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New York cardiologist Robert Philips greets his patients with a handshake, and a Palm. An admitted computer guy, he started with a laptop but was quick to convert to a handheld device. When asked about why he uses the electronic organizer, he explains, "I really wanted to find a way to keep track of my patients and also to be able to start developing ways to electronically capture data about patients."

Dr. Philips is taking his use of technology a step further: He's working with Mount Sinai Medical Center in testing a Palm application called Prompt, thanks to a grant from the National Heart, Lung, and Blood Institute. The program is a heart disease screener that helps doctors determine how blood pressure and lipid level impact patients and how they should be treated. In praise of the program, Dr. Philips comments, "We have the potential to save significant amounts of money and also improve a patient's quality of life by decreasing heart attacks, strokes, and heart failure."

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With 19 percent of physicians already in possession of personal digital assistants (P.D.A.s), companies are racing to provide e-solutions like E-Pocrates, a free software that functions like a drug reference book. Other possibilities include writing prescriptions that can be beamed to a printer or pharmacy, ordering lab tests, and billing patients, all from the palm of the doctor's hand.

About 5 years ago, New York's "wired" hospital, otherwise known as Memorial Sloan Kettering Cancer Center, ramped up efforts to delete paper and radiology film. For Urgent Care Chief Dr. Brian Meltzer, the resulting electronic medical records are life saving. Dr. Meltzer says, "People downstairs would know a patient was coming and they'd try and get us the charts as fast as possible, but it was never fast enough." Now when emergency patients come through the door, says Meltzer, "We not only have access to notes from clinic visits and hospital stays but we also have access to cardiograms and every lab test that has ever been done in this hospital on a particular patient. We were stressed when we had 30 patients to see in about an eighteen hour period. We now are seeing upwards of 50 to 55 people."

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Advances in telecommunications are changing the practice of medicine, both at the hospital and at home. Dr. James Dougherty, who is orchestrating Memorial Sloan Kettering's move into digital medicine, estimates that the hospital has spent upwards of 30 million dollars on information systems. With it comes better medicine and greater efficiency. According to Dr. Dougherty, "One of the elements that is unique here is the opportunity for medical personnel to gain remote access to the patient's full medical record at home, with the appropriate security and confidentiality. The second aspect is that we have a very broad array of radiology services online."

At Columbia Presbyterian Medical Center, Doctor Steven Shea is heading a federally funded twenty-eight million dollar telemedicine project. The study will include fifteen hundred diabetes patients in urban New York City and rural upstate New York. Using a personal computer connected to the Internet, and medical attachments that monitor blood sugar and blood pressure, a nurse case manager at the hospital is helping patients at home to monitor and control their diabetes.

In effect, Dr. Shea and his associates are also testing their theory that an easy-to-use home monitoring system will lower medical costs and improve the health of chronically ill patients. Dr. Shea says, "Many of them are not English speaking, are unfamiliar with technology, and are a little bit intimidated by it. ... A patient with diabetes might have fewer complications, fewer visits to the office, fewer hospital admissions, fewer surgical procedures, and be less likely to go blind or become disabled."

These and other advances in telecommunications technologies will help doctors more and more in bringing medicine to the patient instead of the patient having to go to the doctor.

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