health information technology and medically underserved areas

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Bridging the Digital Divide in Medically Underserved Areas with PDAs

By: Michael J. Rice Ph.D., ARNP. BC.

Michael has been employed by the Washington State College of
Nursing, Spokane Washington since 1989. An associate professor, he
teaches in the Psychiatric Nurse Practitioner Program. He received
his Master's Degree in Psychiatric Nursing from the College of
Nursing at the University of Nebraska Medical Center, Omaha
Nebraska in 1976. He received his PH.D in Clinical Nursing
Research from the University of Arizona College of Nursing in
1988. He has been board certified by ANCC in Psychiatric Mental
Health since 1995 and is licensed as a Psychiatric ARNP in
Washington State. He also has a private practice at the Suncrest
Wellness Center which is located in Steven's County Washington, a
federally designated medically underserved rural community. He is
a strong advocate for the use of technology to meet health care
needs in rural communities and the recipient of the prestigious
EDUCAUSE 2002 Award for Excellence in Technology Solutions.

 

Health care practitioners in rural areas have limited access to expert
consultants and resource knowledge bases. The opportunity to become
informed on the use and application of the newest medications,
essential patient and family teaching and to check potential drug-drug
interactions is hampered in rural and medically underserved
communities because specialists often reside in more urban settings.
While many knowledge bases are available on line, there are
limitations in rural and medically underserved areas because of the
digital divide, or a lack of access to information technology
resources in rural communities. The advent of Personal Digital
Assistants (PDAs) and their use in health care possess the potential
for resolving many of these resource problems. Yet, health care
professionals familiarity with PDAs must begin in their educational
programs.

Washington State is sparsely populated with a total population of
fewer than two million who reside in an area of over 100,000 square
miles. The vast distances have a negative impact on health care and
thirty-six areas in 39 counties are federally designated as medically
underserved or suffer from health professional shortages. When
compared to the eastern seaboard, Washington State's land mass covers
7-8 states (Figure 1).

 

Figure 1:

Washington State Compared to Eastern Seaboard

Addressing these issues is difficult due to the distances which hamper
access to clinical experts and educational resources. These problems
are being addressed by the Intercollegiate College of
Nursing/Washington State University College of Nursing, which has the
mission of preparing graduate and undergraduate students in multiple
locations throughout the region.

The ICN\WSU College of nursing has received national and international
recognition for its excellence in design and support of distance
education. One of the more innovative projects, has been the Medically
Indigent Rural Area (MIRA) Psychiatric Nurse Practitioner Program
funded by the Health and Resource Services Administration. The MIRA
program has been has been addressing these issues through the
innovative use of technologies to bridge the digital divide and offer
graduate psychiatric nursing education to rural and medically
underserved communities. The MIRA program was awarded to prestigious
EDUCAUSE 2002 award for Excellence in Technology and has had an
increase in enrollment by over 900 percent. The effect of the
innovative distance education technology has had a significant impact
on rural communities and over 90 percent of all graduates now practice
in rural areas. As ICN's distance education programs for mental health
professionals has advanced, graduates have identified that they do not
have easy access to expert information and consultation, as do
providers in more urban areas. Often, access to this information makes
the difference of treating and keeping clients in the rural community
near jobs, families, and friends. The absence of current information
often results in patients transported to locations, facilities, and
services hundreds of miles from their homes. The MIRA program is now
addressing the issue of current medication information using PDA's
during the student's education.

MIRA Psychiatric Nurse Practitioner students in clinical settings will
receive one of 33 PDA devices with a drug database and extensive
training on clinical applications. The College of Nursing MIRA program
received the grant sponsored by Suffolk County Community College and
Symbol Technologies, manufacturer of the PDA. The grant provides 33
Windows CE based PPT 2700 Series, a member of the family of Pocket
PC-based terminals from Symbol Technologies. The PDA's are rugged
PDA's using a Pocket PC platform with a simple, fast touch screen
interface, and Internet browsing capabilities. The PDA's use Intel
StrongARM SA 1110 processor, running at 206 MHz and come with 16
megabytes of memory. The PDA's are ideal for students in rural
settings as Symbol's drop; sealing and temperature specifications are
excellent.

 

Saleh Elgiadi, Director of IT
Testing Symbol PDA

In addition to the basic Windows CE programs, the PDA's contain an
extensive drug data base program called Dr. Drug's. The Dr. Drugs
program is published by FA Davis, powered by Skyscape and includes
brand names, dosing, detailed mechanisms, toxicity, and
pharmacodynamics for more than 3900 mediations. Dr. Drugs was selected
for the students because the program is very detailed and has an
extensive database on natural compounds, costs, generic availability,
and patient teaching. The program has also been rated as superior to
many other popular programs (PDARounds, 2002).

The project investigators, Dr. Michael Rice, MIRA program
administrator, and Saleh Elgiadi, Director of Information Services
feel that providing PDA devices will give the students the confidence
to practice in these underserved areas once they have graduated. The
graduate students will use PDA's during their clinical training in
medically underserved, rural communities and clinics serving
migrant/ethnic populations. Clinical training on the use of the PDA's
will teach students how to directly access medical information and
databases used in clinical decision making that otherwise would not be
available in the rural clinical settings because of a lack of clinical
experts and the lack of current technologies in these medically
underserved geographies.

The students will be oriented and trained in the use of the PDA's
through established MIRA videoconference sites in one-hour seminars
conducted by the project investigators. The effectiveness of the use
of the PDAs for teaching and supervision in rural and medically
underserved communities will be evaluated using three tiers of data.
Each Tier of data is unique and offers some insight into the use and
effectiveness of the PDA's as an educational tool in rural and
medically underserved communities.

The first tier of data will be evaluated using a traditional pre-post
test design. Students will initially be screened prior to training on
the PDA's using instruments developed for this project. The two
instruments developed based on the Flashlight programs Current Student
Inventory (CSI). The CSI is currently licensed and in use by over 120
institutions around the world. The CSI is a construction kit for
creating surveys, interview protocols, and focus groups that gather
information from currently enrolled students, on or off-campus.

Each instruments is a mirror instrument designed to measure the change
in the students' attitudes about the use of the PDA's. The initial
measure "PDA Utilization and Cost Assessment: Time 1" will assess the
student's beliefs and attitudes prior to use of a PDA in a clinical
setting. The second instrument "PDA Utilization and Cost Assessment:
Time 2" will measure their reactions to the PDA's when they complete
their last clinical rotation. Each of the two instruments is composed
of items that address areas of interest in the use of the PDA's. The
instrument will gather student data on; 1. Participation (A), 2.
Research (S), 3. Feedback, (F), 4. Time, Using Productively (D) and 5.
Real world problems (X).

A second tier of data will be gathered on the application and use of
the PDA resources used by the students during their clinical training.
Each of the PDA's is programmed with an Excel spread sheet entitled
"PDA Client Contact Activity". This spread sheet will enable the
students to complete the simple questions after each client visit.
This data will be automatically downloaded on a periodic basis from
the PDA's. A web site operated by the College of Nursing will provide
the students with access to weekly information updates of the primary
drug database. Students will connect their PDA's to their home
computers and simply log on to the established web site. Once
connected, the PDA's will be automatically synchronized and the
information databases will be updated.

The third tier of data will be gathered on the use of "Dr. Drugs". The
Dr. Drug data base program provides automatic updates on all of the
latest medical and pharmacological information. Each week, when in the
process of downloading new information, the College web site will
automatically upload and retain information on the areas of the
database that have been used in the prior week. This information is
then complied and sent to the investigators as a formal report. The
information provided in these reports will indicate areas of interest
in the clinical experiences and used to help tailor the curriculum.
Use of PDA's will be systematically monitored using the established
MIRA videoconference sites in one-hour seminars. Funds for
videoconferencing, web site development and staff/faculty time are
provided through the MIRA project funds from HRSA. The opportunity to
learn the use of PDA, accessing resources and making clinical
decisions based on accessible data bases will reduce the rate of
errors due to drug-drug interactions, medical complications and will
enhance the student's professional skills for post graduation practice
in rural and medically underserved communities. Training the students
in the use of PDA's during their educational programs provides them
will skills and resources that they can continue to use after they
graduate regardless of their location and distance to expert
consultants.

Michael can be reached by email

 

WSU College of Nursing MIRA Program Receives Grant for PDAs.

 

 

© PDA cortex. All Rights Reserved

 

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