4G or bust

Physicians find 4G tablets and smartphones alluring. The advantages are significant - if not game-changing,

By David Geer | Tech Notes | Winter 2012


It is no secret that physicians are giving increasing approval to medical applications of tablets and smartphones. The increasing demand for tablet- and smartphone-ready medical software speaks volumes on this. Anyone who has had a moment to catch a glimpse of the latest advertising has heard of 4G (Fourth Generation wireless) and the marked increases in speed, quality and convenience its vendors vow.

But everyone knows what you see in an ad and what you get after committing to a new device and plan can be two different things. Will 4G and its attendant devices lend momentum to mobile device uptake? Let us hear what doctors who are putting them into practice have to say.


From HTC EVO 4G to Motorola PHOTON 4G
The Motorola PHOTON 4G is available for $199.99 (with plan).
Gregg M. Alexander, D.O., a pediatrician at Madison Pediatrics, Inc. in London, Ohio, sees 25 to 30 patients daily. He also performs C-sections and treats newborns at Madison County Hospital in London. Alexander recently upgraded from the HTC EVO 4G to the Motorola PHOTON 4G. He gifted his wife with the EVO.

“My wife needed a phone upgrade, and I was eligible for an upgrade myself. I had been looking at different options,” he says. “The PHOTON is definitely more of a business workhorse than the EVO.” In Alexander’s experience, the PHOTON makes social networking applications such as Twitter and Facebook easier to use. The phone is compatible with Android medical apps. It is globally friendly, switching over easily to European cell systems for physicians who may travel there.

“It also has a nice look and feel and reboots very quickly. The EVO has a long boot process. But the PHOTON is very fast. It almost boots like an iPhone or iPad,” Alexander says.

Speaking of looks, the Motorola PHOTON 4G comes with two cameras, one in front and one in back. The front camera enables video chat with high quality and no skips, stalls or buffering. Alexander uses the PHOTON’s embedded rear camera for medical recording. “If I am examining a patient, I can capture an image of a rash, for example, using the phone’s 8MP camera. This is very handy,” he says.

But Alexander’s favorite feature is the impact the speed of the PHOTON and its 4G connection have on viewing and using medical applications. “I use Peak Practice, which Allscripts acquired when it purchased Eclipsys. It’s an EHR application,” Alexander says. Alexander uses the application through LogMeIn Pro. “I notice the difference when using Peak Practice where 4G is available while I am traveling,” Alexander says.

Despite those features he treasures, Alexander interjects that he does have a wish list of features and capabilities he would still like to see on 4G smartphones.

“The biggest thing is the interoperability factor. I would like to be able to use Microsoft Excel or Word on the device, sync that with my PC, and share those documents,” he says.

He would also like to be able to use telemedicine and remote telepresence applications on a 4G smartphone.

“I am in touch with people who are doing telemedicine and telepresence who are looking at using smartphones for online consults and on-the-spot consults without having to find a telemedicine conference room for it,” Alexander explains. He is also interested in using 4G to tie into patient communication applications to communicate with patients more. “I would like to make more use of social media, which will empower the physician-patient relationship,” he says.

The phone has some empowering hardware options too. Doctors should consider acquiring the compatible HD Station, which enables physicians to attach the PHOTON to a computer display, wireless keyboard, mouse and memory stick. Physicians can start calls from their computer displays and work with their browser windows simultaneously for multitasking. They can even launch calls by selecting a phone number on a website without having to key it in manually. A separate in-car navigation dock converts the PHOTON 4G into a GPS device.

The phone comes with IT policies for enterprise use, which can help enforce compliance with regulatory requirements. It is loaded with multiple messaging and web apps with access to many more. With a dual core processor and 1GB of RAM, this phone competes on speed with some tablets. The PHOTON 4G connects with both 3G and 4G hotspots when roaming for continual connectivity.

The Samsung Galaxy Tab 10.1 4G as MiFi
The Samsung Galaxy Tab 10.1 with 4G is $529.99 with a new contract.
A practitioner in family medicine, Pennie Marchetti, M.D., of Primary Care Physicians of Stow (Ohio) also acquired her 4G device as part of an upgrade. Though the tablet enables Marchetti’s mobile office, it might not be in the way that most people would think. “I use it as a MiFi device to connect my Lenovo to the Internet when on the go,” Marchetti says.

A MiFi device connects to the 4G wireless network, then makes that connectivity available to other devices via WiFi. With the Galaxy Tab, Marchetti takes her own WiFi hotspot with her wherever she goes.

EMRs and faxes come in all the time that require Marchetti’s signature. “I can do the paperwork in the car while someone else drives and keep it from piling up,” she says. The tablet is a critical tool for Marchetti to get her work done in a timely fashion.

That work includes receiving EHRs, answering phone messages, communicating with staff, ordering refills on prescriptions, and checking lab results all while connecting through the 4G tablet.

“I reach the office securely through a VPN connection that extends easily over the WiFi and 4G networks. I can then use the eClinicalWorks software on my notebook to complete my work,” Marchetti says.

The device also has built-in GPS, which Marchetti uses when traveling, and the ability to log on to secure messaging sites so she can communicate with her patients.

“It boots quickly, sets up easily, has a lengthy battery life of about eight hours and the 4G connection is strong and consistent all the way from Akron, Ohio, to Ithaca, N.Y., with very few dropped connections,” Marchetti says.

Finally, all that tablet speed and endurance saves time. “It has saved me hours of work that I would have to complete on my return to the office. It has made the work more efficient, and I don’t have to worry about old work when I get back, just today’s work,” she says.

The Samsung Galaxy Tab comes with a 10.1-inch touchscreen display, 1280 x 800 HD resolution, a fast NVIDIA Tegra 2 dual-core 1GHz chip, and 1GB of RAM memory. The device measures 0.34 inches thin and weighs 20 ounces. A keyboard dock for full legacy keyboard access is available separately.

The Samsung Galaxy S smartphone
The Samsung Galaxy S smartphone is $99.99 with a new contract.
Pedro A. Ballester, M.D., a family physician with a practice in Warren, Ohio, adopted his first smartphone with the Samsung Galaxy S. Though most of his use of the device is not for medical purposes, he does use Epocrates, Medscape, and other medical applications on it.

“I am torn about the lack of a keyboard. I sometimes wish I had a big touch screen or slide keyboard on it, but that would make the device more bulky,” Ballester says.

He would also like to see some kind of verification process for easier login on hospital networks when he first arrives. “I wish there was some way to login automatically and use the hospital’s resources as soon as I am in range of the network. It would be helpful to have access to Epocrates and Medscape as soon as I walk in, some sort of handshake protocol so I am immediately able to use the local WiFi network instead of having only guest access,” Ballester explains.

The phone has a front camera for video chat that uses the QIK video application from Skype and a rear 5MP camera suitable for taking photos or HD video. Busy physicians can use the device as a mobile hotspot and a WiFi phone.

For the physician who has to have more speed today, 4G smartphones and tablets abound with more in the works. With real-time video chat, high-resolution medical image capture, increasing support for social networking, more efficient access to medical apps, GPS navigation tools, and global roaming not the half of it (and discounts for those who choose to upgrade), there’s a lot to consider in the new world of 4G wireless.

David Geer is a frequent contributor to PracticeLink Magazine’s Tech Notes department.





Apps make it possible

From education to communication, a variety of medical apps enrich patient and physician experiences.

By David Geer | Summer 2011 | Tech Notes


DEVELOPERS ARE INCREASINGLY WRITING mobile apps that operate on and across multiple platforms. Mobile apps for doctors, which are available on a variety of devices including Android phones, the iPhone, iPad and Blackberry, reflect that trend. We’ve explored the practical benefits of certain mobile medical apps as observed by physicians working in the trenches.

The Heart Pro    [ iPhone: $9.99; iPad: $17.99 ] 

The Heart Pro app, a 3-D interactive reference tool of the human heart.

The Heart Pro app helps users understand the anatomy of a heart as they rotate, cut open and label it on screen.

The Heart Pro app is a 3-D interactive reference tool depicting the anatomy of the human heart. Designed by cardiologists and cardiac surgeons, The Heart Pro presents 3-D images of all heart components, enabling physicians to rotate the visual representations, cut them open and label sections of the heart via touchscreen. The app comes with controls for accessing an index of English and Latin terms, transparent heart layers, animations and quizzes.

Lacy E. Harville III, M.D., a thoracic and cardiovascular surgeon in Knoxville, Tenn., who performs up to 1,400 cardiac operations annually, uses the app to educate nursing staff and demonstrate the heart’s anatomy and functions to patients.

“Nurses and staff assisting in arduous cardiac operations are not always certain what they are looking at, even though you as a cardiac surgeon are certain,” says Harville.

Harville likes the fact that he can have people looking over his shoulder as he educates them using 3-D images of a moving heart, transecting it to reveal the valves. “Any time patients can better understand the operation they are about to undergo or what their heart problem is, it helps,” says Harville.

Harville is particularly pleased that the application developers are working on 3-D images of abnormal hearts so he can explain these abnormalities to patients. more »


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Transcription gone high-tech

Emdat’s DaRT enables EMR auto-population—sans data entry

By David Geer | Spring 2011 | Tech Notes


Congressional Budget Office forecasts predict that approximately 90 percent of physicians will be using health IT, which includes EMRs, by 2019 as a result of the American Recovery and Reinvestment Act.

But according to a recently published white paper from the AC Group, a healthcare technology consultancy in Montgomery, Texas, it can take a physician an average of 140 minutes per day to fill EMRs using standard data entry. That adds up to hundreds of hours per year of additional tedium for the physician, whose time is clearly better spent seeing patients.

A new technology, Discrete Reportable Transcription (DRT), enables physicians to populate EMRs without the burden of extra typing. DRT technology transforms physician dictations into well-defined notes that it can then insinuate into the EMR automatically, dropping each piece of data neatly in its predetermined space.

Physicians seeking to maintain or increase their availability in the era of EMRs should investigate EMR technologies where DRT technology supplementation has occurred.

Emdat is one example of a popular dictation technology that incorporates DRT to make EMR population seamless. more »


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Robots can extend a physician’s reach and expertise

Through advances in telemedicine, in-demand specialists can reach those in need without having to transport the patient—or the physician—to other facilities.

By By David Geer | Fall 2010 | Tech Notes


Today, telemedicine enables physicians to extend their presence and reach to multiple locations in the form of robots that see, hear, speak and interact with patients and staff.

InTouch Health has the only FDA-cleared remote presence (RP) products on the market, such as the RP-7i (and predecessor RP-7), which connect directly to Class II medical devices including electronic stethoscopes, otoscopes and ultrasound. This enables physicians to diagnose and consult with patients from a distance.


Thanks to the robotic technology, specialists in demand for stroke, ICU care and pediatrics reach patients they otherwise might not. Burn victims, heart patients, psychiatric patients and trauma patients benefit as well.



To accomplish examinations and consultations, the robot's head pans and tilts, giving the doctor a complete view of his surroundings. The robot's camera, monitor/display, microphone and speaker extend the doctor's natural senses while ensuring that the doctor is seen and heard, as well.

For example, the Brooke Army Medical Center Burn ICU employs the robots to assess burn victims from as far away as Baghdad, says Jennifer Neisse, marketing communications manager for InTouch Health, headquartered in Santa Barbara, Calif. The robot’s camera zooms in from multiple angles on skin sections affected with burns for accurate, immediate examination.

Cardiologists facilitate distant monthly cardiology and echocardiogram consults through the robots. Remote hospital staff plug ultrasound devices directly into the robot’s video ports for the cardiologist’s use. Trauma units use the robots to make up for the shortage of trauma doctors. And psychiatrists reach out to rural areas through the robots, providing consultations.

PracticeLink spoke with three physicians specializing in neurology and pediatrics who have made extensive use of RP robots.

Neurologist offers urgent care robotically

Dr. Paul M. Vespa, M.D., director of the Neurocritical Care Program at UCLA Medical Center in Los Angeles, has relied on the RP-7 and now the RP-7i remote presence robots for a total of more than five years. Vespa uses the robots in the neuro ICU as he visits, diagnoses and treats neurosurgical and stroke patients.

Via the RP-7i model, Vespa speeds down clinic and hospital hallways at the patient’s side as staff transport them on gurneys.

Three balls in the robot’s base, each one six inches in diameter, enable this precise locomotion. Motors drive the balls, which also spin passively when following another ball’s lead. The robots maneuver accurately in tight spaces without bumping into walls or people.

In the big picture, the robots help Vespa address the shortage of ICU practitioners available to physically enter the ICU. When needed, Vespa drives the RP-7i model robots into the neuro ICU to offer immediate care to critical stroke victims.

To accomplish examinations and consultations, the robot’s head pans and tilts, giving the doctor a complete view of his surroundings. The robot’s camera, monitor/display, microphone and speaker extend the doctor’s natural senses while ensuring that the doctor is seen and heard, as well. The robot’s audio capabilities enable the physician to tune in to specific sounds or conversations, as if he were in the room himself.

The RP-7i brings Vespa up close to observe and monitor patient response to medicines and treatments in real time. “Rather than ordering a medicine and coming back the next day to see whether it worked, I can see that right away,” he says.

This saves time for the patients, speeds care as the doctor shifts treatment to another medicine more quickly, and even changes outcomes. “By moving more quickly to an approach that works, we can save the patient’s life,” Vespa says.


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Practice-Friendly Apps for Your iPhone

Sync up with these applications to save yourself time and maybe even lives.

By David Geer | Fall 2009 | Tech Notes


Practice-Friendly Apps for Your iPhone

Practice-Friendly Apps for Your iPhone

Twice as many physicians are using iPhones this year, compared to the number of physician-users from only one year ago, according to an April 14th news release by Manhattan Research, LLC—a pharmaceutical and healthcare market research firm. As we take a look at applications (“apps”) for fetal, heart, and general patient care, you may begin to see what they have to offer ‘twice as many’ of you. more »




Is Social Media the New Job Search Engine?

Attention Bloggers, Twitterers and Facebook Friends: Social networking is the up-and-coming way to job hunt, but the tried and true methods remain part of the marketing mix. How to use social media safely, learn online etiquette, and see how recruiters do—and don't—look at your online activity.

By Julie Sturgeon & Karen Edwards | Feature Articles | Summer 2009


Is Social Media the New Job Search Engine?

Is Social Media the New Job Search Engine?

For years, the internet has been shifting from an information repository to a network of individuals who communicate with each other. Web 2.0 is the term that describes that trend. It not only includes social networking sites, such as MySpace, Facebook, and LinkedIn, but also sites that depend on users for content—YouTube and Wikipedia, for example. Businesses, like Amazon, also build and interact with communities of customers on their sites. Blogging and micro-blogging (like Twitter), both of which are forms of web journaling, are the newest Web 2.0 developments.

The data shows social networking is huge. Facebook, for example, claims to have 175 million users, half of whom are in college. The fastest growing segment of Facebook users, in fact, is age 30 and older. YouTube says 10 hours of video are uploaded to its site every minute, primarily by 18- to 34-year olds, although its demographic reaches as high as 55 years. And MySpace has more than 110 million users, age 18 and older. more »


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Who is Dr. Wiki and Why You Need to Know

Managing the risks of online medical communities. How to safely enjoy your time online.

By Bruce Armon & Jim Keller | Legal Matters | Summer 2009


American society is more wired than ever. “Texting,” emailing, and “tweeting” have all but replaced calling and writing. Online social networking communities like Facebook.com™ and MySpace.com™ are quickly growing in popularity. It is not just teenagers and college students who are partaking. Professionals, including physicians, are joining and participating in online networks. Several networks have been created for use exclusively for physicians including Sermo.com™ and Medpedia.com™. Other networks are designed to be forums to exchange information between physicians and patients. While patients can benefit from their physicians’ ability to connect and consult with thousands of other physicians in the United States and around the world regarding treatment advice or similar case studies, these online communities can expose physicians to a host of risks and potential liabilities. more »




Medical Software Goes Mobile

More physicians are implementing these hi-tech products, which save patients, slash costs and curtail time.

By David Geer | Summer 2009 | Tech Notes


Devices such as the iPhone provide the medical software you're used to—whereever you are.

A drug interaction application on the Apple iPhone

What physician wouldn’t love a product that allows access to broad range of medical reference information and comprehensive patient data? Add to that the time-saving feature of increased hospital rounding speed, as well as charge capturing accuracy, and you have a “dream product.” Several such software products are now available, and they’re quickly becoming an indispensible element of physicians’ daily practice.

Epocrates proves “Essential” at UCLA

John Luo, MD, teaches those who practice in an academic medical setting. He is the associate director of psychiatric training at UCLA. He is required to use Epocrates Essentials, a comprehensive medical information resource for mobile devices. “It is a budgeted item,” Luo says.

Epocrates Essentials enables Luo and students to check on lab work and norms for the hospital while on the move. It also enables him to arrive at virtual diagnoses and to check multiple drug interactions for patients.

more »


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Five Tips to Help Your Practice Flourish

Keeping your practice healthy in rocky economic times requires more than simple money management.

By Judy Capko | Financial Fitness | January/February 2009


Growing a healthy patient base that flourishes year after year is second nature to some physicians. They just have the touch. Just as the saying goes, when the going gets tough, economically, it becomes harder to keep the practice growing.

Patients often leave a practice because of their insurance plan or now—with patients paying more of the cost for their medical care with high deductibles—they may be going to the doctor less, contributing to a sinking bottom line for some physicians.

A healthy practice depends on a steady stream of patients, but it also requires physicians to be more efficient with their resources: improving productivity and making wise investments in the practice. Lets look at some of the things you can do to keep your practice in tip-top shape. more »


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