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Clinical and educational uses of handheld computers.

Handheld computers, also known as personal digital assistants (PDAs), are becoming an increasingly valuable aid to physicians at the point of care. We review the use of handheld computers and their impact in clinical practice and medical education. Clinicians commonly use PDAs to access patient data and as a clinical reference tool. In medical education, handheld computers are most frequently used to track patient encounters and procedures done during medical school rotations and residency training. This report describes some interesting applications for present and future use of PDAs in inpatient care and medical education. Physicians and educational programs not using PDAs may wish to consider incorporating this technology.

Computers, Handheld↗

Nine ways to use handheld computers.

Handheld computers can be used to make calculations, share articles with colleagues, store contact information, and even save lives. Translation software can facilitate communication with non-English-speaking patients. You can find out the cost of medications with drug reference software. Make the ED schedules accessible, so that staff can volunteer to fill in gaps.

Computer Peripherals↗

Patient perceptions of physician use of handheld computers.

BACKGROUND: Handheld computers have advantages for healthcare providers including portability and integration into office workflow. However, negative patient perceptions of physician use of handheld computers in the examining room might limit integration. OBJECTIVE: To survey patients' perceptions of handheld use, and compare those with their providers' perceptions. METHODS: A survey of patient attitudes toward handhelds was conducted among patients at a low-income university clinic. Internal Medicine residents providing care were also surveyed. RESULTS: Patients (N=93) were mostly female (79%) and ethnic minorities (67%) with average age of 39. Only 10% of patients did not like the idea of a handheld computer in the exam room. Other negative attitudes were also seen in a minority of patients. Some physicians (23%) reported reservations about using the handheld computer with patients. CONCLUSIONS: Negative attitudes were rare among patients, but some providers were concerned about using the handheld in the exam room.

Adult↗

Handheld computing in dentistry.

Handheld computer sales are increasing rapidly in the United States and worldwide. The convenience and communication features will continue to improve and become commonplace in our lives. Using a handheld computer in the dental environment is efficient and potentially aids the dentist in delivering a higher standard of care to patients.

Computer Storage Devices↗

Handheld computing in medicine.

Handheld computers have become a valuable and popular tool in various fields of medicine. A systematic review of articles was undertaken to summarize the current literature regarding the use of handheld devices in medicine. A variety of articles were identified, and relevant information for various medical fields was summarized. The literature search covered general information about handheld devices, the use of these devices to access medical literature, electronic pharmacopoeias, patient tracking, medical education, research, business management, e-prescribing, patient confidentiality, and costs as well as specialty-specific uses for personal digital assistants (PDAs). The authors concluded that only a small number of articles provide evidence-based information about the use of PDAs in medicine. The majority of articles provide descriptive information, which is nevertheless of value. This article aims to increase the awareness among physicians about the potential roles for handheld computers in medicine and to encourage the further evaluation of their use.

Biomedical Research↗

Handheld computers in radiology.

The next phase of the digital revolution in medicine is taking place through the dissemination of powerful handheld computers. Handheld computers, or personal digital assistants (PDAs), are no longer considered either a curiosity or a toy. The current handheld computer has many features (Internet access, simple e-mail client software, spreadsheet and database programs, word processing, and digital media) that make it an ideal tool for healthcare providers. Improvements in handwriting recognition, display characteristics, and wireless networking capabilities provide a platform for real-time review of both large static and dynamic repositories of patient data. Although earlier PDA models lacked the ability to display medical images appropriately, current PDAs boast display characteristics that approach low-resolution computer monitors. Although the handheld computer is not yet a reliable option for soft-copy reading, it offers many features that can improve work flow and efficiency for the radiologist. These features include improved personal information management, decision support via access to educational materials, and remote access to radiology-related information systems.

Computers, Handheld↗

The transforming effect of handheld computers on nursing practice.

Handheld computers have the power to transform nursing care. The roots of this power are the shift to decentralization of communication, electronic health records, and nurses' greater need for information at the point of care. This article discusses the effects of handheld resources, calculators, databases, electronic health records, and communication devices on nursing practice. The US government has articulated the necessity of implementing the use of handheld computers in healthcare. Nurse administrators need to encourage and promote the diffusion of this technology, which can reduce costs and improve care.

Attitude of Health Personnel↗

Introduction of handheld computing to a family practice residency program.

BACKGROUND: Handheld computers are valuable practice tools. It is important for residency programs to introduce their trainees and faculty to this technology. This article describes a formal strategy to introduce handheld computing to a family practice residency program. METHODS: Objectives were selected for the handheld computer training program that reflected skills physicians would find useful in practice. TRGpro handheld computers preloaded with a suite of medical reference programs, a medical calculator, and a database program were supplied to participants. Training consisted of four 1-hour modules each with a written evaluation quiz. Participants completed a self-assessment questionnaire after the program to determine their ability to meet each objective. RESULTS: Sixty of the 62 participants successfully completed the training program. The mean composite score on quizzes was 36 of 40 (90%), with no significant differences by level of residency training. The mean self-ratings of participants across all objectives was 3.31 of 4.00. Third-year residents had higher mean self-ratings than others (mean of group, 3.62). Participants were very comfortable with practical skills, such as using drug reference software, and less comfortable with theory, such as knowing the different types of handheld computers available. CONCLUSION: Structured training is a successful strategy for introducing handheld computing to a residency program.

Attitude to Computers↗

Impact of patient feedback on residents' handheld computer use: a multi-site study.

Handheld computers are being proposed as a resource for ambulatory care, yet physician reluctance to use the devices in the presence of patients is reported to be a barrier to optimal use. This study examined patient attitudes toward the use of handheld computers and the impact of those attitudes on the physicians' use of the handheld computers in the patient care setting. Most patients hold favorable attitudes toward physician use of handheld computers. Providing these data to physicians, however, did not uniformly lead to significant increases in handheld use in the presence of the patient. More understanding of the factors that influence behavior change and methods that will decrease barriers to the use of handhelds is needed

Adult↗

Survey of handheld computing among medical students.

The purpose of this study was to identify trends in the utilization and acceptance of handheld computers (personal digital assistants) among medical students during preclinical and clinical training. We surveyed 366 medical students and collected information on computer expertise, current handheld computer use, predicted future use, and user acceptance. Handheld computers were primarily used for personal applications by students during their preclinical training and as drug references and clinical calculators during their clinical training. In the future, all participants predicted they would use handheld computers at significantly higher rates and on a broader range of medical applications. The adoption of handheld computing was independent of user satisfaction. Those with more clinical experience were less satisfied with handheld computers, suggesting that the expectations of the more experienced users were not met. The lack of institutional support was seen as a key limitation.

Attitude to Computers↗

Using handheld computers to document family practice resident procedure experience.

BACKGROUND AND OBJECTIVES: We examined the use of inexpensive handheld computers in documenting resident procedures. With a handheld computer, data is entered at the time of the procedure, eliminating the problem of double entry. METHODS: Connectivity and ease of use were important factors considered when choosing a handheld computer. All residents received a handheld computer for data entry. Residency staff downloaded the data to a desktop computer. At the same time, data useful to residents was placed on their devices. The process of generating individual and program reports required 2 hours of staff time each month. Survey data regarding use and acceptance by residents was collected. RESULTS: Eighty-eight percent of residents collected data on their handheld computer. Those residents responding to a survey felt that the handheld computer was "very useful," and 73% reported daily use. Initial costs were $310 per resident. CONCLUSIONS: Handheld computers streamlined the collection of procedure data for family practice residents. Handheld computers assisted in producing timely and useful procedural reports for both residents and the residency program. Additional uses of handheld computers were beneficial to the program and the residents.

Computers↗

Comparison of handheld computers for nutrition assessment and support.

Handheld computers offer a variety of capabilities useful to dietitians in clinical and other settings. Currently, such devices are not available for testing or inspection before purchase. This limits the potential purchaser's ability to compare features and capabilities among various brands and models during the selection process. In this article we compare the anthropometric, biochemical, and dietary assessment and nutrition support computational capabilities of five of the most popular brands and models of handheld computers. Results are presented in tabular form. We present a strategy to guide the selection and purchase of an appropriate handheld computer for nutrition assessment and support that has the features the purchaser desires. The results of this comparison indicate that there is a wide variation in features, capabilities, and prices among different models. The decision as to which model is most efficient depends ultimately on the individual user's unique needs.

Anthropometry↗

Understanding usage patterns of handheld computers in clinical practice.

Handheld computers are commonly used in clinical practice and often considered invaluable by physicians. Though full of promise, the technology is still costly and literature assessing its real use in clinical practice remains scarce. In an effort to better understand how Personal Digital Assistants (PDA) can be utilized as clinical tools, we designed a study that closely monitored the use of a selection of handheld applications by a cohort of interns in a service of Internal Medicine. Information gathered about actual use of the mobile applications offer valuable insights on usage patterns of tools that promise to be become an important part of our clinical practice in the years to come, and will hopefully help guide future developments.

Computers, Handheld↗

Handheld computer use in U.S. family practice residency programs.

OBJECTIVE: The purpose of the study was to evaluate the uses of handheld computers (also called personal digital assistants, or PDAs) in family practice residency programs in the United States. STUDY DESIGN: In November 2000, the authors mailed a questionnaire to the program directors of all American Academy of Family Physicians (AAFP) and American College of Osteopathic Family Practice (ACOFP) residency programs in the United States. MEASUREMENTS: Data and patterns of the use and non-use of handheld computers were identified. RESULTS: Approximately 50 percent (306 of 610) of the programs responded to the survey. Two thirds of the programs reported that handheld computers were used in their residencies, and an additional 14 percent had plans for implementation within 24 months. Both the Palm and the Windows CE operating systems were used, with the Palm operating system the most common. Military programs had the highest rate of use (8 of 10 programs, 80 percent), and osteopathic programs had the lowest (23 of 55 programs, 42 percent). Of programs that reported handheld computer use, 45 percent had required handheld computer applications that are used uniformly by all users. Funding for handheld computers and related applications was non-budgeted in 76percent of the programs in which handheld computers were used. In programs providing a budget for handheld computers, the average annual budget per user was 461.58 dollars. Interested faculty or residents, rather than computer information services personnel, performed upkeep and maintenance of handheld computers in 72 percent of the programs in which the computers are used. In addition to the installed calendar, memo pad, and address book, the most common clinical uses of handheld computers in the programs were as medication reference tools, electronic textbooks, and clinical computational or calculator-type programs. CONCLUSIONS: Handheld computers are widely used in family practice residency programs in the United States. Although handheld computers were designed as electronic organizers, in family practice residencies they are used as medication reference tools, electronic textbooks, and clinical computational programs and to track activities that were previously associated with desktop database applications.

Data Collection↗

Handheld computers in medicine: the way forward.

Handheld computers are now a common sight in medicine, but there are scarce data on who actually uses them and what functions are found to be most useful. This is the first study of handheld computer use in a British hospital, and shows that there is already considerable use and acceptance of the technology, with 22 of 55 (40%) physicians possessing and using such a device. Doctors in training grades are more likely to make use of medical software, particularly textbooks, calculators, and formularies. The main barriers to greater use of this technology were cost of software and poor applicability to UK practice.

Attitude to Computers↗

Doctors' experience with handheld computers in clinical practice: qualitative study.

OBJECTIVE: To examine doctors' perspectives about their experiences with handheld computers in clinical practice. DESIGN: Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. SETTING: Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists. PARTICIPANTS: 54 doctors who did or did not use handheld computers. RESULTS: Doctors who used handheld computers in clinical practice seemed generally satisfied with them and reported diverse patterns of use. Users perceived that the devices helped them increase productivity and improve patient care. Barriers to use concerned the device itself and personal and perceptual constraints, with perceptual factors such as comfort with technology, preference for paper, and the impression that the devices are not easy to use somewhat difficult to overcome. Participants suggested that organisations can help promote handheld computers by providing advice on purchase, usage, training, and user support. Participants expressed concern about reliability and security of the device but were particularly concerned about dependency on the device and over-reliance as a substitute for clinical thinking. CONCLUSIONS: Doctors expect handheld computers to become more useful, and most seem interested in leveraging (getting the most value from) their use. Key opportunities with handheld computers included their use as a stepping stone to build doctors' comfort with other information technology and ehealth initiatives and providing point of care support that helps improve patient care.

Attitude of Health Personnel↗

PubMed on Tap: discovering design principles for online information delivery to handheld computers.

Online access to biomedical information from handheld computers will be a valuable adjunct to other popular medical applications if information delivery systems are designed with handheld computers in mind. The goal of this project is to discover design principles to facilitate practitioners' access to online medical information at the point-of-care. A prototype system was developed to serve as a testbed for this research. Using the testbed, an initial evaluation has yielded several user interface design principles. Continued research is expected to discover additional user interface design principles as well as guidelines for results organization and system performance

Computers, Handheld↗

Wireless handheld computers and voluntary utilization of computerized prescribing systems in the emergency department.

Illegible or invalid hand-written prescriptions can result in avoidable medical errors. Computer-based prescribing can mitigate the problem. An observational study was performed to examine the effect of wireless handheld computers (handhelds) on voluntary utilization of computerized prescribing within an Emergency Department. Handhelds with prescription-writing software were provided to physicians and the numbers of hand-written and computer-generated prescriptions were compared before and after the introduction of the handhelds. The resulting increase in computer-based prescribing was statistically significant and was observed largely among physicians who already used desktop computers for prescribing. The study concluded that handhelds increased voluntary utilization of computerized prescribing, but that the physicians most likely to use handhelds were those who already used desktop-based prescribing.

Attitude to Computers↗