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It seemed like the perfect solution. As it turned out, it was.

Ophthalmology resident John Moran, Ph.D., M.D., chased his hunch with hours of tedious computer programming during a four-month period. The software he developed adapted a popular pocket-sized business organizer to fit the record-keeping needs of residents at the Storm Eye Institute.

“We were keeping hand-written notes,” Moran said, “and it became too much to handle.”

He explained that each patient encounter had to be documented. The medical record number, the circumstance of the visit, and the primary problem or reason for the visit, all basic information to be noted.

Was a procedure performed? And if so, what was the procedure?

All the information needed to keep MUSC's ophthalmology program fully accredited by the Accrediting Council for Graduate Medical Education was being handwritten, often from recollection after the patient encounter, and then turned over to the department's residency coordinator, Sharon Maroney.

The information was often incomplete, inaccurate and illegible. Yet the accreditation of a top-notch ophthalmology program—among the best in the nation—rested on the scraps of paper stacked on Maroney's desk.

She said she spent up to eight hours a week transcribing the data.

“Ask her if this doesn't help,” Moran said with a broad smile matched with a confirming and equally broad smile from Maroney.

“Accreditation is tough and getting tougher,” said residency program director Amy Hutchinson, M.D. “They're looking for more detail. In addition to the number of surgeries, they want to know the types of patients we're seeing, the procedures being done. They want a complete log over the course of each residency.”

Moran's solution began with the Palm III hand-held computer by 3Com. It's probably the most widely used mobile computer for business purposes. He designed templates that allow selection with a stylus from each required category of information— patient medical record number, visit type, problem, procedure, and comments. Exact time and date of the entry is automatic. With the use of pull-down menus and a novel virtual key pad, the full documentation of a patient's visit takes less than 10 seconds.

But the templates—what you see on the screen—are just the visible tip of Moran's project. Beneath the screen are bits, bytes, kilobytes and megabytes of information arranging themselves within the Palm's printed circuitry as directed by Moran's hundreds upon hundreds of lines of computer code.

Even that wasn't the whole solution.

Moran searched the Internet and found Pen Computing Solutions, a company that specializes in writing mobile data collection software for the Palm III handheld computer. Pen contributed the programming that allows data collected in the Palm III to be downloaded to a central computer for storage, retrieval, data analysis and printing.

“This system of documentation may well become the standard in ophthalmology around the country for residents to record the patient contact information needed for our continued accreditation,” said Ophthalmology Department chairman Edward Wilson, M.D. “The PalmPilot program, customized to our needs, allows fast, accurate entry and easy downloading to a desktop computer.”

With minor modifications, his software program, called “Patient Encounter Forms,” can be used in all medical and surgical residencies, Moran said. And the on-site, real time data collection capability of the Palm III makes it an excellent bedside tool that can be integrated with MUSC's emerging Electronic Medical Record system.

Also, there comes a time when a doctor seeks hospital privileges and the hospital wants to know what was done as a resident. Hutchinson said that it can be years later and the residency director has no idea who that person is. “Now we can document the residency without having to search through schedules and surgical records.”

Wilson said that he would like to see the Palm III computer expanded to include faculty evaluation of resident procedures and patient work-ups. Residents in the department also use the Palm III to keep call schedules, study protocols, drug dosages, and teaching calendars at their fingertips.

In-house problem-solving encouraged

John's (Moran) work is just the sort of thing I want to encourage.

My dream for MUSC information technology is to develop a set of intuitively obvious tools that permit physicians and researchers to put together their own solutions to problems they encounter each day—to move problem-solving back to the people who have the problems without requiring intensive technical support.

This represents a move away from central policies and centrally mandated software solutions and moves closer to MUSC students, faculty and staff being able to solve their own problems within the context of a standard's-based infrastructure.

I don't want to suggest that we make all MUSC employees computer geeks, but rather that we find ways to facilitate problem-solving that is so intuitive that anyone could be successful. I see the role of central administration as that of developing a computing infrastructure that contains the damage when someone makes a mistake, rather than limiting what a person can do in order to maintain peace within our computer network. —C. Frank Starmer, Ph.D. Associate Provost for Information Technology

Read more about... Moran's software program on the 3Com corporate website: <http://www.palm.com/enterprise/studies/study5.html> and at the Pen Computer Solutions Inc. website: <http://www.pencomputersolutions.com/DoctorDemo.htm> Also, Moran's story will appear in the May issue of the online computer magazine, Datamation: <http://www.datamation.com/>