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PubMed2004

Introducing new technology: handheld computers and drug databases. A comparison between two residency programs.

There have been numerous efforts to introduce and increase the use of handheld computers, also called personal digital assistants (PDA), in health care, one of which is the distribution of PDAs to Neurology residents at the University of Illinois at Chicago. The authors examined the success of this intervention by comparing PDA use and user attitudes between residents of the intervention group and residents in another residency program where the use of PDAs is neither encouraged nor discouraged. The authors examined in particular the use of drug databases on the PDA as its currently most popular application in health care. The use of PDAs for purposes not related to health care was widespread among individuals in both programs, but the use of drug databases was significantly more common in the control group, which can be interpreted as a success of the intervention.

Adult↗
PubMed2005

Organizational and physician perspectives about facilitating handheld computer use in clinical practice: results of a cross-site qualitative study.

OBJECTIVE: To describe strategies that organizations select to support physicians' use of handheld computers (HHCs) in clinical practice and to explore issues about facilitating HHC use. DESIGN: A multidisciplinary team used focus groups and interviews with clinical, administrative, and information technology (IT) staff to gather data from 161 informants at seven sites. Transcripts were coded using a combination of deductive and inductive approaches to both answer research questions and identify patterns and themes that emerged in the data. MEASUREMENTS: Answers to questions about strategies for HHC support and themes about (1) how to facilitate physician adoption and use and (2) organizational concerns. RESULTS: Three main organizational strategies for HHC support were characterized among sites: (1) active support for broad-based use, (2) active support for niche use, and (3) basic support for individual physician users. Three high-level themes emerged around how to best facilitate physician adoption and use of HHCs: (1) improving usability and usefulness, (2) promoting HHCs and device use, and (3) providing training and support. However, four major themes also emerged related to organizations' concerns about HHC use: (1) security-related concerns, (2) economic concerns, (3) technical concerns, and (4) strategic concerns. CONCLUSION: An organizational approach to HHC support that involves individualized attention to existing and potential physician users rather than one-size-fits-all, organization-wide implementation efforts was an important facilitator promoting physician use of HHCs. Health care organizations interested in supporting HHC use must consider issues related to security, economics, and IT strategy that may not be prominent concerns for physician users.

Attitude of Health Personnel↗
PubMed2002

The use of handheld computers in clinical trials.

A recently completed, randomized, double-blind placebo-controlled clinical trial is presented in which Palm handheld computers were used as a substitute for normal paper-based patient diaries. In this nasal provocation study, a common antihistamine approved for the treatment of seasonal allergic rhinitis was tested against placebo for evidence of additional properties. In addition to their medical examinations, the 12 study volunteers rated subjective complaints in a diary program on 4 examination days, for a duration of 4.5 hours every 15 minutes at each visit. This resulted in 903 data sets consisting of five questions each, or 4515 data points total. In this study the use of handheld computers resulted in an increase in data quality and shortened the time needed to close the database. Moreover, the benefit of electronic reminders for protocol compliance is clearly demonstrated. Our findings support the results found in the literature we reviewed. For more than 16 years, mobile computers have been supporting the implementation of clinical trials. Our review of 27 articles out of more than 100 clinical trials in which mobile computers have been used elaborates on the advantages and problems of this technology. We give a comprehensive overview of the various technologies as used in different settings, and then discuss the methodology of using mobile devices in comparison to traditional methods, the considerations that need to be made and things to be avoided in order to conduct a successful clinical trial with mobile tools. We conclude that mobile devices are very useful in most cases, especially when design and software validation aspects have been taken into account.

Adult↗
PubMedDate not supplied

A handheld computer smoking intervention tool and its effects on physician smoking cessation counseling.

OBJECTIVE: The objective of this study was to evaluate a handheld computer smoking cessation intervention tool designed to assist physicians in their smoking cessation counseling with patients. METHODS: This study used a pre/post survey design, with a 4-month trial period for the software. Study participants included 22 faculty and resident physicians from the University of Virginia. Paired samples t tests were used to assess mean differences in the 4 main subscales (physician behavior, attitudes, comfort related to counseling patients about smoking cessation, and knowledge). RESULTS: No statistically significant mean differences were found for physician behavior (mean increase = 0.44, P = .55) or physician attitude (mean increase = 0.44, P = .16). A statistically significant mean increase of 2.29 was observed for the physician comfort subscale (t = 3.87, df = 16, P = .001). Physicians indicated improved comfort in counseling patients about smoking cessation (P = .007) and improved comfort in using the Public Health Service Clinical Practice Guidelines (P = .012). CONCLUSION: Physician comfort level in counseling patients about smoking cessation can be improved through handheld computer software. When used in conjunction with other practice modifications, this tool has the potential to improve physician smoking cessation intervention practices.

Adult↗
PubMed2005

Usability study on two handheld computers to retrieve drug information.

UNLABELLED: Objective :Performing a usability study on two handheld computers (personal digital assistant and tablet PC), as tools for retrieving drug information. MATERIALS AND METHODS: A randomised crossover study was performed: 34 students in pharmacy and medicine used the two handheld tools in a randomised order, to answer a questionnaire containing 12 questions covering all the aspects of a drug database and a qualitative analysis on six different items to measure access to drug information. The availability of the drug information database Vidal on PDA and on tablet PC implied our choice of the database. Three main criteria for evaluation were chosen: success rates, time-on-task, and number of clicks. RESULTS: There were no significant differences between the two groups neither on age, sex, medical discipline, study years nor previous computer practice. The success rate is significantly higher with the PDA for only one question. The PDA is significantly faster than the tablet PC on 7 of the 12 questions and generates fewer clicks for 3 questions. Compared to the tablet PC, it appears that the PDA is better in terms of clearness, navigability and usefulness for professional practice and it is the only tool which is significantly preferred to all other supports. CONCLUSION: In this study with students, the PDA is significantly more effective quantitatively and qualitatively than the tablet PC to retrieve drug information.

Attitude to Computers↗
PubMed2001

Information at hand: using handheld computers in medicine.

Call them handhelds, palm-tops, or personal digital assistants (PDAs), pocket-sized computers are becoming a common feature on the medical landscape. As the technology improves, more programs become available, and the demands of medical practice heighten, physicians are recognizing the benefits of having information available at the point of care. This article reviews the use of handheld computers in medicine, emphasizing how they might help the practicing physician.

Equipment Design↗
PubMed2004

Synchronized time-motion study in the emergency department using a handheld computer application.

Emergency departments present a challenging environment for workflow evaluation and measurement of the effect of information system interventions. This paper describes a time-motion data collection tool built as a handheld computer application. The tool allows mobility of the observer and the intuitive inter-face supports rapid selection of tasks and frequent changes in tasks. It also allows documentation of overlapping tasks, a common occurrence in the emergency department. Synchronized data collection across the different providers of care in the emergency department is demonstrated, resulting in a data set from which task/event sequences can be built, documenting the ED care of individual patients. This technique should provide a very useful tool in measuring the effect of process changes in this difficult-to-assess environment, particularly changes in the information system.

Computers, Handheld↗
PubMed2005

Continuous murmur caused by a ventricular septal defect post-myocardial infarction: visual display with a handheld computer.

Ventricular septal defects do not typically result in a continuous murmur. The only previously reported case involved a congenital ventricular septal defect. We report a case of an acquired ventricular septal defect following a large anterior myocardial infarction resulting in a continuous murmur. The continUous nature was confirmed both with 2D echocardiography and a specially equipped stethoscope in conjunction with a handheld computer to provide a visual display of the murmur. A proposed mechanism for the continuous murmur was discussed.

Computers, Handheld↗
PubMed2005

A review and a framework of handheld computer adoption in healthcare.

Wide adoption of mobile computing technology can potentially improve information access, enhance workflow, and promote evidence-based practice to make informed and effective decisions at the point of care. Handheld computers or personal digital assistants (PDAs) offer portable and unobtrusive access to clinical data and relevant information at the point of care. This article reviews the literature on issues related to adoption of PDAs in health care and barriers to PDA adoption. Studies showed that PDAs were used widely in health care providers' practice, and the level of use is expected to rise rapidly. Most care providers found PDAs to be functional and useful in areas of documentation, medical reference, and access to patient data. Major barriers to adoption were identified as usability, security concerns, and lack of technical and organizational support. PDAs offer health care practitioners advantages to enhance their clinical practice. However, better designed PDA hardware and software applications, more institutional support, seamless integration of PDA technology with hospital information systems, and satisfactory security measures are necessary to increase acceptance and wide use of PDAs in healthcare.

Access to Information↗
PubMed2006

Use of handheld computer technology to monitor general practice residents' clinical experiences.

The Commission on Dental Accreditation (CODA) requires that General Practice Residency (GPR) programs report a summary of each resident's clinical experiences. The goal of this study was to determine the effectiveness of handheld computer technology in tracking residents' clinical procedures. In the academic years 2004-05 and 2005-06, University of Kentucky GPR residents were provided a Palm M130 with customized forms. These menu-driven forms allowed residents to record procedures. Residents synchronized the data to a centralized database. A separate reporting system interfaced with the database to allow administrators to produce detailed reports on each resident. At the end of the academic year, data were tabulated, clinical procedures were correlated with respective costs, and annual production was determined. Data from fourteen residents were analyzed. Types and frequencies of various clinical experiences were tabulated, financial production summaries assessed, and percentage distribution of procedures by discipline was examined. Palm technology has proven to be an effective tool in monitoring each resident's clinical experiences. This methodology was beneficial to residency directors by allowing the examination of the experience distribution of each discipline in dentistry to determine the range of experiences that residents achieved.

Attitude to Computers↗
PubMed2000

Techniques for identifying the applicability of new information management technologies in the clinical setting: an example focusing on handheld computers.

This article describes techniques and strategies used to judge the potential applicability of new information management technologies in the clinical setting and to develop specific design recommendations for new features and services. We focus on a project carried out to identify the potential uses of handheld computers (i.e., the Palm Pilot or a small WinCE-based device) in the ambulatory practice setting. We found that the potential for a robust handheld computing device to positively affect the outpatient ambulatory clinical setting is enormous, and that the information derived from the exploratory research project is useful in creating specific design recommendations for further development.

Ambulatory Care Facilities↗
PubMed2003

ABase-a tool for the rapid assessment of anthropometric measurements on handheld computers.

Anthropometry is widely recognized as an important method in the evaluation of dysmorphic children. Nevertheless, it has never gained widespread clinical use. We believe that this has mainly practical reasons: appropriate growth charts are not readily available at the bedside or in clinic and taking multiple measurements and plotting them into corresponding growth charts is a time-consuming task. Here we describe a computer program that overcomes both problems: ABase compares entered anthropometric measurements to a database of age- and sex-matched reference values, calculates the centile rank and displays the result either as text or as a digitized growth chart. The program runs on small handheld computers that can easily be carried around in a shirt pocket.

Anthropometry↗
PubMed2003

Handheld computer application for time-motion studies in the emergency department.

Urban academic emergency departments face significant challenges of increasing patient volumes and sicker patients. Better understanding of the timing and interactions between provider activities may assist in efforts directed toward improving patient-care processes to decrease length of stay. Rapidly chang-ing and overlapping activities in the emergency department make time-motion study difficult. This poster describes a handheld computer application that enables synchronized capture of task description and times across multiple patient care providers in the emergency department.

Computers, Handheld↗
PubMed1985

[Studies on a handheld computer system for perinatal care].

The present paper demonstrates a handheld computer system for use in perinatal care. The features of the system are as follows: The gestational age and fetal body weight were determined by analyzing the data from ultrasonography with the high-order regressive equation. The combined use of the linear regressive equation and Ott's equation was more useful in precisely calculating the fetal abdominal circumference. In order to decrease input error, attempts were made to minimize key-operations for data-entry. The use of the screen edition system also made it easier to correct input error. It was concluded that this system was practical and easy to handle, and would be a useful aid in clinical care.

Body Weight↗
PubMed1996

Survey of sociodemographic characteristics of tobacco use among 99,598 individuals in Bombay, India using handheld computers.

OBJECTIVES: To study the diversity and sociodemographic characteristics of tobacco use in Bombay, India. DESIGN: Population-based, cross-sectional, house-to-house survey with face-to-face interviews in the city of Bombay during 1992-94. Data was input directly into a programmed, handheld computer (electronic diary). PARTICIPANTS: Permanent residents of the city of Bombay aged 35 years and older. MAIN OUTCOME MEASURES: Tobacco use in various smoking and smokeless forms. RESULTS: 99598 individuals were interviewed (60% women, 40% men). Among women, prevalence of tobacco use was high (57.5%) but almost solely in the smokeless form. Among men, 69.3% reported current tobacco use and 23.6% were smokers. The most common smokeless tobacco practice among women was mishri use (44.5% of smokeless users) and among men betel quid with tobacco (27.1%). About half of smokers used bidi and half smoked cigarettes. Chewing areca nut without tobacco was rare (< 0.5% of smokeless users). Educational level was inversely associated with tobacco use of all kinds except cigarette smoking. CONCLUSIONS: The pattern of tobacco use varies across India and, in Bombay, is very different from other areas. Using handheld computers to collect data in the field was successful.

Adult↗
PubMed2005

Prehospital triage of acute myocardial infarction: wireless transmission of electrocardiograms to the on-call cardiologist via a handheld computer.

BACKGROUND: Use of intravenous fibrinolytic agents and percutaneous coronary interventions produce the greatest benefit when they are implemented in the first 2 hours after symptom onset. Further delays in the time to treatment typically lead to reduced benefits and poorer outcomes. METHODS: Cabarrus County Emergency Medical Service personnel complete an acute myocardial infarction case report form and assess a 12-lead electrocardiogram (ECG) to determine if ST elevation of at least 1 mV in at least 2 contiguous leads is present and then to transmit the ECG wirelessly to the emergency department (ED). The ECG is then forwarded wirelessly from the ED to the on-call cardiologist who is carrying the IPAQ handheld computer. RESULTS: Five representative patients managed using this system during the initial year of its implementation are presented. CONCLUSION: The examples included in this article illustrate that the system and technology can work if applied in a coordinated fashion using multiple disciplines including emergency medical service, cardiologists, ED personnel, and the hospital cardiac care team, which includes the catheterization laboratory call team, acute coronary care nurses, and clerical support staff.

Adult↗
PubMed2005

Anaesthesia record system on handheld computers--pilot experience and uses for quality control and clinical guidelines.

This paper describes a mobile information system to collect patient information for anesthesia quality control. In this system, a mobile database program was designed for use on handheld computers (Pocket PC). This program is used to collect patient data at the bedside on the handhelds, with a daily synchronization of the data between the anaesthesiologists' handhelds with the anaesthesia database. All collected data are later used for quality control analysis. Furthermore, clinical guidelines will be included on these same handhelds. During the pilot phase, data from a sample set of about 300 patients were incorporated. The processes and interfaces of the system are presented in the paper. The current mobile database system has been designed to replace the original paper-based data collection system. The individual anaesthesiologist's handheld synchronizes patient data daily with anaesthesia database center. This information database is analyzed and used not only to give feedback to the individual doctor or center, but also to review the use of the guidelines provided and the results of their utilization.

Anesthesia↗
PubMed2001

Handheld computing: the next technology frontier for school nurses.

The purpose of this article is to demonstrate the potential utilization of handheld personal digital assistants for school nurses. Handheld devices and their general uses are described. Clinical programs available through downloading and Web sites with handheld resources are included. Finally, specific handheld computer applications that can be adapted for school nurses are discussed.

Forecasting↗