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PubMed2003

Informatics competencies pre-and post-implementation of a Palm-based student clinical log and informatics for evidence-based practice curriculum.

The purpose of this paper is to describe the implementation and evaluation of a two-part approach to achieving informatics competencies: 1) Palm-based student clinical log for documentation of patient encounters; and 2) informatics for evidence-based practice curriculum. Using a repeated-measures, non-equivalent control group design, self-reported informatics competencies were rated using a survey instrument based upon published informatics competencies for beginning nurses. For the class of 2002, scores increased significantly in all competencies from admission to graduation. Using a minimum score of 3 on a scale of 1=not competent and 5=expert to indicate competence, the only area in which it was not achieved was Computer Skills: Education. For 2001 graduates, Computer Skills: Decision Support was also below 3. There were no significant differences in competency scores between 2001 and 2002 graduates. Computer Skills: Decision Support neared significance. Subsequently, the approaches were refined for implementation in the class of 2003.

Computer Literacy↗
PubMed2003

Pediatricians and personal digital assistants: what type are they using?

Increasing attention is being focused on the potential benefits of personal digital assistants (PDA) in medical practice. Although some work has been done to investigate their use, it is still unclear what types of PDAs are being used by pediatricians, and if they are using different types in different ways. Our goals were to determine: (1) which kinds of PDAs were being used by pediatricians; (2) if the personal or professional characteristics of pediatricians differ by type of PDA they are using; (3) if the types of applications they employ differ by the type of PDAs they are using. We randomly selected 2130 pediatricians from the AMA masterfile of United States licensed physicians and surveyed them. Of those respondents that reported using a PDA, 89.7% use a Palm OS based system, 8.9% use a Pocket PC based system, and 1.4% used neither. Residents were significantly more likely to use a Palm OS based PDA than non residents (OR 6.32, 95%CI 1.41-27.53). There were significant associations between the PDA platform being used and types of applications being run on them. More than one third of pediatricians are using PDAs in clinical practice. Palm OS based systems are much more prevalent in clinical practice, and the choice of newer pediatricians.

Computers, Handheld↗
PubMed2003

Why don't physicians use their personal digital assistants?

As the Personal Digital Assistant (PDA) user population continues to expand, there is a need to design more useful devices and applications to facilitate the utilization of PDAs. We conducted a structured interview study to examine PDA usage and non-usage patterns among physicians. The purpose of this descriptive study was to identify the barriers that impede physicians in their PDA use. A data collection tool was developed to record: 1) how physicians use their PDAs, 2) functions and applications used, 3) functions and applications not used, 4) reasons and examples of why physicians don't use PDAs for those functions, and 5) the recall of specific incidents of PDA usage using Critical Incident Technique (CIT). Interview data were transcribed and analyzed. Study findings and how those barriers can be addressed are discussed.

Academic Medical Centers↗
PubMed2003

Web-based data and knowledge sharing between stroke units and general practitioners.

We describe a telemedicine application for emergency management in Stroke Units, where prompt decisions must be taken, often knowing neither the clinical history nor the stroke symptoms onset modality. We have designed and implemented an Information and Communication Technology architecture for the situation in which a general practitioner is called for a suspected stroke and provides for the admission to a Stroke Unit. By means of a palmtop and a wireless Internet connection, he can send to the Stroke Unit the demographic data, the list of the patient's problems, current and/or recent therapies, and a guideline-based stroke-specific form with the objective examination results. In this way, the Stroke Unit team is alerted and informed before the patient arrival, and can manage the urgency at the best. The proposal involved 20 general practitioners and one Stroke Unit in the Lombardia Region, Italy.

Computer Systems↗
PubMed2003

Information needs of residents during inpatient and outpatient rotations: identifying effective personal digital assistant applications.

Last year, we reported (2002 AMIA Proceedings, p 971) on how medical school residents report on their use of personal digital assistants (PDA) or hand held devices. We first surveyed 88 residents in six residency programs representing both generalist and specialist practices (Family Medicine, Internal Medicine, Neurology, Pediatrics, Radiology, and Surgery. Following our survey, we contacted some of these same residents for follow-up advantages and disadvantages of specific software applications, and what information residents would like to have on their PDAs. Our survey and interview results included several specific advantages and disadvantages of PDA usage by residents. Advantages included: (1) many residents readily adapted the personal organizers (calendars. address books, to-do lists) to help keep track of their clinical tasks, and keeping in touch with patients, (2) commercial medical references (such as ePocrates) are used most by the surveyed residents to answer immediate medical questions. Perceived drawbacks include: (1) calculators and patient trackers that were not clearly able to be tailored to residents' needs, e.g., to limit and modify types of calculations to just those actually used, (2) physical size (both too small a display size, and too bulky overall), and (3) several residents mentioned a concern of becoming too dependent on one source of information, a source that was viewed as being too easy to lose or break. Three broad patterns emerged. First, residents in all seven of our surveyed practices use PDAs and most surveyed residents use them on a daily basis; we conclude that PDAs are being widely used across the spectrum of generalist to specialty practices, regardless of whether a residency program specifically encourages PDA usage. Second, security and HIPAA compliance issues need to be addressed, in part by resident education about archiving PDA files. Lastly, PDAs may become even more widely used if clinical data specific to an individual resident can easily and securely be maintained on PDAs. Design of Current Studies Our current study builds on the above perceived needs: we will follow residents during portions of a clinical day. Preliminary observations in three clinical areas (Medical Intensive Care Unit (MICU), General Medicine Outpatient, and Family Medicine Outpatient) confirm the conclusions of our previous study. PDAs are used for: (1) medical references (e.g., five minute clinical consult, Infotriever) (2) pharmaceutical information (such as ePocrates), and (3) professional organization (calendar, address book). Our intention in this new study is to identify the overall flow of information and how PDAs might improve the information flow in clinical settings. We choose to observe residents in both inpatient and outpatient clinics. We anticipate that PDAs will have different uses in these two settings; preliminary observations in one outpatient clinic (Family Medicine) suggests that PDAs are used during the doctor - patient interaction, specifically to suggest the importance of smoking cessation. Preliminary observations in an inpatient clinical setting (the MICU) suggest that PDAs are primarily used outside of patient rooms, e.g. to make medical calculations and to obtain diagnostic procedures. We plan to observe residents during various parts of their days in order to develop a detailed understanding of what information sources (e.g., consultations, computer reports, paper charts) are available at different times and which sources are frequently used. This information will help us develop a pocket-sized, paper-based checksheet that the residents carry with them. The checksheet will help us identify which information sources are used, at various times and frequencies. Interviews with the residents using these checksheets should provide additional details of how utility of the resource, disadvantages of the resource, etc. Specific Goals The goals of our current study include: (1) direct observations of residents PDA usage to determine how this compares to our previous results (above), ts (above), (2) determine if PDA usage varies between outpatient and inpatient clinics, (3) determine how different information sources are used in these clinics. Our long range goal includes considering how PDAs might improve the information gathering processes by identifying useful PDA applications, along with user interfaces residents find intuitive.

Computers, Handheld↗
PubMed2003

Core problems reported by students in a palm OS and Internet-based problem entry system predicts performance on the third-year internal medicine clerkship.

CWeblog is a web and palm OS-based system used by medical students to record the problems and diagnoses of patients encountered in third-year clerkships at the Uniformed Services University. Data is available for analysis by clerkship directors as soon as it is entered. A pretest is given on the first day of the internal medicine third-year clerkship (the clerkship), and the National Board of Medical Examiners shelf examination (NBME) is given during the final twelfth week. Internal medicine specialty societies publish a list of 20 core problems in internal medicine to be emphasized during the third-year clerkship.

Clinical Clerkship↗
PubMed2003

A comparison of self-documentation in diabetics: electronic versus paper diaries.

Attention needs to be given to how patients can capitalize on the benefits of Personal Digital Assistant technology. The specific aims of this pilot study are to compare the efficacy of diabetic patients documenting their health maintenance data (i.e. blood glucose levels, meal intake, and exercise) using an electronic patient diary (ED) versus a traditional pen and paper (PD) diary; and determine participants' satisfaction with each diary approach.

Computers, Handheld↗
PubMed2003

Technology failure analysis: understanding why a diabetes management tool developed for a Personal Digital Assistant (PDA) didn't work in a randomized controlled trial.

Managing Type 1 Diabetes Mellitus is a challenging feat especially for young patients. It is a tedious and demanding disease which requires painful self-monitoring and injections multiple times per day. Many patients are unable to achieve good blood sugar control, in spite of strong evidence that good control leads to better outcomes. Many caregivers believe that more communication between caregivers and patients could lead to better control. This paper describes a tool that was developed to improve communication between caregivers and patients, its testing, how it failed to achieve its outcomes and recommendations for improvement.

Blood Glucose Self-Monitoring↗
PubMed2003

Development of nursing care support system using PDA with wireless and barcode reader.

In this study, we developed nursing care support system using Personal Digital Assistants (PDA) with wireless and barcode reader. Our goals were to minimize the cost of deployment, to maximize the ease of operation, and to adapt to existing features and tasks of nursing care. The success of achieving these objectives was evaluated from the case study results involving system training session and trial of the system at a university hospital.

Computers, Handheld↗