Aug. 27, 2003 Wireless technology may put doctors who don't rely on desktop computers and paper charts in a better position to treat their patients. That theory is being tested by students in the Penn State School of Information Sciences and Technology (IST) at the Mont Alto, York and University Park campuses where they are developing wireless technology for fast and secure transmission of patient information using hand-held devices.
Last spring, the IST students developed a mobile/wireless application prototype with a limited number of information fields. Using IBM's mobile database product, the prototype enabled communications between handheld devices and Penn State Milton S. Hershey Medical Center's Acute Pain Management Database, developed by Patrick McQuillan, M.D., and Christine Gelnett, B.S.N, R.N., at the Medical Center's Department of Anesthesiology.
The two-way synchronization allowed for creation, updating and deletion of patient records from any location.
"It's virtual, and it's multi-processing--it can have several processes on at once," said Stan Aungst, assistant professor of information sciences and technology. "It allows physicians to query the database and have the answers they need."
The project began in the Department of Anesthesiology at the Medical Center as a way to log post-operative pain management data on patients who had had epidural anesthesia during surgery.
Nurses would accompany doctors to patients' bedsides, and with hand-held devices, record patients' answers to a series of questions about their comfort and pain. Then the nurse would have to take the information back to a desktop computer and download the information from the hand-held device into a desktop computer. Because the data transfer was unidirectional, medical staff would have to leave patients to query the database -- an inefficient use of time.
"The goal was to improve patient care by looking at how well people who had certain types of procedures did with certain types of anesthesia," said Gregg Schuler, senior research assistant. "But not only was it cumbersome to download the information, but as it became a research tool, we had to figure out ways to query and transmit the information."
Schuler went through the various approvals necessary to turn the database, which by then contained information on about 600 patients, 300 or more of whom were pediatric, into a pool of research data.
The next step was going to wireless. But patient confidentiality laws and regulations are strict about how patients' private medical information can be transmitted.
"One of the problems when you go wireless is that it gets a little easier for people from outside to hack in," Schuler said. "So we talked with Dr. Aungst about how to create a wireless secure acute pain management database that would allow health care providers to put information into a hand-held device and transmit it wirelessly to a cell phone, or some other receiver in a secure fashion."
This is done with IBM's mobile database product, DB2 Everyplace. With DB2 Everyplace, the students had the tools they needed to write the software, which recorded the patients' input on hand-held devices and synchronized it wirelessly with a central database on a desktop computer.
The students, enrolled in IST 240 and IST 495, solved the major challenge of ensuring patient privacy over a wireless network by encrypting data through user IDs and passwords, a secure Virtual Private Network or VPN, and data encryption. In addition to encryption from mobile devices to the wireless provider, there also is encryption from the provider to the service gateway and from the gateway to the wireless server, according to Aungst.
Users are put into groups such as doctors and nurses, with each group having a password, said Karen Fleagle, a senior IST major at Penn State York who worked on the prototype.
"Depending upon your user name, you can only transfer and view certain tables," Fleagle said. "So, if you didn't have access to patient names, for instance, then you wouldn't be able to sync that information."
In addition, Aungst is examining different encryption algorithms with IBM to determine the trade off between strength of encryption and level of performance.
Two IST interns are now building an application on a larger scale than what was done last spring. As part of that, they are converting the anesthesiology department's database from Microsoft Access to DB2.
Penn State Hershey Medical Center is one of two healthcare providers beta-testing IBM's mobile database, DB2Everyplace or DB2e Version 8.1.
"It's a learning process," said Jonathan Kelly, a senior at Penn State Harrisburg and former student of Aungst. "Every Wednesday, there are conference calls with people all over the world who discuss their hurdles and technical difficulties. We're all doing wireless applications, just with different scopes."
In the future, this type of technology would allow operating room staff to exchange information from one part of the hospital to another, or for physicians working at a satellite location, such as those working at an outpatient surgery center or with appointments at the Lebanon VA Medical Center, to receive important patient information wirelessly and privately.
"Ultimately, this way of tracking data and safely sharing information could be extended to almost every part of our patient care," Schuler said.
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