Pocket Computers Chip In To Help Doctors

Richard Saltus, Boston Globe Staff 

MARLBOROUGH, Mass. - September 3, 1994 - A year after Apple's pocket-sized Newton computer hit the stores with a deafening thud, the overhyped ''personal digital assistant'' is winning friends among doctors, who are carrying it in their lab coat pockets at two Boston teaching hospitals. In hospital corridors or at patients' bedsides, the physicians can tap into the equivalent of 1,500 pages of medical and drug information programmed into the Newtons. In less time than it would take to thumb through a textbook, the doctors can flip open the Newton, tap its glass face with a stylus and read about the side effects of Prozac or how to treat an exotic tropical disease. They can browse a new article from a medical journal or get a specialist's phone number.

Dr. Michael Glickman, a second-year resident in internal medicine at Massachusetts General Hospital, says having the information so handy can make all the difference.

"Even if you only have to walk one floor down to a medical library" to get the same information, "that's enough to keep you from doing it" during a hectic day, Glickman said.

Twenty-eight resident physicians at MGH and Brigham and Women's Hospital are toting the Newtons in the first phase of a research project named Constellation, aimed at determining the usefulness of portable computers in making medical decisions.

In the first phase, which began in July, doctors are testing the Newton's use as an electronic reference book. In a second phase, beginning later this year or in 1995, the Newton will be linked to hospital databases so that doctors can enter or retrieve data from computerized patients' records or other medical databases. Hookups like these are evolving across the country, hand in hand with changes in health care delivery.

However, cautions Dr. Steven Labkoff, head of the Constellation Project, it's too early to say whether the Newtons will make a significant difference in how doctors perform their jobs. "It's going to have to be as useful as their stethoscope," he said, or they won't be willing to carry it around.

Labkoff, an internist and a member of the Decision Systems Group at Brigham, periodically interviews the resident physicians about their use of the Newtons. He also retrieves data from a program in the Newton that measures the use of the devices.

So far, says Labkoff, physicians at MGH have been more enthusiastic about the Newtons than the users at Brigham and Women's, probably because the Brigham is already well equipped with electronic information systems. Doctors and other health professionals can sit down at one of 3,000 computer terminals throughout the hospital and access a wide range of medical resources.

At MGH, where more information is on paper and in books or manuals, a doctor who would like to consult a reference "might not get to until late at night or the next day," said Dr. Philip Wang, a resident in internal medicine.

The Newton, of course, is only as useful as its contents. Only so much text material can fit in its limited memory, and Labkoff said some of the doctors would prefer different medical references from those available in electronic form. Their wishes may be fulfilled: a demonstration of the Constellation at the MacWorld Expo in Boston last month generated great interest among publishers, he added.

At present, the Newtons contain an electronic version of a multivolume reference called the Medical Knowledge Self-Assessment Program of the American College of Physicians; the Electronic Monthly Prescribing Guide; the Intensive Care Unit/Cardiac Care Unit Drug Reference Book, and the Brigham and Women's Medical Resident's Handbook and phone book.

Also programmed into the Newton is the American College of Physicians Journal Club, a constantly updated selection of articles from 30 to 40 leading medical journals, Labkoff said.

Apple Computer Inc., which has conceded it took the wrong tack in trying to launch the Newton as a general consumer item, provided the Newtons for the Constellation project. (Two of them have already been stolen from MGH.)

Labkoff did some custom programming of the units, but he said much credit for the Newton's user-friendliness goes to Sandeep Shah, president of K2 Consultants Inc. of Nashua, who devised data compression and search strategy programs.

Dr. Gail Daumit, another participant in Constellation, said last week as she worked in the emergency room at MGH that she uses the Newton frequently, "mainly to look up general medical principles."

"I think what we're seeing here is the next generation" of medical reference and record-keeping, she said. "I think in the next few years, everyone will have something like this."