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Silicone-based sandman Local Anesthetist creates software to help out the snooze into surgery Sunday, June 16, 2002 By Scott Deacle, Post-Gazette Staff Writer
John Michael Borza puts people to sleep for a living. Now, the nurse anesthetist is doing something he hopes will wake up his colleagues to new possibilities.
The software is called MOSES, the name of the Biblical character who bore the Ten Commandments on a pair of tablets. Hand-held computers are tablets, too, Borza noted.
It's not a perfect analogy for what the software does, but it's a simpler name than many high-tech products carry, Borza said. And simplicity was one of Borza's goals when he started eAnesthesiaSoftware, the company he operates from the second floor of his Richland home.
Simplicity, and perhaps fun. As he tapped his stylus to show the program's features, he repeatedly chuckled and asked, "Isn't that cool?"
Anesthesia providers rely on paperwork. They are regularly preparing three types of forms: patient records, billing forms and forms that list drug charges.
MOSES puts those forms in a program that can be loaded onto hand-held computers with the Palm operating system. (It's not available for operating systems made by Microsoft.) MOSES asks the user questions, making the forms interactive, which is more precise.
Hand-held computers provide several advantages over desktop personal computers-- the larger computers aren't portable, operating rooms have little space for them, and anesthesia providers must turn away from their patients to use PCs in the operating room.
Borza expects anesthesia providers to lay their small computers next to their patients and record information as they work. They also can take the hand-held computers to presurgical interviews and to the recovery room.
"You can carry it places PCs don't go," he said.
MOSES starts with a screen that asks for the patient's name, age, height, weight, account number and other information. As a safeguard, it asks users to verify the information.
Then the software records information from presurgical interviews, marks surgical charts and inputs data taken after surgery.
Currently, most anesthesia providers fill out paper graphs to record pulse and blood pressure. They make marks every five minutes that roughly correspond to their readings.
If a patient's heart is beating 67 times a minute, for example, they draw a dot somewhere between 60 and 70 on the graph's vertical axis. Someone observing the chart later can't be sure exactly what the pulse was.
To show how MOSES helps keep more precise records, Borza tapped a line on the screen for recording pulse and blood pressure. A dot appeared, marking a pulse reading on the virtual graph. At the same time, a number indicating the dot's value appeared in the upper left-hand corner.
Borza tapped the dot, held the stylus down and dragged it. The number fluctuated as Borza pulled the stylus up and down the screen. He stopped when the number matched the number he wanted to enter.
When MOSES users administer a drug, they tap a pull-down menu and pick the one they want to record. MOSES asks how much they're using and it goes on the virtual chart. The software automatically sends the drug information to a billing form. That, Borza said, helps eliminate a common problem -- forgetting to charge for drugs.
The information collected from each patient can be sent to personal computers through an adapter, or cradle, that comes with most hand-held computers. The information is converted to Microsoft Word or Excel format. The computers can print paper charts.
MOSES lets users search patient records, organize information in a database and make changes. Programmers wrote MOSES so a patient's record can be on only one hand-held computer at a time. That way, two anesthesia providers can't accidentally record conflicting information about the patient.
Borza recommends MOSES users load the program on hand-helds with, rechargeable batteries. During tests, anesthesia providers used MOSES on such hand-held computers their entire working day, and the batteries didn't die.
Beyond anesthesia
Hand-held computers promise to slash paperwork and costs for all types of medical providers. Since they were first mass marketed in the early 1990s, the small computers have made their way into the palms of thousands of health-care professionals
The majority of residency programs now incorporate hand-held computers into physician training, said Dr. Scott Strayer, an assistant professor at the University of Virginia Medical School who studies hand-held computers in health care.
Thousands of health-care applications have been developed for the small computers, he said. One of the most popular is ePocrates. Used by more than 100,000 physicians, according to its manufacturer, it lets doctors find information on drugs in their hand-held computers before prescribing them.
"Hand-held computers are being compared to the stethoscope for this generation of doctors," Strayer said.
Several programs have been developed for anesthesia providers, though none provide all of the options MOSES does. One carries an anesthesia handbook, one allows providers to store a limited amount of case data, and one lets them store billing information.
Hand-held computers are simple and fun to use, Strayer said. Doctors often buy them for personal use and realize they can use them for work-related tasks.
"I think the majority of physicians are going to be using these in the next two to three years," he said. "I think it will have an impact on quality of care and the frequency of errors."
Startups as well as established businesses are developing hand-held computer products for health care, said Susan K. Newbold, a doctoral student in nursing informatics at the University of Maryland School of Nursing and the organizer of an upcoming conference on mobile devices in health care.
Most products focus on physicians, Newbold said. Because of concerns about cost and confidentiality, few nurses store patient data on hand-held computers, Newbold said.
Those same concerns bother some health care executives, Strayer said. Reluctant to pay for the new technology, they also say law suits could follow if confidential patient information is taken from a hand-held computer, Strayer said.
But small computers can be equipped with password protection or devices that require a thumbprint to access them. Strayer argues information is more likely to be pilfered from patient files sitting on unattended desktops than from password-protected hand-held computers.
MOSES will be used in restricted areas, and the software can also require users to enter a password, Borza said. He said it complies with the Health Insurance Portability and Accountability Act of 1996, a federal law that, among other things, created rules intended to keep electronic patient records confidential.
The ability of hand-held computers to save money and reduce errors may ultimately persuade health care professionals to use them more. In an informal online survey conducted by a Boston hospital, 50 percent of physicians said ePocrates helped them avoid one or more adverse drug events per week. Newbold said a Maryland commission on the nursing shortage is studying hand-held technology to determine whether it can reduce nurses' paperwork, one reason many nurses say they leave the field.
Prompted by dissatisfaction
Borza, 42, grew up in Duquesne and has spent most of his life in Western Pennsylvania. He trained to be a nurse anesthetist at La Roche College in McCandless and at the Allegheny Valley Hospital School of Anesthesia in Harrison.
He works as chief nurse anesthetist at Ingham Regional Medical Center in Lansing, Mich., because he can't find a similar job in the Pittsburgh region. He wants to stay here, however, so he drives 5 1/2 hours between work and home at the beginning and end of every work week.
He started eAnesthesiaSoftware in 1999 after he became dissatisfied with personal computer-based products for anesthesia providers and decided to find a way to use hand-held computers in his field. Believing many anesthesia providers aren't computer literate, he tried to make his solution simple, reliable and compatible with standard computers.
With no experience writing software, Borza paid contractors to write the code. Consultants gave legal and marketing advice. EAnesthesiaSoftware has no full-time employees.
"I gathered the people we needed to create the product, and the programmers did the rest," he said.
After two years of working on the program, Borza tested it at a hospital in Morgantown, W.Va., with nurse anesthetists and anesthesiologists. He gave hand-held computers loaded with MOSES to the anesthesia providers without any instructions. He said they figured out how to use it in an average of 20 minutes.
Borza made his first sales pitches this month. Two hospitals in the Philadelphia area agreed to test it in August, he said.
He's charging $5,000 per user, about half of what he says a typical PC-based system for anesthesia providers costs.
Borza said he has received offers of venture capital but turned them down. It's easy to imagine lucrative ways the idea could be applied to other branches of medical care.
Asked if he's planning to develop other products, Borza only said, "We're working on a lot neat things I can't tell you."
Copyright ©1997-2002 PG Publishing Co., Inc. All Rights Reserved.
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