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At Columbia-Presbyterian Medical Center, a clinical information system (CIS) called WebCIS is used by health care providers. We have developed a palm-based extension to WebCIS, called PalmCIS, which provides physicians access to clinical data through a wireless connection. As part of PalmCIS, we have added links to two on-line information resources: PubMed and Micromedex.
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A new communication support system has been developed for assisting elderly people communicating by telephone and e-mail. The system consists of a conventional tablet computer, a computer-telephony interface board, a microphone, a speaker, a telephone line and the Internet. The tablet liquid crystal screen (TLCS) is used as a display device and an entry device, instead of a keyboard. When an elderly person telephones or sends an email, they then choose a communication person from the registered support personnel pictures displayed on the TLCS. The computer dials or sends e-mail, which is directly handwritten on the TLCS. When their home system receives a telephone call or e-mail, the computer displays the calling communication person's picture and name on the TLCS. The elderly person can therefore easily recognize and verify the person. Since this newly-developed communication support system does not employ a keyboard, it is easily operated by elderly persons.
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OBJECTIVES: Wearable systems can be broadly defined as mobile electronic devices that can be unobtrusively embedded in the user's outfit as part of the clothing or an accessory. In particular, unlike conventional mobile systems, they can be operational and accessed without or with very little hindrance to user activity. To this end they are able to model and recognize user activity, state, and the surrounding situation: a property, referred to as context sensitivity. Wearable systems range from micro sensors seamlessly integrated in textiles through consumer electronics embedded in fashionable clothes and computerized watches to belt worn PCs with a head mounted display. The wearable computing concept is part of a broader framework of ubiquitous computing that aims at invisibly enhancing our environment with smart electronic devices. The goal of the paper is to provide a broad overview of wearable technology and its implications for health related applications. METHODS: We begin by summarizing the vision behind wearable computing. We then describe a framework for wearable computing architecture and the main technological aspects. Finally we show how specific properties of wearable systems can be used in different health related application domains. RESULTS: Wearable computing is an emerging concept building upon the success of today's mobile computing and communication devices. Due to rapid technological progress it is currently making a transition from a pure research stage to practical applications. Many of those applications are in health related domains, in particular, health monitoring, mobile treatment and nursing. CONCLUSIONS: Within the next couple of years wearable systems and more general ubiquitous computing will introduce profound changes and new application types to health related systems. In particular they will prove useful in improving the quality and reducing the cost of caring for the aging population.
Both personal digital assistants (PDAs) and tablet computers have emerged to facilitate data collection at the point of care. However, little research has been reported comparing these mobile computing devices in specific care settings. In this study we present an approach for comparing functionally identical applications on a Palm operating system-based PDA and a Windows-based tablet computer for point-of-care documentation of clinical observations by eye care professionals when caring for patients with diabetes. Eye-care professionals compared the devices through focus group sessions and through validated usability surveys. This poster describes the development and use of the survey instrument used for comparing mobile computing devices.
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Healthcare errors among nurses are common because of the fast-paced work environment, in which extensive data must be analyzed and quick decision making is required. Assistive computing devices can help reduce nursing errors by providing timely access to client information and by assisting nurses with client monitoring, decision making, and bedside documentation. The purpose of this pilot study was to determine what assistive computing device features, functions, and input/output modalities nurses would find most useful as support for their nursing duties. Twenty nurses completed a questionnaire that examined their needs and preferences. Data analysis revealed a strong desire for capabilities related to facilitating information access and administering safe medication. The results of this study will be used to develop design criteria for an assistive computing device that will aim to improve the performance of nurses through appropriate information and data support.
@Home is a robust platform for real-time remote monitoring of patients at their home by doctors at the hospital. Health monitoring sensors, which have the capability to measure quick and easy vital parameters such as blood pressure, pulse rate, temperature, oxygen saturation (SpO2), as well as ECG 12 leads are used. Additionally, an advantage of the platform is that all the sensors are wearable and the patient is able to walk around indoors or outdoors. Moreover, the sensors are able to convey the recorded data over Bluetooth, a short-range wireless communication, to any Bluetooth enabled device such as Desktop computer or a Pocket PC.
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OBJECTIVE: Clinicians often have difficulty determining the appropriate Current Procedural Terminology Evaluation and Management code to assign to the type and intensity of patient care they provide. The purpose of this study was to develop, implement, and evaluate a handheld charge capture program for use by providers in the long-term care setting. DESIGN: Using a pre-post study design, we compared the coding accuracy and user satisfaction of an established paper process with a handheld charge capture program created for this study by means of: (1) preimplementation and postimplementation assessment of coding accuracy, and (2) preimplementation and postimplementation clinician survey. SETTING: We studied an academic division of geriatric medicine. PARTICIPANTS: Participants consisted of six clinicians who currently spend at least 50% of their clinical time practicing in the long-term care setting. INTERVENTION: A handheld charge capture program to replace the current paper-based charge capture process was reviewed. RESULTS: Overall coding accuracy improved by approximately 20% when the handheld program was used instead of a paper coding process. The majority of clinicians found that the handheld program was more widely available, efficient, easier to use, and encouraged the participants to document more completely and accurately in the patient's medical record. CONCLUSION: A handheld billing and coding program used by clinicians who provide care for long-term care residents is not only feasible, but leads to an improvement in coding accuracy when compared with a paper process. In addition, clinician satisfaction toward the billing and coding processes improved with the use of the handheld program.
This article describes the application of group computer-assisted therapy for social phobia. The computer program includes a diary function for ongoing self-monitoring of anxiety as well as guidance on the practice of relaxation, cognitive restructuring, and self-control desensitization. Although the program was originally designed to treat individuals with generalized anxiety disorder (GAD), it was hypothesized that the program also would be effective for individuals with social phobia; therefore, it was implemented in a group of individuals with a primary diagnosis of GAD or social phobia. We present the case of a client with social phobia who received six sessions of group therapy and who carried the ambulatory computer throughout this treatment. Outcome data suggest that the treatment was highly effective for this client as well as others with a diagnosis of social phobia or GAD.
RATIONALE AND OBJECTIVES: We describe a simple technique for transmission of a complete set of cranial computed tomography (CT) images to a commercially available wireless personal digital assistant (PDA) for remote teleradiology consultation. MATERIALS AND METHODS: A complete set of images from the head CT of a trauma patient with subdural hematoma (19 images) was captured from a picture archiving and communication system and transmitted wirelessly as an e-mail attachment after being compressed. The images were retrieved, decompressed, and reviewed using commercially available software and a PDA with cellular phone capability. RESULTS: A complete head CT was transmitted to a remote radiologist's wireless PDA for consultation. The entire procedure (including image capture, transmission, and review) took approximately 11.5 minutes. CONCLUSION: Using the technique described in this article the wireless PDA may function as a robust medium for facilitating care of brain trauma patients by allowing rapid access to trauma radiologists or neurosurgeons.
INTRODUCTION: Healthcare organisations are nowadays expecting the support of IT in the daily routines. Personal digital assistants (PDAs) are in use in some healthcare organisations but in an irregular and unplanned way. The aim of the present study was to describe nurses' and nurse students' demands of functions and usability in a PDA. METHODS: Interviews were made with 12 nurses at the County Hospital of Kalmar and a questionnaire was given to nurse students (n=84) in their last, i.e. third, year at the Department of Health and Behavioural Sciences, University of Kalmar. RESULTS: There was a need for nurses to make the information in general more rich and efficient by means of a PDA. In a PDA, the nurses and nurse students expected access to information about the patients, knowledge resources and functions for their daily work. CONCLUSIONS: The nurses and nurse students had high expectations of a PDA for information retrieval. A PDA has the potential to be accepted as a supportive tool in healthcare organisations if it contains the demanded content which must be adapted to the users' needs and the general IT-system used, and the PDA must have a user friendly design.
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