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PubMed2001

Use of handheld computers as bedside information providers.

Access to clinical reference information at the point-of-care is a goal that is difficult to achieve by lack of really portable reference material. Handheld computers have matured to the point where they are powerful enough to be used as clients of a distributed knowledge system serving reference information and decision-aid applications in a highly portable form factor. We describe a pilot project launched at the Geneva University Hospital studying the use of handhelds and associated clinical applications in two internal medicine clinics. Results garnered by this study will help answer the many questions raised by the use of handhelds in medical practice, in term of cost, benefits, risk and change in workflow.

Hospitals, University↗
PubMed2000

A guideline implementation system using handheld computers for office management of asthma: effects on adherence and patient outcomes.

OBJECTIVE: To evaluate effects on the process and outcomes of care brought about by use of a handheld, computer-based system that implements the American Academy of Pediatrics guideline on office management of asthma exacerbations. DESIGN: A before-after trial with randomly selected, office-based Connecticut pediatricians. In both the control and intervention phases, physicians collected data from 10 patient encounters for acute asthma exacerbations. During the intervention phase, the computer provided for structured encounter documentation and offered recommendations based on the guideline of the American Academy of Pediatrics. Patients were contacted by telephone 7 to 14 days after the visit to assess outcomes. RESULTS: Nine study-physicians enrolled 91 patients in the control phase and 74 in the intervention phase. Follow-up information was available for 93% of encounters. Use of the intervention was associated with increased mean frequency/visit of: 1) measurements of peak expiratory flow rate (2.18 vs 1.57) and oxygen saturation (1.12 vs.42), and 2) administration of nebulized beta2-agonists (1.25 vs.71). Visits in the intervention phase lasted longer and fees were higher ($145.61 vs $103.11). There were no significant differences in immediate disposition or subsequent emergency department visits, hospitalizations, missed school, or caretaker's missed work during the 7 days post visit. CONCLUSION: Use of handheld computers that provide guideline-based decision support was associated with increased physician adherence to guideline recommendations; however, visits were prolonged, fees were higher, and no improvement could be demonstrated with regard to the observed intermediate-term patient outcomes. Guideline implementers (and users) should be cautious about putting unvalidated recommendations into practice.

Adolescent↗
PubMed2006

Development and testing of a scale to assess physician attitudes about handheld computers with decision support.

OBJECTIVE: The authors developed and evaluated a rating scale, the Attitudes toward Handheld Decision Support Software Scale (H-DSS), to assess physician attitudes about handheld decision support systems. DESIGN: The authors conducted a prospective assessment of psychometric characteristics of the H-DSS including reliability, validity, and responsiveness. Participants were 82 Internal Medicine residents. A higher score on each of the 14 five-point Likert scale items reflected a more positive attitude about handheld DSS. The H-DSS score is the mean across the fourteen items. Attitudes toward the use of the handheld DSS were assessed prior to and six months after receiving the handheld device. STATISTICS: Cronbach's Alpha was used to assess internal consistency reliability. Pearson correlations were used to estimate and detect significant associations between scale scores and other measures (validity). Paired sample t-tests were used to test for changes in the mean attitude scale score (responsiveness) and for differences between groups. RESULTS: Internal consistency reliability for the scale was alpha = 0.73. In testing validity, moderate correlations were noted between the attitude scale scores and self-reported Personal Digital Assistant (PDA) usage in the hospital (correlation coefficient = 0.55) and clinic (0.48), p < 0.05 for both. The scale was responsive, in that it detected the expected increase in scores between the two administrations (3.99 (s.d. = 0.35) vs. 4.08, (s.d. = 0.34), p < 0.005). CONCLUSION: The authors' evaluation showed that the H-DSS scale was reliable, valid, and responsive. The scale can be used to guide future handheld DSS development and implementation.

Analysis of Variance↗
PubMed2005

Handheld computer surveillance: shoe-leather epidemiology in the "palm" of your hand.

BACKGROUND: Although urinary tract infections (UTIs) are the most common nosocomial infection, active UTI surveillance is often not feasible for infection control departments. METHODS: As part of an ongoing urinary catheter evaluation, we investigated the accuracy and cost-effectiveness of using handheld personal digital assistants (PDA) and computer-based UTI surveillance in comparison with traditional surveillance of UTIs among medical intensive care unit (MICU) patients. From September 22, 2000, to October 22, 2000, an infection control practitioner (ICP) actively surveyed all MICU patients who had a urinary catheter to determine criteria for a nosocomial UTI as defined by the Centers for Disease Control and Prevention (CDC). Research assistants visited the unit each day to determine which patients had urinary catheters, and this information was uploaded to a database designed for laboratory-based UTI surveillance. Patients with a urinary catheter were included if admitted to the MICU for >48 hours and excluded if symptoms developed <48 hours after admission. RESULTS: Both data collection methods identified 8 UTIs within the 1-month period, with 3 UTIs meeting inclusion criteria. Traditional surveillance required 8 hours weekly, whereas the PDA-computer surveillance required 1-and-a-half hours weekly. Traditional surveillance correctly attributed all 3 UTIs to the MICU. The PDA-computer surveillance incorrectly attributed the location of 2 of the UTIs. In both cases, the UTI occurred less than 48 hours after the patient was transferred from the MICU. CONCLUSION: Our data demonstrate that PDA surveillance detects nosocomial UTIs efficiently and is a novel, timesaving technique that realizes a cost savings in the first year.

Catheters, Indwelling↗
PubMed2005

Diversion of ST-elevation myocardial infarction patients for primary angioplasty based on wireless prehospital 12-lead electrocardiographic transmission directly to the cardiologist's handheld computer: a progress report.

BACKGROUND: Time to reperfusion is critical for outcome in patients with ST-elevation myocardial infarction (STEMI). In our region, patients are routinely treated by primary percutaneous coronary intervention (pPCI), but rerouting patients from the primary receiving hospital to a catheterization center can cause unacceptable delays that may exceed 1 hour in the emergency department. Wireless transmission of prehospital electrocardiograms (ECGs) to receiving stations in hospitals has been shown to reduce time from symptom onset to reperfusion. However, transmission directly to a cardiologist's handheld digital device has not been investigated. AIM: To report preliminary data from a larger ongoing trial evaluating prehospital 12-lead ECG transmission to a cardiologist's handheld device in patients with symptoms suggesting an acute coronary syndrome. METHOD: Patients suffering acute, nontraumatic chest pain have their prehospital ECG transmitted by wireless technology directly to a cardiologist's handheld device at an invasive hospital, allowing diversion of STEMI cases to rapid pPCI. Transmission failures are documented. Times for symptom onset, 911 alert, ECG recording, hospital arrival, and pPCI are obtained. All time intervals are summarized as median values and are compared with historic controls from the Danish multicenter study, DANAMI-2. RESULTS: During the first 15 months of the trial, prehospital ECGs were transmitted for 408 chest pain patients with an overall success rate of 93%. Cardiologist receiving the ECGs recommended that 113 patients (28%) be diverted for pPCI. Mean time from symptom onset to 911 alert was 2 hours 16 minutes (range, 1 minute to 23 hours 15 minutes), and the ambulance response interval was 5 minutes (range, 1-25 minutes). The ambulance on-scene time had increased by 7 minutes compared with historic controls (P<.05). Time from ECG recording to hospital arrival was 25 minutes. The total prehospital time was 2 hours 57 minutes. The hospital treatment time was substantially reduced among diverted patients. Hospital arrival to procedure start was 40 minutes, compared with 94 minutes in the DANAMI-2 historic control group (P<.01). CONCLUSION: These preliminary data suggest that transmission of prehospital 12-lead ECGs directly to the attending cardiologist using handheld devices is a technologically sound concept without major safety concerns and markedly reducing time to reperfusion in patients with STEMI.

Adult↗
PubMed2000

Text entry on handheld computers by older users.

Small pocket computers offer great potential in workplaces where mobility is needed to collect data or access reference information while carrying out tasks such as maintenance or customer support. This paper reports on three studies examining the hypothesis that data entry by older workers is easier when the pocket computer has a physical keyboard, albeit a small one, rather than a touch-screen keyboard. Using a counter-balanced, within-subjects design the accuracy and speed with which adults over 55 years of age could make or modify short text entries was measured for both kinds of pocket computer. The keyboard computer was the Hewlett Packard 360LX (HP), but the touch-screen computers varied across studies (experiment 1: Apple Newton and PalmPilot; experiment 2: Philips Nino; experiment 3: Casio E10). All studies showed significant decrements in accuracy and speed when entering text via the touch-screen. Across studies, most participants preferred using the HP's small physical keyboard. Even after additional practice with the touch screen (experiments 2 and 3) many entries still contained errors. Experiment 3 showed that younger people were faster but not more accurate than older people at using the touch-screen keyboard. It is concluded that satisfactory text entry on palm-size computers awaits improvements to the touch-screen keyboard or alternative input methods such as handwriting or voice. Interface developments that assist older people typically benefit younger users too.

Aged↗
PubMed2002

Development of a handheld computer documentation system to enhance an integrated primary care clerkship.

Documentation systems are used by medical schools and residency programs to record the clinical experiences of their learners. The authors developed a system for their school's (Dartmouth's) multidisciplinary primary care clerkship (family medicine, internal medicine, pediatrics) that documents students' clinical and educational experiences and provides feedback designed to enhance clinical training utilizing a timely data-reporting system. The five critical components of the system are (1) a valid, reliable and feasible data-collection instrument; (2) orientation of and ongoing support for student and faculty users; (3) generation and distribution of timely feedback reports to students, preceptors, and clerkship directors; (4) adequate financial and technical support; and (5) a database design that allows for overall evaluation of educational outcomes. The system, whose development began in 1997, generated and distributed approximately 150 peer-comparison reports of clinical teaching experiences to students, preceptors, and course directors during 2001, in formats that are easy to interpret and use to individualize learning. The authors present report formats and annual cost estimate comparisons of paper- and computer-based system development and maintenance, which range from $35,935 to $53,780 for the paper-based system and from $46,820 to $109,308 for the computer-based system. They mention ongoing challenges in components of the system. They conclude that a comprehensive documentation and feedback system provides an essential infrastructure for the evaluation and enhancement of community-based teaching and learning in primary care ambulatory clerkships, whether separate or integrated.

Clinical Clerkship↗
PubMed1999

The usefulness of handheld computers in a surgical group practice.

We designed a system using hand-held computers allowing physicians in the hospital setting to access their surgical schedules, to track patients in multiple hospitals, and to quickly enter billing information. The physicians would then update their schedules and pass billing information electronically when they returned to the office. The system was successfully implemented, it was well accepted by clinicians and staff users, and it showed an increased capture of charges. Whether an economically important effect on the number of days to post hospital charges will be evident after follow-up data has been collected.

Appointments and Schedules↗