Auxiliary Brain

When it comes to medical accoutrements, Justin Graham, M.D., is both old and new school. When he makes rounds, the San Francisco-based infectious diseases specialist totes a black leather bag that evokes medicine’s pre-managed care era. But when it comes time to prescribe medications, Graham pulls out a PDA, using the hand-held device to check on recommended doses and possible drug interactions.

Graham has used handheld devices since 1997, when be began his residency training at Beth Israel Deaconess Medical Center, a Boston hospital known for its IT. His first device, the Apple “Newton,” is long since obsolete. Now, almost a decade later, Graham has graduated to a much tinier device from Sunnyvale, Calif.-based Palm Inc. that fits in a shirt pocket. The technology may have improved, he says, but the need is still the same. Physicians making inpatient rounds need easily portable clinical decision-support tools, and often hospitals are lacking in such resources. “In the inpatient setting, your lab coat is your desk,” says Graham, who practices medicine part-time. “You need to have everything you need to know on your person or in your head.”

Graham’s handheld runs software from Epocrates, a San Mateo, Calif.-based vendor of drug-reference tools. Using a small stylus, Graham clicks through a series of screens. He should know the tool well—he helped develop it for Epocrates when the company launched several years ago. At that time, Graham was a full-time physician making the rounds at several San Francisco area hospitals. Now he works solely at St. Mary’s Hospital in San Francisco, an organization that is just beginning to upgrade its clinical documentation tools.

When Graham is not serving as an infectious disease consultant, he serves as medical director for quality and informatics at San Francisco-based Lumetra, a vendor-neutral, nonprofit healthcare consulting company.

Graham leads a project aimed at promoting electronic medical record technology in small to mid-size primary-care physician office practices.

Although he loves his PDA, Graham says handheld devices can be challenging to use in the primary-care setting. For one thing, the devices don’t lend themselves to data capture. For another, hospitalists now handle most hospital rounds, so primary-care physicians have other ways to transport their EMR data to the hospital. With specialists, however, it’s another story. According to Graham, physicians such as obstetricians or surgeons who navigate between office and hospital settings might find the PDA a valuable tool. “Ultimately, there may be better integration between hospital information systems and the physician office,” he says. “But in the short-term, the PDA can help.”

—Gary Baldwin