Handheld Healthcare Efficiency Windows CE operating system makes its debut

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1 Handheld Healthcare Efficiency Windows CE operating system makes its debut by John D. Carpenter, Jr. It s 8 a.m. and the morning shift of hospital physicians is just arriving. Stopping by their offices, they call up the morning s patient visitations from their Windows-based PCs. Then they do something extraordinary. Using a standard communications link, the doctors download everything necessary to complete their rounds patient demographics, medical histories, current care plan descriptions, and drug therapy information into a mobile, Windows-based handheld personal computer. They slip the lightweight units into their coat pockets and leave for their appointments. Upon returning, the physicians palm-size computers contain up-to-date histories for every patient. What s more, the units can produce clearly written medical charts, generate pharmacy script orders, and output all the documentation and billing codes necessary for third-party reimbursement. No illegible hand-written notes. No costly dictation. As easily as they downloaded their patient histories, the physicians upload the results of their rounds to update the patient records on their PCs. Mobile Computing Finally Arrives The technology making these kinds of efficiencies possible is the handheld personal computer. This powerful tool streamlines the processing of patient data by capturing it at the point-of-care and distributing it electronically throughout the healthcare infrastructure to physicians and pharmacists, administrators and

2 accountants. But unlike previous generations of mobile devices whose closed architectures limited application development and information integration, handheld PCs rely on an open, extensible, and powerful operating system: Windows CE from Microsoft. A scalable, 32-bit operating system, Windows CE allows handheld PCs to communicate with each other, share information with Windows-based PCs, and connect to the Internet. Last month, Microsoft announced the availability of the operating system on seven different handheld PC platforms, each of which conforms to a lightweight and power-efficient design, and carries a price tag of approximately $500. The new operating system has analysts heralding the arrival of a new era in mobile computing. When Bill Gates gets up on stage with seven hardware vendors, it s the start of the handheld PC industry, said Andrew Seybold, who tracks developments in the mobile and wireless computing industries. Seybold predicts sales of 750,000 to 1 million Windows CE-based handhelds in the next year alone. I m as bullish as I can be about this operating system, he said. Hardware manufacturers are equally happy. With about 32 million mobile professional workers in the US alone, the market potential is far beyond what has been seen yet, said Roy Breslawski, product marketing manager Hewlett-Packard Company, one of the seven handheld PC vendors. Windows CE is winning over developers, too. Over 40 software and peripheral vendors have announced their support for Windows CE including a

3 company that will release a virtual charting environment for handheld PCs by the end of this year (see sidebar). The small, unobtrusive form factor and fast start-up time makes handheld PCs ideal for mobile computing, said Mike Beller, vice president of PenVision Information Systems, Inc. The firm is collaborating with Dendryte International to provide wireless access to Dendryte s pharmaceutical databases, speeding sales representatives visits physicians. And the openness and available applications of Windows CE solve longstanding problems in the mobile computing industry, said Breslawski. The key reasons for being skeptical in the past have been that most products were proprietary and of dubious value. Now that a system exists that not only works with industry-standard PCs, but also works like industry-standard PCs, the fears of adopting these systems have been eliminated. Finally, the arrival of Windows CE also establishes clearly Microsoft s presence at all levels of the healthcare delivery system from point-of-care data collection to back-end processing. The company has enjoyed an impressive string of technological accomplishments lately Windows CE promises to be one of the best. Windows CE: Under the Hood Rather than squeeze its desktop operating system into a handheld PC, Microsoft built Windows CE from the ground up, using a comprehensive subset of the Windows 95 interface. This approach let the company tailor its new operating system to meet the unique demands of handheld computing.

4 For example, to maximize a handheld PC s 480 X 240 screen, Windows CE combines the menu bar of the user s current application with the toolbar. A person using a word processing application, for example, would see the File and Edit menus along the top line of the screen, along with such toolbar functions as Save, Copy, and Print, and be able to select any of them. Microsoft applied the same space-saving rules to Windows CE kernel and interface. Both reside in ROM to speed processing and reduce costs; accommodating new applications is a straightforward matter of replacing the unit s ROM card. This approach lets developers create configurations for specific markets and user needs while retaining the same programming model and user interface, said Jim Floyd, product marketing manager for Windows CE. The basic Windows CE handheld measures 3.5 X 1 X 6.9 inches, weighs about one pound, and features a PC card slot, QWERTY keyboard, and 480 X 240 gray-scale, liquid-crystal display. The basic model features 24 MB of storage with either a MIPS R4000 RISC microprocessor or a SH3 RISC processor from Hitachi as its CPU. Windows CE contains several built-in applications, including pocket versions of Microsoft Word and Excel, an application that works with Microsoft Exchange, and a version of the Microsoft Internet Explorer for browsing the Internet and corporate intranets. Designed for low-power consumption, Windows CE handhelds should be able to run for days on rechargeable batteries, Floyd said. Each unit contains two AA batteries for primary power and a lithium coin cell that lasts for months and

5 serves as a backup for the AA batteries should they become exhausted or while the user switches to a fresh pair. Best of all, handheld PCs running Windows CE can communicate seamlessly with Windows-based PCs. Users simply place one in a communications cradle or connect it to a serial cable linked to their desktop to transfer information. Seybold said this feature solves a major problem for users frustrated with trying to integrate information from the current crop of mobile devices into their desktop systems. Only the road warriors have been able to do that, prior to Window CE s release, he said. Microsoft will license the Windows CE operating system to computer and consumer-electronics companies. Casio Computer Co., Compaq Computer Co., Hewlett-Packard Co., Hitachi Computer, LG Electronics, NEC Corp., and Philips Electronics have all announced plans to manufacture the device, with delivery slated for November. A Top-To-Bottom Strategy Windows CE is the capstone of Microsoft s effort to participate at every level of the healthcare delivery process, and the highlight of an alreadyimpressive year. In March, Shared Medical Systems Corp. embraced Microsoft s Windows NT Server and SQL Server products as the preferred platform for its NOVIUS client-server systems. Lanier Worldwide Inc. s new patient record application, HealthFrame, will also run on the two products, as will the entire healthcare information system from Medical Information Technology, Inc. (MEDITECH). Meanwhile, Visteon Corporation s BIGVISION suite of

6 applications for large physician organizations became the first healthcare solution to be certified for the Microsoft BackOffice platform. Microsoft also made significant strides in extending its Internet and intranet expertise to the healthcare industry. In September, PDX, a leading supplier of pharmacy software, chose the Windows NT platform and Microsoft s ActiveX network communications technology to anchor a new generation of applications that will link physicians, pharmacists, and patients via the Internet. And Blue Cross-Blue Shield of Massachusetts, has installed a Windows NTbased intranet that gives its 12,000 physicians browser-based access to healthcare guidelines, medical text databases, article archives, physician directories, and an system. But it is the release of Windows CE that solidifies the role that the mobile computer user the doctor, nurse, and home-health practitioner will play in the company s future development plans. If you look at the current trend, it s to take information off the desktop and put it on the person, said the analyst Seybold. For that reason, he predicted customers and organizations will recognize the new operating system as essential to their success. In order for a device to be accepted, it has to do what it does well, he said. Windows CE does that. ###

7 Sidebar: Windows CE Boasts Virtual Charting Application Healthcare providers and administrators won t have long to wait for the first Windows CE application. PocketChart, a virtual charting environment for handheld personal computers will be available by the end of the year, according its developer, PHYSIX Inc. PocketChart put handheld PC technology at the point-of-care. Physicians can use the application to update patient charts, document treatment plans, review potential drug therapies, send prescriptions to pharmacies, and collect billing information and they can upload and download patient histories to Windows-based PCs easily. The compact design of the Windows CE kernel and the operating system s low overhead makes this kind of application possible said Dr. Thomas Giannulli, PHYSIX president and PocketChart s designer. And necessary. I don t think physicians can provide the kind of care they want to without a system like this, he said. PocketChart uses on-screen templates driven by a clinical knowledge base to capture patient histories. Each template contains diagnostic questions related specific medical conditions; PocketChart contains 250 templates covering over 5,000 diseases, all of which can be customized to suit the needs of a physician or practice.

8 As a patient responds to the questions in PocketChart s template, a physician uses an electronic pen to notes their responses in the application s onscreen menus, entering any additional note using the handheld PC keyboard. Using this information, the application can generate a patient note the physician s a notation style. And the physician can add care plan information or HMO guidelines to the note with a tap of a pen. PocketChart supports approximately 200 patient visits per megabyte of storage. If a prescription is necessary, PocketChart offers a database of over 1,200 drugs, searchable by class or name, that includes dosage and dispensation information to reduce the risk of error; this formulary may be calibrated to conform with a physician s PBM or HMO guidelines. The application also displays a patient s known allergies to prevent inappropriate prescriptions. Physicians enter the drug, dosage, method, frequency, and dispensary information they typically write by hand; the application then generates a prescription that the doctor can upload to a desktop system and print. PocketChart includes ICD-9 and CPT billing codes for all its disease and injury states and procedures. Physicians can load the diagnostic codes on a chapter-by-chapter basis to fit their specialty. A hierarchical browser ensures that it takes no more than four taps of a pen to access the most specific billing code, maximizing third-party reimbursement and the quality of the patient record. Our streamlined approach lets physicians enter the majority of their common daily encounters with greater productivity and lower costs than they could using handwritten or voice-dictated records, Giannulli said.

9 PocketChart can exchange data with Windows-based PCs or transfer information to other handheld PCs running the application. The initial release of PocketChart will use a standard communications link to perform transfers; wireless communication will be available shortly thereafter. John D. Carpenter, Jr. is the worldwide healthcare industry manager for Microsoft Corporation. Further information about the Windows CE operating system is available through the Microsoft web site (microsoft.com/industry/health/).