Doctors with iPhones carry lighter load

Dermatologist Julie Lin attached a dermatoscope to her iPhone and held it over her arm to demonstrate how the device works. She uses it on patients at Fletcher Allen Health Care in Burlington every day in tandem with her iPhone camera, and an app to identify skin irregularities.

Using this magnifying detection device is just one of many advances in information technology that have changed the way doctors practice medicine.

Tablet and smart phones allow information about medicine to be easily accessible and searchable. Doctors who have gone the mobile medicine route no longer need to scour patient charts for information, or hunt through text books to learn about medication interactions.

Dr. Lin's dermatoscope captures images to be electronically sent through her iPhone to patient charts and colleagues for collaborative consultation. Virtual consulting saves a vast amount of her time, she said.

Fletcher Allen, together with the University of Vermont College of Medicine and the College of Nursing and Health Sciences, is Vermont's academic medical center, providing advanced care to about one million people in Vermont and northern New York.

Chief Medical Officer Dr. Stephen Leffler no longer uses the thick tomes of old he once relied on. What is most valuable to him in his emergency room nowadays is found right in his pocket — his smart phone.

"When I was a new doctor, we used books," Leffler said. "As we waited for the newest edition, when changes occurred, we would place sticky notes on the back of the books with updates until the next publication was released, sometimes a year out."

Time saving tricks of the medical trade

In the course of a year many new drugs and advances are made. Today's doctors have that information at the ready as soon as it becomes available in industry approved clinical reference applications. "They are like an up-to-date online text book," Leffler said. "The problem with text books is as soon as they are published, they are out of date because medicine is always changing."

Smart phone apps are updated with new information daily — no sticky notes needed. "This has transformed emergency medicine," Leffler said.

Putting vital photos into a patient's chart used to be the biggest time-consuming hassle, according to Lin. Photos that document skin changes over time, for example, are of paramount importance in the field.

Today, those photos go directly into the patient's chart moments after they are taken. "It's a huge breakthrough," Lin said. "It's seamless and simple."

Leffler depends on Epocrates on the job. It's a drug reference app that gives information about any drug, including average dosages, possible side effects, and interactions it may have with other drugs. He also relies on an app called MedCalc to calculate common, and not so common, medical equations.

"I used to have a book I kept with me at all times filled with pearls, you know, valuable hints, tips, and equations that every doctor needs … now there are apps for that," Leffler said.

Information free flow

The Haiku app allows medical staff at Fletcher Allen easy access to digital medical records, which are organized under a program Prism.

Haiku, a mobile phone-based electronic health record application, allows Prism users to access and search patient charts, clinic schedules, patient lists, test results, and more. Device IDs and security codes are required. Phone apps are designed to comply with privacy rules and be secure.

Hippa, the Health Insurance Portability and Accountability Act of 1996, outlines privacy, security, as well as breach notification rules for providers, hospitals and data companies when there is a lapse.

Hacking of electronic health records occurs around the nation despite precautions as cyber thieves attempt to access valuable personal banking information, prescriptions and other data.

Earlier this month, one of the largest hospital companies in the United States disclosed hacking on a massive scale: Community Health Systems Inc. revealed that 4.5 million patient records had been breached in a cyber attack by Chinese hackers.

The stolen data includes patient names, social security numbers and telephone numbers, the company said in legally required disclosures to the government.

In the wake of the attack, the FBI warned that health care industry companies are being targeted by hackers.

"The FBI has observed malicious actors targeting healthcare related systems, perhaps for the purpose of obtaining Protected Healthcare Information (PHI) and/or Personally Identifiable Information (PII)," the agency said in a public statement.

Mike Noble, senior media relations strategist at the Fletcher Allen, said Wednesday that Fletcher Allen patients were not affected by the breach. The Burlington hospital is not affiliated with Community Health Systems.

A lighter load

Medical students are no longer tasked with schlepping armloads of cumbersome patient charts. Medical records are easily cued up with tablets and smart phones through mobile applications. There's no need to even log into electronic medical records on a desktop work station.

Douglas Gentile is medical director, clinical information systems, and emergency medicine physician at Fletcher Allen.

"With Haiku we just take our tablets from room to room," Gentile said. "We can see patient X-rays, medications, and how they slept last night. It's instant access."

For now, residents use their own devices, Gentile said. "We are in the middle of a pilot to figure out what devices work best for what we need to make our jobs easier," he said.

Advances in how information flows in a hospital allows for more efficient treatment and higher quality care for patients, Gentile said. The process in place now at the hospital is better and safer than the old way and "unbelievably efficient," he said.

Access to digital patient charts, and apps with up-to-date medical information, has saved time for doctors who often have to make quick decisions, Leffler said. "We are a tertiary referral medical center so we have problems that come here from other hospitals that might need a neurosurgeon or specialists," he said. "With electronic medical records, hospitals can access a patient's records from the referring hospital. We can see their latest set of X-rays rather than having to take another set."

Visitors from out-of-state are less likely to face treatment delays and redundant tests. "Before we had to go through a huge process to get information from their chart, to have it faxed or whatever," Leffler said. "Electronically shared medical records is a huge advance. It saves on cost. And it saves lives."

For more information about Fletcher Allen visit http://www.fletcherallen.org or go to Facebook, Twitter, YouTube, and blog sites at www.fletcherallen.org/socialmedia.

Contact Lynn Monty at LynnMonty@FreePressMedia.com and follow her on Twitter at www.twitter.com/VermontSongbird.

Read and scan

Leffler's book, "Minor Emergencies," is written on paper but houses technology within its pages by featuring quick response codes, better known as "QR" codes, that link to educational videos when scanned using an iPhone app.

The book allows doctors to access some 200 examination tips and treatment videos for health problems ranging from swimmer's ear to facial fractures. Leffler demonstrated by opening his book to a common emergency room ailment. Using a QR code reader on his iPhone, he pulled up a video of a colleague performing a procedure in a step-by-step educational format.

"We felt there was a spectrum of common minor emergencies that were not well covered in other textbooks of Emergency Medicine," Leffler said. "We are working on an app."