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Handhelds help with heart attacks at hospital

September 3, 1999
Web posted at: 3:50 p.m. EDT (1950 GMT)

by Meg Mitchell

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(IDG) -- Two patients enter the emergency room of St. Joseph's Hospital in Phoenix complaining of chest pain. The doctor who treats the first decides she's at high risk for a heart attack and requires ICU admission; the second doctor assesses his patient as low risk and keeps him for further observation before discharging. On the surface there's nothing unusual about this scene, which is played out in hospital emergency rooms every day. But at St. Joseph's there's a new twist: Palm computers help the doctors make better decisions, and that means both lives and money are saved.

This approach to diagnosing patients may be novel, but the problem it addresses is as old as emergency rooms themselves. With medical research constantly underway, it's impossible for every doctor to remember and access the results of every study. Taking outside information into account is particularly tricky in the area of heart attack assessment, which requires quick decision-making.

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As medical director of the ICU and other pulmonary and cardiac units at St. Joseph's, Dr. Philip Fracica was painfully aware of the abundance of medical literature that didn't always make it into doctors' hands. "Every physician's experience can be colored by the unique characteristics of the particular patients that they have cared for," he says. "But are those experiences truly representative of all patients?" When one of the hospital's monthly educational sessions introduced him to an objective scoring system for assessing heart attack risk, Fracica built a Web-based application so that doctors in the ER could access the system with a PC. The procedure was simple: After evaluating a patient, doctors would use the PC in the emergency department to answer a series of questions about the patient. The doctor could then incorporate the results of the studies into the diagnosis. "Some people have spent their lives studying this," says Fracica. "Now we can [use that information to] weed out patients that don't need admission to the hospital."

The remote application proved handy, but doctors still had to leave the patient's side, wasting critical seconds. So Dr. Fracica teamed up with AvantGo Inc., based in San Mateo, Calif., which specializes in delivering enterprise applications to handheld computers.

Now doctors can follow a link on the handheld's text-based browser to a Web page residing on St. Joseph's Web server, which in turn contains the risk assessment evaluation. The AvantGo software allows the Web page to transfer the information right on to the Palm computers-literally at the doctors' fingertips. The Web pages used in the application are then stored on the user's handheld, until doctors decide to delete them. This way, they can access the Web pages on subsequent occasions without having to download them again, which saves even more precious minutes.

Now when someone comes into the ER complaining of chest pain, the doctor performs the traditional assessment and examines the cardiogram. Then the Palm computer program takes him through a series of questions, which vary from patient to patient depending on the results of their cardiogram At the end, the program delivers a percentage of heart attack risk, and the doctor can treat the patient accordingly. Avoiding unnecessary hospital admissions has benefits beyond the patient: It can help keep HMOs' bottom lines healthy.

All 14 of St. Joseph's emergency room physicians have been using the remote PC application for several months and have had access to the Palm application since June. And while it's difficult to quantify the value of lives saved, Fracica believes that doctors are acting faster and making more informed decisions.

But it doesn't stop with chest pain. The software's flexibility means unlimited potential for targeting different illnesses. Fracica has introduced a similar program for treating pneumonia, though it had not been converted to a Web-based application at press time. But he stresses that these applications are meant to supplement, not supplant doctors' judgment. Technology will never replace years of medical school, but it may just help make more study results common knowledge.

Written by Meg Mitchell. Send Working Smart ideas to her at

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