gms | German Medical Science

50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie (dae)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Deutsche Arbeitsgemeinschaft für Epidemiologie

12. bis 15.09.2005, Freiburg im Breisgau

Medical ward rounds with mobile handheld computers, possible and helpful?

Meeting Abstract

Suche in Medline nach

  • Daniel Zeiß - Universitätsklinikum Erlangen, Erlangen
  • Christof Seggewies - Universitätsklinikum Erlangen, Erlangen
  • Hans-Ulrich Prokosch - Universität Erlangen, Erlangen

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. Deutsche Arbeitsgemeinschaft für Epidemiologie. 50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie. Freiburg im Breisgau, 12.-15.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05gmds470

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gmds2005/05gmds373.shtml

Veröffentlicht: 8. September 2005

© 2005 Zeiß et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction

During daily ward rounds health care professionals are not well equipped by today’s hospital information systems. They rely on stationary keyboard and mouse based input, which connects to hardware that is virtually impossible to transport during this dynamic and hectic process of ward rounds.

Many studies show that the use of handheld computers can help clinicians “increase productivity and improve patient care” [1], [2]. Two outstanding features which characterize handheld computers are excellent mobility and constantly evolving touch-screen technology. In the presence of a wireless local area network (WLAN), handheld computers can be utilized to provide online access to clinical databases.

With wireless connectivity and the proper hardware and software solutions, therapists would have the option to stay at the patient’s side to access medical data. The first attempts with mobile computing were so-called “Computer On Wheels” (COW) devices. These are commonly laptop computers mounted onto a rolling trolley. Inside the trolley, special equipment like batteries, charging installations, and sometimes paper based patient records are kept. One major disadvantage is that the mobility of such device is low. According to Microsoft, the “[..] Tablet PC [..] is the evolution of notebook computing. If you want the reliability and power [..] with the natural interface and mobility of Tablet PC, this is the solution for you.“ (http://www.microsoft.com/windowsxp/tabletpc/evaluation/default.mspx (23.Jan 2005 20:00h)) As office space is a limited resource, mobile computing can be an excellent solution for saving space. Furthermore, mobile computing is a step towards making “ubiquitous computing” the third generation of computer usage (http://www.ubiq.com/hypertext/weiser/acmfuture2endnote.htm (23. Jan 2005 20:00h)).

Currently some clinicians use handheld devices to lookup up treatment guidelines, search drug databases, access patient medication, and write MS Office based documentation (Visiting Nurse Service of New York (VNSNY) http://www.microsoft.com/resources/casestudies/CaseStudy.asp?CaseStudyID=15909 (23.Jan 2005 20:00h)). Another study shows that clinicians “mainly use[s] the patient record as their principal repository of information” [3]. The current applications mainly use data retrieval techniques to satisfy the user’s demands. Greater interaction is inhibited by the user interface, as tablet PCs just offer pen based input, which does not permit the speed of data entry found with regular keyboard. The available soft-keyboard, a software function which displays a keyboard like structure onto the touch-screen, can only be used for sporadic data input, since it is very cumbersome and slow to use. Handwriting recognition applications and voice recognition application have not yet evolved to a level that would make them viable. Therefore, profiting from the tablet PCs’ strong advantages, e.g. high mobility, intuitive user interface, and online data access via wireless networks, requires that the software user interface changes from keyboard centric to the intuitive use of the pen via touch-screen technology. A similar approach in a field study [4] showed that there are still problems in designing an intuitive and easy-to-use interface. The positive remarks in the study suggest that “mobile equipment was much lighter and more useful than a paper record” [4].

Materials and methods

Before handheld computers on ward rounds can be used, analysis of the needed infrastructure has to be conducted. This infrastructure consists out of handheld computers, wireless networks, and clinical software solutions already in use.

In order to better understand the positive and negative effects of mobile computers, a set of tablet PCs, convertibles, and PDAs was deployed to medical and IT staff. They were tasked with performing their every day computer work on their devices. Also included in this test was a usability test of current clinical software solutions already found in their daily routine.

After two months an evaluation was conducted. The wireless network infrastructure was analysed in a WLAN test lab scenario. After a thorough screening of different wireless network solutions, consulting different computer science and informatics magazines and journals, and evaluating many presentations at conferences, 4 products were selected for final testing. Each of them had to meet a detailed list of criteria. Special interest was directed to the security features.

To better understand the process of a clinical ward round, an analysis of this process was also performed. Medical doctors were questioned, and the received information has been modelled into UML (Unified Modeling Language) diagrams. These diagrams aid in understanding the process and customizations required of the software prototype.

Results

These tests showed us that mobile computing for the healthcare professional today is possible. They proved that handheld computers are capable of providing the user with enough resources to fulfill daily tasks. Wireless networks showed that they have evolved to a level where they can be safely and securely integrated into the existing computer network. Usage of mobile handheld computers seems to have enormous potential to improve information management at the point of care. Tablet PCs, like any other PC, present the possibility for a natural and intuitive user interface. It is very important for the daily routine that the clinician’s attention, while using a computer, is not entirely drawn to it, but that a more natural doctor-patient relationship is preserved. Therefore, we can agree to the statement that “pen-based technology not only was more comfortable for the clinicians to use, but also less intrusive during a patient visit.” (Visiting Nurse Service of New York (VNSNY) http://www.microsoft.com/resources/casestudies/CaseStudy.asp?CaseStudyID=15909 (23.Jan 2005 20:00h))

Discussion

The success of mobile handheld computers for daily ward rounds not only depends on the implementation and quality of the chosen software and hardware, but also on economical deliberations. The usage of at least two tablet PCs per round produces high costs. The Gartner Group estimated a total cost of ownership for PDAs and mobile computers to be around $2,500 per device each year (Gartner Group: TCO for PDAs: Higher Than Expected 27 July 1999 X http://www.gartner.de). Additionally the maintenance for two user interfaces (one for regular keyboard and mouse based workstations and the other for handheld PCs) will increase software engineering costs, and therefore the price of the quality software.

The combination of savings derived from a reduction of double data input, the opportunity to reduce errors created by dual data entry, and the productivity gains realized by faster data access should not only compensate but ultimately overcome any increased costs. The difficult task of achieving data entry at a faster pace than paper can only be offset by the ability to instantly access multiple sources of information, which in paper form can be slow and result in a greater error rate. This will take longer to achieve, requiring built in automatic calculations, an intuitive user interface, and many clever ideas for automation. This opportunity to eliminate wasteful dual entry and reduce potential error, all while giving the doctor a vast and valuable resource of information at the point of care, paves the way for further investigations. Such studies can further prove the possibilities presented by software that creates an intuitive, pen-based user interface. Additionally, further studies can verify the necessary calculations required to better understand the return on investment that mobile handheld computing can achieve in modern hospitals.


References

1.
Ann Scheck McAlearney, Sharon B Schweikhart, Mitchell A Medow, Doctors' experience with handheld computers in clinical practise: qualitative study, BMJ 2004;328:1162
2.
Aaron E. Carroll, Dimitri A. Christakis, Pediatricians' Use of and Attitudes About Personal Digital Assistants, Pediatrics 2004, 113: 238-242
3.
E. Reuss, M. Menozzi, M. Büchi, J. Koller and H. Krueger, Information access at the point of care: what can we learn for designing a mobile CPR system?, International Journal of Medical Informatics, Volume 73, Issue 4, May 2004, 363-369.
4.
M. Urban, M. Kunath, Design, Deployment and Evaluation of a Clinical Information System which uses Mobile Computers and Workstations, Workshop of the Project Group MoCoMed 11.04.2002, Heidelberg
5.
Elizabeth S. Chen, Eneida A. Mendonça, Lawrence K. McKnight, Peter D. Stetson, Jianbo Lei, and James J. Cimino, PalmCIS: A Wireless Handheld Application for Satisfying Clinician Information Needs, J. Am. Med. Inform. Assoc., Volume 11: 19-28
6.
F. Buschmann, R. Meunier, H. Rohnert, P. Sommerlad, M. Stal., Pattern-Oriented Software Architecture: A System of Patterns, John Wiley & Sons Ltd., 1996