitability, efficiency and compliance with federal and local coding regulations.

PocketCode works extremely well on the small form factor of the P/PC. It uses about 350K of internal RAM, with the majority of (database) information loading to an external CF card. PocketCode synchronizes with a desktop PC version of the program (both versions included in the package). I have used this program on a Cassiopeia E-105 and a Compaq Aero 2180 and it works flawlessly on both devices. Be sure to follow the manual very closely when setting up PocketCode on your P/PC. It is not as straightforward as it may appear. If you have difficulties, Dynamedix has an excellent, friendly technical support department. They will be there for you (during their regular business hours) and get you and keep you up and running.

Both PEPID 2000 and PocketCode can be installed on an external PC or CompactFlash card. I am currently using the Cassiopeia E-105 Palm-size PC with 32 MB of internal RAM. The brilliant color screen of the Casio E-105 is ideal for a weary-eyed doctor like myself. (Note: PocketCode is currently partnered with Casio, and is co-marketing the Cassiopeia E-100/105 with Dynamedix.)

I use a 340 MB IBM microdrive CompactFlash II plus (CF+) card for file storage on my Palm-size PC. I use a 440 MB SanDisk Type II PC Card and a 96 MB SanDisk CompactFlash Card with my HP Jornada 680 Handheld PC Pro. With all of this external storage memory I feel I'm in pretty good shape. But you can never have too much file storage space. SanDisk will be shipping 300 MB CF Cards and 1.2 GB (1,200 MB) Type II PC Cards next year.

Windows CE to the healthcare forefront

Over the past year, there has been a dramatic maturation of hardware and software programs available for both Handheld PCs and Palm-size PCs. Recent software enhancements have made the smaller P/PC more functional than ever before. Future developments by Learnout and Hauspie and Microsoft will give your P/PC speech-to-text capability. Medical photographic images (as well as family pix) can be shared using Sierra Imaging's CE Image 2000 (www.sierraimaging.com). And you can even leave your digital camera at home with the Digital Camera Card Casio is marketing for its E-105 Palm-size PC. These incredible current and future abilities are destined to topple the Palm Pilot's dominance in the Palm PC wars and bring Windows CE to the forefront of medical informatics and patient management.