P&S Journal: Spring 1995, Vol.15, No.2
TB Treatment Goes Wireless
A handful of supporters, including the U.S. Department of Commerce's National Telecommunications and Information Administration, last fall awarded grants to CPMC to create a wireless and standard communications network that links three major health care providers in Manhattan. Called Applied Informatics, the venture aims to fight and track the rise of tuberculosis. An estimated 10 million people in the United States are infected with TB, which causes 2,000 related deaths each year.
Conducted in conjunction with the New York City Department of Health and the Visiting Nurse Services of New York City, this 18-month demonstration project will enable Columbia-Presbyterian TB specialist physicians to treat TB patients in their homes via visiting nurses and public health assistants equipped with hand-held communication devices and wireless modems.
"Many TB patients just show up in the emergency room, even though they may be on therapy at the Department of Health," says Dr. Charles Knirsch, assistant clinical professor of medicine who also holds a specialist position with the city health department.
"It's up to the people in the emergency room to obtain accurate patient histories. Very often that's hard; the patients may not give a decent history. A lot of what we hope to do is create a computer interface between the Department of Health and Columbia-Presbyterian. So if a patient that's known at the Department of Health shows up at Columbia-Presbyterian, a physician who logs on the computer to find out about the patient may obtain a limited amount of information from the New York City Department of Health TB Registry. There will be increased information flow between the two places."
A key component of the project is security of patient privacy, says Dr. George Hripcsak, assistant professor of medical informatics. Information will be transferred only to providers with proper authority to receive the information.
TB is difficult to treat because several medications must be taken over a long period of time, often ranging from six months to two years. Partial compliance with therapy not only fails to treat the disease, but also induces the development of TB strains that are resistant to the medication. The most effective way to reduce the spread of TB and the development of drug-resistant strains is by having a qualified health care provider on hand to ensure that patients take their medication.
For the Applied Informatics project, eight visiting nurses and eight public health assistants will visit patients in their homes to track medication compliance and conduct general checkups. Portable computers featuring automated protocols-medical rules encoded in an electronic form-enable them to coordinate the care and update each patient's record for other network users.
"If a patient complains of blurry vision, the nurse is able to enter that into the computer, which lists questions that help determine the cause," says Dr. Hripcsak.
"We're not just linking our electronic medical records, but we're really using an automated physician support system, wireless computers, and new technologies like natural language processing that take something that you would write down in English and turn it into a coded form that can be used by the computer."
Though only 16 health care professionals carry portable computers, Dr. Hripcsak predicts that hundreds of physicians will benefit from the network.
"Whomever sends a patient for VNS care will be helped by this," he says. "For example, when a doctor wants a patient to be seen by a visiting nurse, a doctor or social worker has to fill out forms. We're streamlining that. Part of sharing the electronic mail record is a forms application that streamlines the flow of information among us."
Dr. Hripcsak says the applied informatics system eventually will be used to meet all health care needs. He expects it to be fully operational for TB patients by July.