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PubMed2006

Nurses' perceptions of adopting a PDA system--application of Lewin's change theory.

PDAs have recently been used in nursing information systems, but few studies have explored their impact on users. The purpose of this study was to explore nurses' perceptions of PDAs. Lewin's theory was used for data analysis. Fifteen nurses participated in in-depth interviews. Results indicated that they initially resisted using the PDA (unfreezing stage), then came around to using it (moving stage), and finally adopted the system (re-freezing stage). An anticipatory stage was added as a feedback mechanism to improve the system. By understanding clinicians' experiences, strategies can be implemented to smooth this process and to achieve optimal nursing care.

Attitude to Computers↗
PubMed2006

Personal diabetes management system based on ubiquitous computing technology.

Assisting diabetes patients to self manage blood glucose test and insulin injection is of great importance for their healthcare. This study presented a PDA based system to manage the personal glucose level data interfaced with a small glucometer through a serial port. The data stored in the PDA can be transmitted by cradle or wireless communication to the remote web-server, where further medical analysis and service is provided. This system enables more efficient and systematic management of diabetes patients through self management and remote medical practice.

Blood Glucose Self-Monitoring↗
PubMed2006

Mobile decision support for advanced practice nurses.

Mobile Decision Support for Advanced Practice Nurses (MODS-APN) is a PDA-based decision support tool designed to assist APNs in the diagnosis and management of smoking cessation, obesity, and depression. It is currently being tested in a randomized, controlled trial (RCT) in a sample of APN students to determine the effect on adherence to clinical practice guideline (CPG) recommendations. Tools such as MODS-APN have the potential to increase CPG adherence, enhance evidence-based practice, promote patient safety, and in the long term improve patient outcomes.

Computers, Handheld↗
PubMed2006

In-training evaluation using hand-held computerized clinical work sampling strategies in radiology residency.

PURPOSE: The in-training evaluation and final in-training evaluation are the mainstay format for evaluation summaries in Canadian residency training programs. This study investigates the feasibility of a clinical work sampling (CWS) approach to evaluation in radiology residency, with the aid of personal hand-held computing devices METHODS: This study was conducted over a 1-year period with 14 radiology residents spanning 4 postgraduate years. Residents were provided with a hand-held device to enter evaluation data, with entries assessing 9 categories of resident performance. Results from the CWS entries were compared with standard in-training evaluations completed at the end of the residents' rotations, as well as with an established annual objective evaluation tool. RESULTS: The overall reliability of the CWS approach according to the observed 7 forms per resident was 0.62, suggesting that a minimum of 20 forms would be required to achieve a reliability of 0.80. For the in-training evaluation report (ITER), internal consistency was 0.98, reflecting very high correlations between categories and indicating that the individual categories are not discriminating. Correlation across rotations was 0.36, which is low for summative evaluation. Correlation between the 2 measures was 0.47 (P = 0.09); neither measure was correlated with the American College of Radiology evaluation. CONCLUSION: The CWS strategy is feasible for adaptation to radiology residency, although compliance with voluntary entries was less than expected. It is not clear whether this reflects the additional burden of using the hand-held device, the fact that entries were voluntary rather than mandatory, or the many demands on both residents and evaluators. The added potential of this evaluation format includes the opportunity to discuss performance at the time of data entry, rather than resorting to the usual end-of-rotation evaluation. Nevertheless, the study has shown that the ITER remains only of marginal value for summative evaluation; the addition of the CWS would require at least 20 forms for acceptable reliability and might not justify the additional cost and complexity.

Canada↗
PubMed2006

Podcasts--an emerging form of digital publishing.

Podcasting has recently emerged as an important information technology tool for health professionals and consumers around the world. Prestigious journals, international conferences, universities and government agencies among other entities are starting to publish digital informotion via audio and video podcasts. Podcosting is distinguished from other forms of digital audio-video content because it can be subscribed to (using Real Simple Syndication or RSS) and easily accessed from a personal computer. Further, it can be downloaded to a mobile device, such as an iPod where the user is able to listen to or watch it anywhere, anytime. Podcosting is used in new and evolving ways to publish information for healthcare education, patient care, professional continuing education, and in support of healthcare research. In addition to a description of what podcasting is, how podcasts are created, and how they are used, this paper addresses four critical issues that are emerging concerning podcasts. These issues are intellectual property and copyright, podcast preservation, podcast location, and podcast standards. As podcasting matures and new uses are discovered, we will see podcasting incorporated into our education, research and patient care publication paradigm.

Computers, Handheld↗
PubMed2003

A web and handheld based diagnosis & procedure tracking system.

Personal computing devices such as personal organizers, handheld PC's, and tablet PC's are becoming common tools in clinical care and medical education. There is an increasing need for these devices to track various tasks students and medical trainees perform. In particular, in undergraduate medical education, there is a need for tracking the depth and breadth of each student's clinical encounters over the course of his or her education. The authors have developed an application which allows for easy and rapid deployment of a tracking system for medical students' experiences during their clinical training years.

Computers, Handheld↗
PubMed2003

Mobile physician order entry.

Because both computerized physician order entry (CPOE) systems and mobile technologies such as handheld devices have the potential to greatly impact the industry's future, IT vendors, hospitals, and clinicians are simply merging them into a logical convergence--"CPOE on a handheld"--with an expectation of full functionality on all platforms: computer workstations, rolling laptops, tablet PCs, and handheld devices. For these trends to succeed together, however, this expectation must be revised to establish a distinct category--mobile physician order entry (MPOE)--that is different from CPOE in form, function, and implementation.

Clinical Pharmacy Information Systems↗
PubMed2001

Decisions at hand: a decision support system on handhelds.

One of the applications of clinical information systems is decision support. Although the advantages of utilizing such aids have never been theoretically disputed, they have been rarely used in practice. The factor that probably often limits the utility of clinical decision support systems is the need for computing power at the very site of decision making--at the place where the patient is interviewed, in discussion rooms, etc. The paper reports on a possible solution to this problem. A decision-support shell LogReg is presented, which runs on a handheld computer. A general schema for handheld-based decision support is also proposed, where decision models are developed on personal computers/workstations, encoded in XML and then transferred to handhelds, where the models are used within a decision support shell. A use case where LogReg has been applied to clinical outcome prediction in crush injury is presented.

Confidence Intervals↗
PubMed2006

The use of virtual patients to teach medical students history taking and communication skills.

BACKGROUND: At most institutions, medical students learn communication skills through the use of standardized patients (SPs), but SPs are time and resource expensive. Virtual patients (VPs) may offer several advantages over SPs, but little data exist regarding the use of VPs in teaching communication skills. Therefore, we report our initial efforts to create an interactive virtual clinical scenario of a patient with acute abdominal pain to teach medical students history-taking and communication skills. METHODS: In the virtual scenario, a life-sized VP is projected on the wall of an examination room. Before the virtual encounter, the student reviews patient information on a handheld tablet personal computer, and they are directed to take a history and develop a differential diagnosis. The virtual system includes 2 networked personal computers (PCs), 1 data projector, 2 USB2 Web cameras to track the user's head and hand movement, a tablet PC, and a microphone. The VP is programmed with specific answers and gestures in response to questions asked by students. The VP responses to student questions were developed by reviewing videotapes of students' performances with real SPs. After obtaining informed consent, 20 students underwent voice recognition training followed by a videotaped VP encounter. Immediately after the virtual scenario, students completed a technology and SP questionnaire (Maastricht Simulated Patient Assessment). RESULTS: All participants had prior experience with real SPs. Initially, the VP correctly recognized approximately 60% of the student's questions, and improving the script depth and variability of the VP responses enhanced most incorrect voice recognition. Student comments were favorable particularly related to feedback provided by the virtual instructor. The overall student rating of the virtual experience was 6.47 +/- 1.63 (1 = lowest, 10 = highest) for version 1.0 and 7.22 +/- 1.76 for version 2.0 (4 months later) reflecting enhanced voice recognition and other technological improvements. These overall ratings compare favorably to a 7.47 +/- 1.16 student rating for real SPs. CONCLUSIONS: Despite current technological limitations, virtual clinical scenarios could provide students a controllable, secure, and safe learning environment with the opportunity for extensive repetitive practice with feedback without consequence to a real or SP.

Clinical Competence↗
PubMed2007

Integrating and promoting medical podcasts into the library collection.

Podcasts offer a way for medical professionals to listen to current information in medicine from an iPod, MP3 player, handheld device, or computer. As podcasts become more popular, libraries may be interested in integrating programs into the library collection. South Pointe Medical Library evaluated medical podcasts relevant to the scope of the library collection and explored methods for finding and organizing such programs in ways that are efficient for both the librarian and the patron. doi:10.1300/J115v26n01_03.

Access to Information↗
PubMedDate not supplied

From early wireless to Everest.

Medical information has been transmitted using wireless technologies for almost 80 years. A "wired wireless" electronic stethoscope was developed by the U.S. Army Signal Corps in the early 1920's, for potential use in ship-to-shore transmission of cardiac sounds. [Winters SR. Diagnosis by wireless. Scientific American June 11, 1921, p. 465] Today, wireless is used in a wide range of medical applications and at sites from transoceanic air flights to offshore oil platforms to Mt. Everest. 'Wireless LANs' are often used in medical environments. Typically, nurses and physicians in a hospital or clinic use hand-held "wireless thin client" pen computers that exchange patient information and images with the hospital server. Numerous companies, such as Fujitsu (article below) and Cruise Technologies (www.cruisetech.com) manufacture handheld pen-entry computers. One company, LXE, integrates radio-frequency (RF) enhanced hand-held computers specifically designed for production use within a wireless LAN (www.lxe.com). Other companies (Proxim, Symbol, and others) supply the wireless RF LAN infrastructure for the enterprise. Unfortunately, there have been problems with widespread deployment of wireless LANs. Perhaps the biggest impediment has been the lack of standards. Although an international standard (IEEE 802.11) was adopted in 1997, most wireless LAN products still are not compatible with the equipment of competing companies. A problem with the current standard for LAN adapters is that throughput is limited to 3 Mbps--compared to at least 10 Mbps, and often 100 Mbps, in a hard-wired Ethernet LAN. An II Mbps standard is due out in the next year or so, but it will be at least 2 years before standards-compliant products are available. This story profiles some of the ways that wireless is being used to overcome gaps in terrestrial and within-enterprise communication.

Emergencies↗
PubMed2005

A prototype user interface for a mobile electronic clinical note entry system.

Recent advances in mobile computing technologies have made electronic medical records(EMRs) on handheld devices an attractive possibility.However, data entry paradigms popular on desktop machines do not translate well to mobile devices 1,2. Based on a review of the literature on mobile device usability 1-4,we built a prototype user interface for mobile EMRs and held focus groups with clinician users whose feedback provided useful insight about design choices,functionality and optimal workflow integration.

Computers, Handheld↗
PubMed2002

Mobile computing acceptance grows as applications evolve.

Handheld devices are becoming more cost-effective to own, and their use in healthcare environments is increasing. Handheld devices currently are being used for e-prescribing, charge capture, and accessing daily schedules and reference tools. Future applications may include education on medications, dictation, order entry, and test-results reporting. Selecting the right handheld device requires careful analysis of current and future applications, as well as vendor expertise. It is important to recognize the technology will continue to evolve over the next three years.

Clinical Pharmacy Information Systems↗
PubMed2002

Assessment of perceptions of nutrition knowledge and disease using a group interactive system: the Perception Analyzer.

Food labels can be used as a tool for nutrition education, but the information available is of little value to consumers who do not understand how to apply it. In an effort to assess nutrition knowledge and identify misconceptions, a group interactive system--the Perception Analyzer--was used as a lecture aid and data collection tool. The Perception Analyzer is composed of a laptop computer, an antenna, and handheld electronic handsets, or dials, that participants use to answer questions. Participants (N = 621) were surveyed on 14 multiple-choice questions concerning nutrition with 4 nutrition questions repeated at the end of a session as a posttest. A knowledge score was calculated by counting correct answers. Linear regression analyses were used to study the main effects of demographic variables on the knowledge score. Our study reports the following: although participants reported reading food labels, nrisconceptions about label content were identified; analyses of mean scores indicated that age, education, and race influenced the nutrition knowledge score; and participants found the Perception Analyzer to be enjoyable. The findings indicate that because the Perception Analyzer provides immediate and anonymous feedback to a discussion leader about audience's current knowledge, it is a promising tool for nutrition education by dietetic practitioners.

Adolescent↗
PubMed2004

Clinical activities of an academic pediatric pharmacy team.

BACKGROUND: Pharmacy school faculty, residents, and students have been shown to positively impact patient care in multiple settings. However, their potential role in the care of pediatric patients has not been described. OBJECTIVE: To document the contribution of pharmacy school faculty, residents, and students to the optimization of medical care for pediatric patients. METHODS: All clinical interventions performed by faculty, residents, and students for pediatric patients seen from January through December 2002 were recorded and analyzed. The interventions were concurrently recorded using a handheld and desktop computer-based documentation system, the Pharmacist's Electronic Database for Interventions, developed by the pediatric practice team. Practice sites included general pediatrics, pediatric intensive care, neonatal intensive care, and ambulatory clinics. RESULTS: Four faculty members, 5 residents, and 44 students collected intervention data. A total of 4605 interventions were performed for 3978 patients. The most common interventions performed were drug therapy change, pharmacokinetic monitoring, drug information, and medication histories/patient education. Drug added and drug deleted were the most frequent interventions performed in the drug therapy change category. The most common indications for which interventions were made were infectious (39.6%) and respiratory (23.3%) diseases. A total of 223 adverse drug events or medication errors were prevented or detected during the study period. Errors in dosing (overdose or underdose) were the most commonly encountered adverse events. CONCLUSIONS: Pharmacy school faculty, residents, and students perform numerous clinical activities that play a significant role in the multidisciplinary care of pediatric patients.

Child↗
PubMed2002

Real-time clinical application of quality-of-life assessment in advanced lung cancer.

In the management of advanced non-small-cell lung cancer (NSCLC), quality of life (QOL) is a very important consideration when determining therapy. However, clinicians and patients generally make their treatment decisions based upon informal appraisal of QOL rather than formal assessment. Previously, we showed that Functional Assessment of Cancer Therapy-Lung (FACT-L) data were highly prognostic of survival in advanced NSCLC, suggesting the potential value of FACT-L scores for treatment decision making. A key barrier is the impracticality and burden of real-time administration and scoring of paper forms in the clinic. Handheld and touch screen computer administration and scoring can address that barrier. This pilot study assessed the feasibility of using computer technology to aid in the collection and interpretation of QOL and selected clinical data in real time, reducing human effort. The technology was found to be acceptable to patients and staff and feasible within the clinical setting. Integrating formal QOL assessment into treatment decision making in a clinical oncology setting requires further evaluation.

Journal Article↗
PubMed2001

Electronic prescribing: criteria for evaluating handheld prescribing systems and an evaluation of a new, handheld, wireless wide area network (WWAN) prescribing system.

OBJECTIVE: The objectives of this study were: 1) to establish criteria for evaluating handheld computerized prescribing systems; and 2) to evaluate out-of-box performance and features of a new, Palm Operating System (OS)-based, handheld, wireless wide area network (WWAN) prescribing system. The system consisted of a Palm Vx handheld organizer, a Novatel Minstrel V wireless modem, OmniSky wireless internet access and ePhysician ePad 1.1, the Palm OS electronic prescribing software program. DESIGN: A dermatologist familiar with healthcare information technology conducted an evaluation of the performance and features of a new, handheld, WWAN electronic prescribing system in an office practice during a three-month period in 2000. System performance, defined as transmission success rate, was determined from data collected during the three-month trial. Evaluation criteria consisted of an analysis of features found in electronic prescribing systems. METHODS: All prescriptions written for all patients seen during a three-month period (August - November, 2000) were eligible for inclusion. Prescriptions written for patients who intended to fill them at pharmacies without known facsimile receiving capabilities were excluded from the study. The performance of the system was evaluated using data collected during the study. Criteria for evaluating features of electronic prescribing systems were developed and used to analyze the system employed in this study. RESULTS: During this three-month trial, 200 electronic prescriptions were generated for 132 patients included in the study. Of these prescriptions, 92.5 percent were successfully transmitted to pharmacies. Transmission failures resulted from incorrect facsimile numbers and non-functioning facsimile machines. Criteria established for evaluation of electronic prescribing systems included System (Hardware & Software), Costs, System Features, Printing & Transmission, Formulary & Insurance, Customization, Drug Safety and Security. CONCLUSION: This study is the first effort to establish comprehensive criteria for evaluating handheld prescribing systems and to evaluate the performance and features of a handheld, electronic prescribing system. The results demonstrated that the evaluated system: 1) was simple to install; 2) successfully interfaced with a commonly used practice management system; 3) was user-friendly and easy to operate; 4) offered a robust variety of standard features; and, 5) resulted in a high rate of success for transmitting electronic prescriptions. The criteria established for the evaluation of features of an electronic prescribing system can be used to critically evaluate the performance and features of other handheld and personal computer-based electronic prescribing systems.

Adult↗
PubMed2004

Integrating context-aware public displays into a mobile hospital information system.

Hospitals are convenient settings for deployment of ubiquitous computing technology. Not only are they technology-rich environments, but their workers experience a high level of mobility resulting in information infrastructures with artifacts distributed throughout the premises. Hospital information systems (HISs) that provide access to electronic patient records are a step in the direction of providing accurate and timely information to hospital staff in support of adequate decision-making. This has motivated the introduction of mobile computing technology in hospitals based on designs which respond to their particular conditions and demands. Among those conditions is the fact that worker mobility does not exclude the need for having shared information artifacts particular locations. In this paper, we extend a handheld-based mobile HIS with ubiquitous computing technology and describe how public displays are integrated with handheld and the services offered by these devices. Public displays become aware of the presence of physicians and nurses in their vicinity and adapt to provide users with personalized, relevant information. An agent-based architecture allows the integration of proactive components that offer information relevant to the case at hand, either from medical guidelines or previous similar cases.

Artificial Intelligence↗