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As part of the pilot program, Vaughan has been paired with a physician, an interventional cardiologist who had used electronic medical records in her practice.

Allscripts TouchWorks, a suite of software sold by Allscripts Healthcare Solutions of Chicago, is loaded on Vaughan's Pocket PC. "It allows me to access outpatient information such as prior physician visits, lab results, stress test, electrocardiogram, ultrasound or other test results," she said.
Before this new pilot, most of this information was kept on paper records. With 266 employees in an office setting, finding an available desktop computer to use TouchWorks took up too much time.

And worse, "I couldn't carry that into the room," Vaughan said.
Now, a typical day can quickly illuminate just how much of a time-saver this hardware and software combination is for Vaughan.

"There's not been a day in the clinic I've not had a walk-in," she said. "I remember a day where I literally sat for an hour, ready and available to see a patient. She was ready, but I had no information to see her with."

Staff from another floor at the center had to retrieve paper medical records and charts-a wait that, for Vaughan, averaged 45 minutes. Now, the center's RF wireless data network retrieves the same records into Vaughan's iPAQ within seconds.

Vaughan's iPAQ's digital memory stores not just text and numbers, but also her voice, as she can dictate right into the device, with TouchWorks embedding these words right into the patient's electronic record.

Previously, Vaughan's words had to be captured via telephone. And to use the old system, she had to enter a potpourri of identification numbers.

With the new system, dictation is a click away. TouchWorks can even act as a coach during dictation of physical histories or, if the narration is preparing a patient for hospital admission, offer a series of hints to the NP. Eliminate error-prone number entry and offer handy checklists to NPs and you reduce error, as well as speed information capture and retrieval, Vaughan said.

"We'll eventually be able to do our prescriptions in the computerized setting," Vaughan said. "I know without a doubt that there have been pharmaceutical errors because of the difficulty of reading handwriting."

Once prescriptions can be entered in the PDA, Vaughan said, errors in drug, dose, route and frequency will be reduced. Stern's devices also will offer the same kind of drug interaction and contraindication advice that Keeling and her students enjoy.

Although the Stern center's PDA initiative is still a work in progress, Stern's wireless network may be the most cutting edge technology in use. In fact, it's so new, Vaughan said, that "any office that is considering using this-and I think it's a wonderful system-needs to have good tech support easily accessible. There are times I have to make multiple attempts to upload data."

Vaughan has yet to take her iPAQ into a hospital setting, where further savings await. "I'm in the hospital 75 percent of the time, making rounds, seeing new consults," she said. "At admissions, a secretary has to try to locate reports, get them printed, typically faxing them to you. Having the ability of this device to carry that into a hospital setting, or to get a report downloaded, will help with cost-effective and efficient treatment of patients without having to unnecessarily repeat tests-what's called defensive medicine."

Vaughan added that PDAs have evoked wows from patients, too, who feel it is improving their quality of care.

To billing and beyond

Can a combination of PDAs and other computing devices free nursing from paperwork? Jeneane Brian says yes.

In January 2001, nonprofit VNA Home Health Systems in Santa Ana, Calif., began a special project to determine if it could reduce the paperwork burden for nurses through the use of point-of-care technology. "We decided to try out Palm OS devices for that purpose," said Brian, CEO of VNA Home Health Systems, which has a mobile workforce that travels from patient to patient.