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Personal digital assistants.

Personal digital assistant sales are growing exponentially, and as medical technology advances the amount of information available becomes staggering, making a handheld device, with the ability to store a great amount of information, progressively more valuable to health care providers. Mobile computing allows for a great deal of knowledge in a small package, creating a "walking library" with a mobile collection of data always accessible. There are many diverse types of PDAs, and this article discusses the history of PDAs, general purchasing issues, general PDA features, and the most significant differences between the Palm and the Windows CE operating systems.

Computer Communication Networks↗

Personal digital assistants change management more often than paper texts and foster patient confidence.

INTRODUCTION: Rapid retrieval of information, including drug treatment options, is critical to emergency department practice. OBJECTIVES: To assess feasibility and patient acceptance of personal digital assistants and to determine the scope of management changes. METHODS: Emergency medicine residents (EMRs, n = 18) and emergency medicine attending (EMAs, n = 12) used personal digital assistants with drug database and clinical references. Text versions were also available in the emergency department. We did a prospective, random, cross-over time-motion study, recording retrieval time, source, and changes to patient care for 16 and 8 h for EMRs and EMAs, respectively. We surveyed patients for confidence in EMRs and EMAs with personal digital assistants, and perceived efficiency. RESULTS: EMRs accessed paper (n = 131) or personal digital assistant (n = 181) information on 92.3% of patients (n = 17, both). They accessed personal digital assistant on 61.4% of patients vs. 44.5% with texts (odds ratio 1.99, 95% confidence interval 1.4-2.80). Mean access times were 9.3 and 9.4 s, respectively, +1.4 for both. Personal digital assistant access was 75%/25% between pharmacopeia and clinical resource. Personal digital assistants changed drug choice in 39/181 patients (21.5%), and other management (diagnosis, treatment or disposition) in 15/181 patients (8.3%). Odds ratio for change in management for personal digital assistant vs. paper was 2.00 (95% confidence interval 1.11-3.60). We surveyed patient perception for 198 of 295 patients (67.1%). Fifty percent reported more confidence in their EMRs and EMAs with a personal digital assistant, while 5% reported less confidence. Sixty percent agreed strongly that there is too much medical information to remember. CONCLUSIONS: Personal digital assistants are feasible in an academic emergency department and change management more often than texts. EMRs accessed personal digital assistants more often than paper texts. Patient perceptions of physicians who use personal digital assistants are neutral or favorable.

Attitude of Health Personnel↗

HDR quality assurance methods for personal digital assistants.

An important component of every clinical high-dose-rate (HDR) brachytherapy program is quality assurance (QA). One of the QA recommendations of the AAPM TG59 report is an independent verification on the results of treatment planning. It is desirable for the verification procedure to be as quick and easy to perform as possible and yet to have a high probability of detecting significant errors. The objective of this work is to describe the dosimetric methods and software developed to implement a departmental HDR QA program using personal digital assistants (PDAs). Verification of MammoSite treatment plans is presented as a practical example. PDAs that run the PalmOS were selected for their low cost and popularity among health care professionals. General-purpose applications were developed for linear sources, planar, and volume implants, that estimate the total dwell time of an HDR implant. This value can then be compared to the total dwell time calculated by the primary treatment planning system. The software incorporates the Paterson-Parker (PP) radium tables and the Greenfield-Tichman-Norman (GTN) version of the Quimby radium tables, which have been modified to a form more convenient for HDR calculations. A special purpose application based on the AAPM TG43 formalism was developed for the MammoSite breast applicator. For QA calculations perpendicular to the center of a single Iridium-192 (192I) HDR source, as exemplified by MammoSite treatments, linearly interpolating the PP or GTN tables is equivalent to applying the TG43 formalism at distances up to 5 cm from the source axis. The MammoSite-specific software also offers the option to calculate dosimetry based on the balloon volume. The PDA clock/calendar permits the software to automatically account for source decay. The touch-sensitive screen allows the familiar tabular format to be maintained while minimizing the effort required for calculations. The PP and GTN radium implant tables are easily modified to a form more convenient for HDR calculations. Deploying the HDR versions of the tables as PDA software makes general-purpose HDR QA effortless. For less conventional HDR applications such as MammoSite implants, a QA solution based on the TG43 formalism becomes practical when implemented on a small computer.

Brachytherapy↗

Paper or plastic? Data equivalence in paper and electronic diaries.

Concern has been raised about the lack of participant compliance in diary studies that use paper-and-pencil as opposed to electronic formats. Three studies explored the magnitude of compliance problems and their effects on data quality. Study 1 used random signals to elicit diary reports and found close matches to self-reported completion times, matches that could not plausibly have been fabricated. Studies 2 and 3 examined the psychometric and statistical equivalence of data obtained with paper versus electronic formats. With minor exceptions, both methods yielded data that were equivalent psychometrically and in patterns of findings. These results serve to at least partially mollify concern about the validity of paper diary methods.

Adolescent↗

A PDA-based system for online recording and analysis of concurrent events in complex behavioral processes.

This article outlines how a Palm- or Newton-based PDA (personal digital assistant) system for online event recording was used to record and analyze concurrent events. We describe the features of this PDA-based system, called the FIT-System (flexible interface technique), and its application to the analysis of concurrent events in complex behavioral processes--in this case, anesthesia work processes. The patented FIT-System has a unique user interface design allowing the user to design an interface template with a pencil and paper or using a transparency film. The template usually consists of a drawing or sketch that includes icons or symbols that depict the observer's representation of the situation to be observed. In this study, the FIT-System allowed us to create a design for fast, intuitive online recording of concurrent events using a set of 41 observation codes. An analysis of concurrent events leads to a description of action density, and our results revealed a characteristic distribution of action density during the administration of anesthesia in the operating room. This distribution indicated the central role of the overlapping operations in the action sequences of medical professionals as they deal with the varying requirements of this complex task. We believe that the FIT-System for online recording of concurrent events in complex behavioral processes has the potential to be useful across a broad spectrum of research areas.

Adult↗

Communicable disease case entry using PDAs and public wireless networks.

Concerns about detecting and responding to attacks with biowarfare agents have resulted in the development of deployable case reporting systems, e.g. RSVP. We implement a proof of concept web-based information system to be used securely from personal digital assistants over public wireless networks, by public health field workers for routine and emergent case reporting. The system collects data for a local health jurisdiction, provides content- and event-based notification, and forwards case reports to the Colorado State communicable disease reporting system (CEDRS). We believe this demonstrates a useful integration of portable and web-based technologies with public health practice.

Colorado↗

A wireless, handheld decision support system to promote smoking cessation in primary care.

Tobacco use remains a relatively unaddressed cause of disease and death in the daily care of patients by physicians. To overcome the barriers that physicians face in addressing tobacco use and its treatment in the primary care setting, we have developed a clinical decision support system that is readily accessible through the use of familiar wireless handheld devices and supportive of treatment through the implementation of the Tobacco Use and Dependence Treatment Guideline recommendations. We adopted the Information Management Services model to ensure that the application would effectively implement the guideline. The techniques used here are readily adaptable to implementing a broad range of clinical guidelines.

Computer Systems↗

MEMOS: a mobile extensible memory aid system.

Memory disturbances are a frequent outcome of brain damages. Maintenance or enhancement of the patients' quality of life requires enormous effort on the part of caregivers. To support patients with brain injuries, the mobile distributed care system named MEMOS (Mobile Extensible Memory System) was designed, implemented, and tested in the day-care clinic for cognitive neurology at Leipzig University. MEMOS is implemented as a distributed system, using CORBA technologies and Enterprise Java Beans. A special palmtop computer, the Personal Memory Assistant (PMA), reminds the patient of important tasks and supervises the patient's actions. The PMA communicates with the stationary care system via a bi-directional cellular radio connection. The stationary care system was developed to be dependable and scalable. This paper describes the design and function of the MEMOS system.

Activities of Daily Living↗

Exploring patient reactions to pen-tablet computers: a report from CaReNet.

PURPOSE: We wanted to study patient receptivity to using pen-tablet computers for collecting data in a practice-based research network. METHODS: We analyzed exit interviews and field notes collected by trained research assistants as part of a larger Colorado Research Network (CaReNet) study comparing pen-tablet and paper-pencil methods to collect data for the Primary Care Network Survey (PRINS). RESULTS: A total of 168 patients completed a patient exit interview after completion of the pen-tablet-based survey instrument. Analyses of these brief interviews and field notes indicated that patients had favorable reactions to using pen-tablet computers. The most common barriers were related to glitches in the technology; the voice recognition software was the most problematic, with patients (as well as clinicians) finding this feature to be frustrating. CONCLUSIONS: Patients were able and willing to use pen-tablet computers for completing forms within busy primary care offices. Increasing patient involvement in practice-based research may be even more practicable through the use of this novel technology, which can allow patient-directed data collection at a single point in time as well as longitudinally.

Attitude to Computers↗

Miniaturized module for the wireless transmission of measurements with Bluetooth.

The wiring of patients for obtaining medical measurements has many disadvantages. In order to limit these, a miniaturized module was developed which digitalizes analog signals and sends the signal wirelessly to the receiver using Bluetooth. Bluetooth is especially suitable for this application because distances of up to 10 m are possible with low power consumption and robust transmission with encryption. The module consists of a Bluetooth chip, which is initialized in such a way by a microcontroller that connections from other bluetooth receivers can be accepted. The signals are then transmitted to the distant end. The maximum bit rate of the 23 mm x 30 mm module is 73.5 kBit/s. At 4.7 kBit/s, the current consumption is 12 mA.

Amplifiers, Electronic↗

A usability study of the PubMed on Tap user interface for PDAs.

Healthcare providers are challenged by the availability of information at the point of care. Overcoming these challenges requires access to current, reliable, and accurate information. The purpose of the PubMed on Tap project is to discover and implement design principles to facilitate healthcare practitioners' access to medical information at the point-of-care, related to user interface design, organization and performance. The PubMed on Tap prototype was developed for personal digital assistants (PDAs) as a testbed to study these design principles. Usability testing was used to derive conclusions regarding the functionality of PubMed on Tap. Participant events (n=323) mostly occurred in navigational ability (31%) and perceived functionality (33%). A strong correlation (r=0.87) was observed between total time and the sum of negative events in locating functions and navigational categories. Researchers concluded the basic functionality of the PubMed on Tap interface was valuable to users. However, there was room for improvement in the navigational and functional characteristics, such as placing labels on icons, which affected the users' ability to use the research tool.

Attitude to Computers↗

Handheld tools assess medical necessity at the point of care.

An emerging strategy to manage financial risk in clinical practice is to involve the physician at the point of care. Using handheld technology, encounter-specific information along with medical necessity policy can be presented to physicians allowing them to integrate it into their medical decision-making process. Three different strategies are discussed: reference books or paper encounter forms, electronic reference tools, and integrated process tools. The electronic reference tool strategy was evaluated and showed a return on investment exceeding 1200% due to reduced overhead costs associated with rework of claim errors.

Computers, Handheld↗

The implementation of a Personal Digital Assistant (PDA) based patient record and charting system: lessons learned.

Personal Digital Assistants (PDAs) offer many potential advantages to clinicians. A number of systems have begun to appear for all types of PDAs that allow for the recording and tracking of patient information. PDAs allow information to be both entered and accessed at the point of care. They also allow information entered away from a central repository to be added or "synced" with data through the use of a wireless or wired connection. Few systems, however, have been designed to work in the client/server environment. Even fewer have been designed as point of care additions to already existing enterprise systems. This paper describes the issues encountered in deploying such a system for use in the University of Washington Neonatal Intensive Care Unit (NICU). The lessons learned could be applied to other institutions that will seek to add handheld technology to information systems in the future.

Computers, Handheld↗