There are unique informational needs of academic medical professionals based partly on the complexity of the organizations at which they practice.  Thus, there are many potential roles of mobile technologies in academic settings, including:

• Providing access to parts of the patient record.
• Providing a platform to place and track orders.
• Allowing for point-of-care documentation.

While all largely help improve quality of patient care, there is also another potential role for the handheld computer: enhancing business efficiency by improving the accuracy and speed of billing.  Academic medical centers remain solvent, in part, by ensuring that they receive payment for all services rendered; careful coordination of caregivers, billing staff and administration is a necessity.

Why Mobility Makes Sense

Medicine by its very nature is a distributed art; care is provided where and when patients require.  Billing administration, on the other hand, is almost always centralized in the academic medical center.  Handheld computers, equipped with the appropriate software, such as charge capture, facilitate medical billing (billing code selection) for the physician because they allow for the timely capture and submission of charges from wherever care is administered.  The electronic charge can then be validated and tracked all the way to the hospital's billing system.  Clearly this transparency is one of the greatest advantages of handheld charge capture.

The Lahey Clinic Medical Center in Burlington Massachusetts has about 350 physicians using handhelds for charge capture, and is also adding electronic prescribing and dictation to its mobile platform. Linda Cagle, senior vice president of clinical services at Lahey remarks, "Handheld computing has significantly improved the overall quality of our business processes.  We have seen improvements in coding accuracy, time to charge entry and overall collections. We expect that the addition of electronic prescribing will greatly enhance our quality of care as well."

Lahey's results are not isolated.  University Physician Associates of New Jersey (UPA), the faculty practice plan of the University of Medicine and Dentistry New Jersey (UMDNJ) has also seen overwhelmingly positive improvements.  After implementation of a charge capture solution, they experienced the following:

• Increase in gross charges of 25.5 percent.
• Reduction in days to billing of 15 days.
• Net annual benefit of over $6 million dollars.

Michael Saulich, executive director of UPA, suggests that, "Individuals are sometimes reluctant to adopt a new paradigm, so develop physician champions to foster the process and serve as peer examples.  Be sure to also study the results of your implementation.  We presented our findings of financial improvement to all members of our practice plan."

From Those Who Know

The implementation of handheld solutions is not without obstacles.  Practical advice from implementations at large, academic medical centers includes:

• The need for proper training on the basics of the handheld device.
• The importance of selecting the appropriate device (size, memory, connectivity).
• Early identification of the appropriate channels of support.
• Planning an incremental implementation of solutions (charge capture, dictation, results, etc...).
• Ensuring physician buy-in.

Physician buy-in is key and can not be discounted.  Ultimately any large project will fail if the appropriate stakeholders are not engaged.  This is why the M. D. Anderson Cancer Center in Houston created a committee that undertook a nearly six-month investigation of charge capture and digital dictation options before deciding on a solution and a platform.  The committee included physician leaders, information technology, finance, compliance, medical records and administration.  According to John A. Tietjen, vice president of finance at M. D. Anderson, "Having physicians directly engaged in the process of decision-making as well as implementation is critical to the overall success of a handheld project.  We invited a physician from each one of the proposed pilot departments to be involved in our selection process."

Academic medical centers are often cash-starved and new endeavors must either self-fund or be associated with a substantial return on investment.  It is important to select a solution to serve as an "anchor" in an academic medical center's mobility strategy. Implement that solution first, and then incrementally add additional applications.  This minimizes the workflow disruptions while allowing the physicians to get accustomed to new hardware, software and processes.

Charge capture is a good choice as the foundation for a mobility strategy, based on its positive return on investment.  After successful implementation of one solution, be prepared to offer others.  Lori English, associate director of patient financial services at M. D. Anderson adds, "We chose charge capture as our initial application, having modeled and understood the financial impact.  We recognize, however, that physicians want further clinical and workflow enhancing applications such as dictation and results."

The last ten years have seen a dramatic improvement in the quality of handheld devices.  Five years ago the hardware itself was an obstacle to implementation, due to poor speed, insufficient memory and limited battery life.  The newest devices, although much improved, are not without their limitations. When choosing to implement any handheld solution it is important to select the right hardware based on the features/functions of the application(s).  Factors to take into account include:

• Size: Choose a device with adequate screen size while minimizing the overall size of the device.  Screen size is a key for most clinical applications. Also, make sure that physicians are willing to carry the device.
• Memory: Even with the best compression and encryption, sound files associated with digital dictation are large. If you're planning to implement dictation, ensure adequate volatile memory (RAM) as well as flash memory (such as SD cards).
• Wireless: If there is any intention to leverage wireless connectivity, choose a device with secure and reliable built-in wireless to minimize additional hardware to support.
• Battery: Choose a device with a replaceable battery, no matter how good the battery life is purported to be.  There is nothing more frustrating to a busy physician that having his or her workflow disrupted by a non-replaceable drained battery.

There is tremendous financial and clinical value to be achieved by the thoughtful implementation of handheld technology.  Choosing the right applications and hardware, gaining physician support, and implementation in a logical, well-supported fashion are critical factors to success.