REVIEW
A review and a framework of handheld computer adoption in healthcare

https://doi.org/10.1016/j.ijmedinf.2005.03.001Get rights and content

Summary

Wide adoption of mobile computing technology can potentially improve information access, enhance workflow, and promote evidence-based practice to make informed and effective decisions at the point of care. Handheld computers or personal digital assistants (PDAs) offer portable and unobtrusive access to clinical data and relevant information at the point of care. This article reviews the literature on issues related to adoption of PDAs in health care and barriers to PDA adoption. Studies showed that PDAs were used widely in health care providers’ practice, and the level of use is expected to rise rapidly. Most care providers found PDAs to be functional and useful in areas of documentation, medical reference, and access to patient data. Major barriers to adoption were identified as usability, security concerns, and lack of technical and organizational support. PDAs offer health care practitioners advantages to enhance their clinical practice. However, better designed PDA hardware and software applications, more institutional support, seamless integration of PDA technology with hospital information systems, and satisfactory security measures are necessary to increase acceptance and wide use of PDAs in healthcare.

Introduction

Despite the differences in practice environments, the information needs of health care professionals at the point of care are universal. Most clinicians would benefit from mobile computing resources (such as evidence-based guidelines, medical reference, drug reference and patient information) to meet their information needs. Mobile computing adds value to clinical practice in a number of ways, such as by giving clinicians access to clinical information where and when the information is needed, by improving the exchange of information (thus, reducing medical errors resulting from inadequate access to clinical data), and by providing clinical decision support to give clinicians feedback at the point of care [1], [2], [3], [4].

Personal digital assistants (PDAs) are lightweight, compact handheld computers that literally fit into one's palm or pocket [5]. The terms “PDA,” “handheld computer,” “handheld,” “Palm Pilot,” and “pocket PC” all refer to similar devices with comparable capabilities.

Mobile computing allowed by PDAs is becoming an important tool in health care and has grown in popularity among health care professionals during the past 5 years [6], [7], [8]. A wide range of mobile devices is used by health care professionals to improve efficiency and effectiveness in the delivery of patient care. These devices are designed to assist users in both everyday work and off-duty activities.

As more health-care-related applications are introduced and used, a growing body of literature has been established that can guide the future design and deployment of mobile computing solutions. Those published reports also provide insight into barriers to the wide adoption of mobile computing solutions and the effect of these devices on health care. For example, Fischer et al. [9] assessed the literature for evidence of the impact of handheld devices in terms of patient outcomes. We also systematically reviewed the literature on the use of handheld computing devices, but focused on the issue of their adoption in health care practice. We examined the potential benefits of PDAs as factors that will promote their adoption and identified barriers to their acceptance in health care.

Section snippets

Sources

We used Medline, the National Library of Medicine's searchable database of peer-reviewed publications; the published proceedings of one primary conference (Proceedings of Healthcare Information and Management Systems Society [HIMSS]). In addition, to assess the types of application available for different platforms, we used Internet search engines (Google and Yahoo) and electronic resources (Download.com, CNet.com, Microsoft.com, Palm.com, Blackberry.com, ePocrates.com, MedCalc3000.com,

Operating systems

Most PDAs run either a Palm OS® (operating system) or Window CE/Pocket PC OS. Each system has its own strengths and weaknesses, but the two have much in common. Based on our manual searches from Download.com and PDA Cortex.com, more third-party applications and medical applications are available to the Palm OS (approximately 1450 third-party applications and 527 medical applications) than Window CE (900 third-party applications and 306 medical applications) as of June 2004. We used these two

Cost saving

Silva et al. [26] reported using PDAs to document the services offered by pharmacists to physicians (such as providing drug information and pharmacotherapy consultation). The cost reduction associated with electronic documentation totaled $662,335 during a 6-month period for the four pharmacists and four residents who participated in the study. Potential claims for pharmacists’ cognitive services recorded with PDAs amounted to $1,025,834 during the study period [26].

Education

Leung et al. [35] evaluated

Conclusion

A number of benefits of the use of PDAs in medical care have been articulated and demonstrated in the literature. These benefits include offering clinicians mobility, providing real-time access to data and information, reducing medical errors, saving time, supporting evidence-based practice, enhancing productivity and quality of care, and providing a tool for communication. Along with technology advances (such as wireless connectivity), these benefits contributed to the reported trend that

References (89)

  • D.W. Bates et al.

    Improving safety with information technology

    N. Engl. J. Med.

    (2003)
  • R. Kaushal et al.

    Information technology and medication safety: what is the benefit?

    Qual. Saf. Health Care

    (2002)
  • B.C. Grasso et al.

    Reducing errors in discharge medication lists by using personal digital assistants

    Psychiatr. Serv.

    (2002)
  • N. Smithline

    Handhelds, the holy grail of health care?

  • D.F. Criswell et al.

    Handheld computer use in US family practice residency programs

    J. Am. Med. Inform. Assoc.

    (2002)
  • A.E. Carroll et al.

    Pediatricians’ use of and attitudes about personal digital assistants

    Pediatrics

    (2004)
  • W. Gillingham et al.

    Hand-held computers in healthcare: what software programs are available?

    N. Z. Med. J.

    (2002)
  • S. Fischer et al.

    Handheld computing in medicine

    J. Am. Med. Inform. Assoc.

    (2003)
  • T. Monahan

    Hot and cold on PDAs. Competition among manufacturers is heated, but doctors are still lukewarm about handhelds

    Healthc. Inform.

    (2002)
  • M.J. Tooey et al.

    Handheld technologies in a clinical setting: state of the technology and resources

    AACN Clin. Issues

    (2003)
  • K.E. Keplar et al.

    Personal digital assistant applications for the healthcare provider

    Ann. Pharmacother.

    (2003)
  • V. Anantraman et al.

    Open source handheld-based EMR for paramedics working in rural areas

    Proc. AMIA Symp.

    (2002)
  • J. Wrostad, PDA sales plunge in Q3. Waiting for Microsoft? http://www.newsfactor.com/perl/story/14578.html,...
  • L. Stammer

    A show of handhelds

    Healthc. Inform.

    (2004)
  • A.E. Carroll et al.

    The implementation of a personal digital assistant (PDA) based patient record and charting system: lessons learned

    Proc. AMIA Symp.

    (2002)
  • K. Crowell et al.

    Extending the hand of knowledge: promoting mobile technologies

    Med. Ref. Serv. Q.

    (2003)
  • S.N. Ali et al.

    Pocket pc: an aid to clinical consultation

    Plast. Reconstr. Surg.

    (2003)
  • D.H. Goldstein et al.

    A model for real time information at the patient's side using portable computers on an acute pain service

    Can. J. Anaesth.

    (2002)
  • R. Roe

    The future if wireless personal digital assistants (PDAs) in healthcare

  • O.M. Goldblum

    Practical applications of hand-held computers in dermatology

    Semin. Cutan. Med. Surg.

    (2002)
  • P.J. Embi

    Information at hand: using handheld computers in medicine

    Cleve. Clin. J. Med.

    (2001)
  • J. Blackman et al.

    The usefulness of handheld computers in a surgical group practice

    J. Am. Med. Inform. Assoc.

    (1999)
  • M.A. Silva et al.

    Using personal digital assistants to document pharmacist cognitive services and estimate potential reimbursement

    Am. J. Health Syst. Pharm.

    (2003)
  • L. Bosma et al.

    Point of care use of a personal digital assistant for patient consultation management: experience of an intravenous resource nurse team in a major Canadian teaching hospital

    Comput. Inform. Nurs.

    (2003)
  • E. Coiera et al.

    Communication behaviours in a hospital setting: an observational study

    Br. Med. J.

    (1998)
  • A.E. Carroll

    Development of a personal digitasl assistant based client/server NICU patient data and charting system

    Proc. AMIA Symp.

    (2001)
  • S.E. Lapinsky et al.

    Handheld computers in critical care

    Crit. Care

    (2001)
  • A.E. Flanders et al.

    Handheld computers in radiology

    Radiographics

    (2003)
  • P.D. Bent et al.

    Professional monitoring and critical incident reporting using personal digital assistants

    Med. J. Aust.

    (2002)
  • G.N. Fox

    Electronic solutions to implementing lipid guidelines

    J. Fam. Pract.

    (2002)
  • G.M. Leung et al.

    Randomised controlled trial of clinical decision support tools to improve learning of evidence based medicine in medical students

    Br. Med. J.

    (2003)
  • D.M. Torre et al.

    Clinical and educational uses of handheld computers

    South Med. J.

    (2003)
  • M. Iregui et al.

    Use of a handheld computer by respiratory care practitioners to improve the efficiency of weaning patients from mechanical ventilation

    Crit. Care Med.

    (2002)
  • J.M. Rothschild et al.

    Clinician use of a palmtop drug reference guide

    J. Am. Med. Inform. Assoc.

    (2002)
  • Cited by (251)

    • A review on the rights of children in the digital age

      2018, Children and Youth Services Review
    View all citing articles on Scopus
    View full text