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PubMedDate not supplied

Developing an educational reminder system for a handheld encounter log.

BACKGROUND AND OBJECTIVES: Medical students increasingly log patient encounters on handheld computers. Detailed patient records captured at the bedside would allow these log programs to complement medical education with automated reminders. We evaluated progress toward this goal. METHODS: A series of electronic student encounter logs (ESEL) were designed to quickly record common diagnoses in a family medicine clerkship. Common diagnoses were organized in a shallow, broad-tree structure that locates many concepts with one to four taps. Third-year clerks' ESEL records of patient problems were evaluated longitudinally and across two similar clerkships. Grading criteria were introduced to encourage attention to target problems, especially infrequently reported psychosocial issues. A pilot reminder system in ESEL-4, the latest version of the computer application program, included 17 high-specificity reminders. Students' viewing of reminders was monitored. RESULTS: Students recorded complex patients in ESEL-4 and entered 80% of patients during office hours. ESEL grading generated anxiety but was associated with significantly increased and plausible documentation of tobacco abuse, depression, and alcohol abuse. Students viewed titles of about 25% of generated reminders but reviewed less than 1% of reminders in detail. CONCLUSIONS: Students using ESEL-4 document plausibly complex patients, usually during office hours. Grading probably improves completeness and accuracy. Diagnosis-driven educational reminder systems are possible but do not yet capture students' attention.

Adult↗
PubMed2006

Adopting a personal digital assistant system: application of Lewin's change theory.

AIM: This paper reports a study exploring nurses' perceptions of adopting an information system using handheld computers (personal digital assistants) in their daily practice. BACKGROUND: Handheld computers have recently been used in nursing information systems for patient care, but few studies have explored their impact on users. By understanding clinicians' experiences of using this technology, strategies can be implemented to smooth the change process in adopting their use, thus achieving optimal patient outcomes. METHOD: A descriptive, exploratory approach was used to study nurses' perceptions of using personal digital assistants as part of a hospital information system. A purposive sample of 15 nurses participated in one-to-one, in-depth interviews from February to March 2004. Nurses' perceptions of the adoption process were analysed using Lewin's force field theory of change as a framework. FINDINGS: Nurses initially resisted using the personal digital assistant system (unfreezing stage), then came around to using it (moving stage), and finally adopted the system in their daily practice (re-freezing stage). However, an anticipatory stage also occurred and this could serve as a feedback mechanism to improve the system for current and future use. CONCLUSION: Educational programmes should be provided and strategic planning should be done in the early stage of implementing a policy to adopt new technology. In addition, the adoption process and learning period could be shortened by improving the system's content design. During this transition stage, dual charting should be used as a backup only for a limited time to avoid adding extra work to nurses' already heavy workload. Finally, the concept of confidentiality should be reinforced and stressed early in the educational programme to protect patient data, which can easily be accessed in computerized systems.

Adult↗
PubMed2001

A comparison of a printed patient summary document with its electronic equivalent: early results.

Clinicians are always searching for efficient access to clinical data. The Regenstrief Medical Record System has a printed report that fills this niche: Pocket Rounds. Handheld computers may offer an alternative, but it is unclear how effectively a handheld computer can display such data. We surveyed residents and students on the general medicine services for their opinions regarding Pocket Rounds. Those with handheld computers were given access to an electronic version of Pocket Rounds-e-Rounds. We surveyed the subjects who used e-Rounds for their opinions on the electronic format and how it compared to paper. Users overall satisfaction with Pocket Rounds was 5.8 on a seven-point scale. User s overall satisfaction for e-Rounds was 5.6 on a seven-point scale. The most useful function was retrieval of lab data for both modalities. The results suggest that the electronic format is a viable alternative to paper. Further evaluation is needed, and we plan a prospective controlled trial to study this further.

Hospital Information Systems↗
PubMedDate not supplied

Rhinoplasty perioperative database using a personal digital assistant.

OBJECTIVE: To construct a reliable, accurate, and easy-to-use handheld computer database that facilitates the point-of-care acquisition of perioperative text and image data specific to rhinoplasty. METHODS: A user-modified database (Pendragon Forms [v.3.2]; Pendragon Software Corporation, Libertyville, Ill) and graphic image program (Tealpaint [v.4.87]; Tealpaint Software, San Rafael, Calif) were used to capture text and image data, respectively, on a Palm OS (v.4.11) handheld operating with 8 megabytes of memory. The handheld and desktop databases were maintained secure using PDASecure (v.2.0) and GoldSecure (v.3.0) (Trust Digital LLC, Fairfax, Va). The handheld data were then uploaded to a desktop database of either FileMaker Pro 5.0 (v.1) (FileMaker Inc, Santa Clara, Calif) or Microsoft Access 2000 (Microsoft Corp, Redmond, Wash). DESIGN: Patient data were collected from 15 patients undergoing rhinoplasty in a private practice outpatient ambulatory setting. Data integrity was assessed after 6 months' disk and hard drive storage. RESULTS: The handheld database was able to facilitate data collection and accurately record, transfer, and reliably maintain perioperative rhinoplasty data. Query capability allowed rapid search using a multitude of keyword search terms specific to the operative maneuvers performed in rhinoplasty. CONCLUSIONS: Handheld computer technology provides a method of reliably recording and storing perioperative rhinoplasty information. The handheld computer facilitates the reliable and accurate storage and query of perioperative data, assisting the retrospective review of one's own results and enhancement of surgical skills.

Computers, Handheld↗
PubMed2003

Personal digital assistant applications for the healthcare provider.

OBJECTIVE: To review some common medical applications available for personal digital assistants (PDAs), with brief discussion of the different PDA operating systems and memory requirements. Key search terms included handheld, PDA, personal digital assistants, and medical applications. DATA SOURCES: The literature was accessed through MEDLINE (1999-August 2002). Other information was obtained through secondary sources such as Web sites describing common PDAs. DATA SYNTHESIS: Medical applications available on PDAs are numerous and include general drug references, specialized drug references (e.g., pediatrics, geriatrics, cardiology, infectious disease), diagnostic guides, medical calculators, herbal medication references, nursing references, toxicology references, and patient tracking databases. Costs and memory requirements for these programs can vary; consequently, the healthcare provider must limit the medication applications that are placed on the handheld computer. CONCLUSIONS: This article attempts to systematically describe the common medical applications available for the handheld computer along with cost, memory and download requirements, and Web site information. This review found many excellent PDA drug information applications offering many features which will aid the healthcare provider. Very likely, after using these PDA applications, the healthcare provider will find them indispensable, as their multifunctional capabilities can save time, improve accuracy, and allow for general business procedures as well as being a quick reference tool. To avoid the benefits of this technology might be a step backward.

Computers, Handheld↗
PubMed2003

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

OBJECTIVE: To assess the educational effectiveness on learning evidence based medicine of a handheld computer clinical decision support tool compared with a pocket card containing guidelines and a control. DESIGN: Randomised controlled trial. SETTING: University of Hong Kong, 2001. PARTICIPANTS: 169 fourth year medical students. MAIN OUTCOME MEASURES: Factor and individual item scores from a validated questionnaire on five key self reported measures: personal application and current use of evidence based medicine; future use of evidence based medicine; use of evidence during and after clerking patients; frequency of discussing the role of evidence during teaching rounds; and self perceived confidence in clinical decision making. RESULTS: The handheld computer improved participants' educational experience with evidence based medicine the most, with significant improvements in all outcome scores. More modest improvements were found with the pocket card, whereas the control group showed no appreciable changes in any of the key outcomes. No significant deterioration was observed in the improvements even after withdrawal of the handheld computer during an eight week washout period, suggesting at least short term sustainability of effects. CONCLUSIONS: Rapid and convenient access to valid and relevant evidence on a portable computing device can improve learning in evidence based medicine, increase current and future use of evidence, and boost students' confidence in clinical decision making.

Adult↗
PubMed2006

Automated vs manual triage for bioterrorist disaster: a blinded crossover feasibility study comparing personal digital assistant to paper-based triage.

INTRODUCTION: This article reports results of a National Institutes of Health/National Library of Medicine Small Business Innovation Research-funded research grant comparing paper-based and automated Palm handheld computer disaster triage documentation. OBJECTIVES: The aim of this study was to test the feasibility of automated handheld computer triage and compare it to handwritten triage. METHODS: A paired t test was used in an intraindividual, blinded, crossover study to compare the 2 methods of disaster triage by 2 objective measures--time and accuracy. A total of 57 experienced, licensed first responders participated. Results are from analysis of 8 disaster scenarios with a total of 400 patients triaged using the 2 methods of documentation, crossed over, blinded, and paired per participant. RESULTS: The study demonstrated the feasibility of using TriageDoc, a Palm personal digital assistant (PDA ) program, as a viable alternative to current manual disaster triage. Furthermore, the PDA program gave advantage to bioterrorist agent identification. CONCLUSIONS: The feasibility of an automated Palm (Palm, Inc., Sunnyvale, CA) PDA triage program was demonstrated in this study. Study limitations, by the number of participants and the fact it is feasibility research, are acknowledged. Nevertheless, the research demonstrated TriageDoc was as accurate or more accurate as the manual method of triage with a tendency to require less time. Also there was no statistically significant difference between research sites with respect to accuracy or time to completion when the TriageDoc system was used. The program provided consistency and had flexibility in adapting to the various differences in triage methods at different locations. Hence, PDA programs such as TriageDoc may have potential advantages over handwritten documentation for disaster triage.

Bioterrorism↗
PubMedDate not supplied

Enhancing survey data collection among youth and adults: use of handheld and laptop computers.

Tobacco use, alcohol and other drug use, early sexual behavior, dietary practices, physical inactivity, and activities that contribute to unintentional and intentional injuries are a significant threat to the health of young people. These behaviors have immediate and long-term consequences and contribute to diminished health, educational, and social outcomes. Research suggests that health risk behaviors exhibited during adolescence and adulthood have their origins earlier in childhood and preventive interventions are less successful after the risk behaviors have begun. Therefore, efforts to prevent health risk behaviors are best initiated in late childhood or early adolescence. However, to document the efficacy of these efforts, reliable, valid, and parent/child-friendly systems of data collection are required. Computerized data collection for research has been found to improve privacy, confidentiality, and portability over the paper-and-pencil method, which, in turn, enhances the reliability of sensitive data such as alcohol use or sexual activity. We developed programming tools for the personal computer and a handheld personal data assistant to offer a comprehensive set of user interface design elements, relational databases, and ample programming languages so that adults could answer 261 items and youth 346 items. The purpose of the article was to describe an innovative handheld computer-assisted survey interview method of collecting sensitive data with children aged 9 to 11. The method was developed as part of a large multisite, national study to prevent substance use.

Adolescent↗
PubMed2006

Screening of neuropathic pain components in patients with chronic back pain associated with nerve root compression: a prospective observational pilot study (MIPORT).

OBJECTIVE: Chronic back pain is characterized by a combination of neuropathic and nociceptive mechanisms of pain generation. The prevalence of the neuropathic pain component is unknown. Thus, in the context of an explorative study, we aimed to determine the prevalence of signs and symptoms indicating neuropathic pain in adult patients treated by orthopaedists. We also aimed to assess the usefulness of handheld computers (PDAs) in data collection. METHODS: Prospective epidemiological study in 18 orthopaedic practices or centres throughout Germany. Physician and patient questionnaires (paper/pencil or on handheld computers, PDAs) for patients with back pain of at least 3 months in duration were applied, as well as the von Korff score to assess pain intensity (visual analogue scale, VAS; 0 = no pain, 10 = worst possible pain) and pain characteristics, the Hannover Functional Ability Questionnaire (FFbH-R), and if patients agreed to provide information, the short-form Patient Health Questionnaire (PHQ-D) for depression. RESULTS: For 717 patients, both patient and physician questionnaires were available. Mean patient age was 56 years; pain was predominantly located in the low back (87%). Median current pain intensity on the VAS was 5.0. Confirmed key signs and symptoms indicated neuropathic pain was frequent, e.g. radicular pain radiating beyond the knee towards the foot (40.0%), positive Lasegue sign (18.4%), or absent patellar reflex (17.3%). A third of all patients (33.5%) had >or=3 characteristic signs for neuropathic pain. Patient functionality was severely reduced (median 43.3%). There were no relevant differences in outcomes between patients using the paper/pencil method (47%) versus those preferring PDAs (53%). CONCLUSION: Screening for neuropathic pain in this setting is feasible with simple questionnaires and scales on PDAs. Neuropathic pain is a major contributor to chronic back pain and a frequent component in patients seen by orthopaedists. At least one third of all patients should undergo additional diagnostic measures to confirm the cause of neuropathic pain.

Back Pain↗
PubMed2004

Organizing literature information for clinical decision support.

Answers to clinical questions occurring during healthcare practitioner/patient interaction can be often found in National Library of Medicine's (NLM) databases. The recent advances in wireless handheld computers promise to make them a widely used tool to deliver needed information to the practitioner at the point of service. This paper addresses challenges in organizing and presenting information obtained from NLM's MEDLINE database of indexed citations in a way that will help practitioners reduce literature search time on handheld computers. We study two clustering algorithms and two methods of labeling document clusters.

Algorithms↗
PubMed2003

A chemotherapy incident reporting and improvement system.

BACKGROUND: The Vanderbilt University Medical Center (VUMC) has designed and deployed the Chemotherapy Incident Reporting and Improvement System (CIRIS), which is embedded into daily care processes. The system uses commercial information technologies, including handheld computers, to create a mobile Web-based chemotherapy incident reporting system for nurses and pharmacists. Two phases--(1) development and implementation of the CIRIS incident reporting safety registry and (2) development of the handheld-computer interface--were implemented. The final phase entails integration of the computerized order entry system into the front end of the CIRIS architecture. The voluntary incident reporting system data are stored over time for use by the multidisciplinary safety improvement team. RESULTS: Staff buy-in has been demonstrated by increased reporting rates, the high number of provider-initiated improvements made to the reporting tool during the first year of implementation, and specific chemotherapy safety interventions conceived from analysis of the reported data. CONCLUSION: The CIRIS model for pediatric chemotherapy safety improvement has been implemented in the inpatient setting but could easily be configured for a variety of other clinical applications in inpatient or outpatient settings. CIRIS has been effective, especially in the chemotherapy pharmacy, where incident reporting has increased dramatically.

Child↗
PubMed2006

A new way to integrate clinically relevant technology into small-group teaching.

Medical educators need to teach learners to efficiently access the best available evidence at the point of care and apply it in a patient-centered manner. As information becomes more readily available via the Internet and handheld computers, strategies to use these tools as part of the educational process become more important. New teaching skills are needed when attempting to seamlessly introduce technology into small-group settings in the midst of blending old and new teaching methods. The authors' development of a conceptual model known as "e-microskills" at the University of Connecticut School of Medicine in 2002 has facilitated the smooth integration of technology into teaching. This model's cornerstone is direct empowerment of learners during small-group sessions to perform observed searches for the best medical evidence on the Internet and with handheld computer resources. This is done in the context of a mnemonic, PEARL: (1) Choose a "Preplanned search intervention"; (2) allow learners to "Execute the search," thus committing themselves; (3) "Allow learners to teach other learners" about their search process; (4) "Review the quality of evidence" for the information found; and (5) discuss "Lessons of the search." Additional features of this teaching model include ground rules for teaching with technology that optimizes teaching time by reducing anticipated obstacles. The rules add structure in an otherwise impromptu setting thus maximizing the teachable moment. While "e-microskills" are described here within the context of a third-year family medicine clerkship, they can easily be adapted to other small-group teaching settings.

Computers, Handheld↗
PubMedDate not supplied

Handheld technology to improve patient care: evaluating a support system for preference-based care planning at the bedside.

OBJECTIVE: Despite an increasing movement toward shared decision making and the incorporation of patients' preferences into health care decision making, little research has been done on the development and evaluation of support systems that help clinicians elicit and integrate patients' preferences into patient care. This study evaluates nurses' use of CHOICE, a handheld-computer-based support system for preference-based care planning, which assists nurses in eliciting patients' preferences for functional performance at the bedside. Specifically, it evaluates the effects of system use on nurses' care priorities, preference achievement, and patients' satisfaction. DESIGN: Three-group sequential design with one intervention and two control groups (N=155). In the intervention group, nurses elicited patients' preferences for functional performance with the handheld-computer-based CHOICE application as part of their regular admission interview; preference information was added to patients' charts and used in subsequent care planning. RESULTS: Nurses' use of CHOICE made nursing care more consistent with patient preferences (F=11.4; P<0.001) and improved patients' preference achievement (F=4.9; P<0.05). Furthermore, higher consistency between patients' preferences and nurses' care priorities was associated with higher preference achievement (r=0.49; P<0.001). CONCLUSION: In this study, the use of a handheld-computer-based support system for preference-based care planning improved patient-centered care and patient outcomes. The technique has potential to be included in clinical practice as part of nurses' routine care planning.

Aged↗
PubMed2005

A high-level specification for adaptive ecological momentary assessment: real-time assessment of drug craving, use and abstinence.

In psychological research, efforts to capture day-to-day human experience traditionally relied on pen-and-paper diaries and questionnaires. Some current studies, however, incorporate handheld computers, which provide researchers with many options and advantages in addition to providing more reliable data. One advantage of using handheld computers is the programmability of the electronic diary, which, compared to old-fashioned paper diaries, affords the researchers with a wealth of possibilities. An important possibility is to construct a built-in mechanism in the computer-administered questionnaires that would allow transparent branching, in which question presentation is contingent on participants' answers to previous questions. The major hurdle in implementing such an approach is the limitations of the platform used for such assessments: inexpensive "low-end" handheld devices. We propose a high-level specification which enables non-programming researchers to "branch" their questionnaires without modifications to the source code in a highly user-friendly fashion, with backtracking capability and very modest hardware requirements. A finite state automaton approach was implemented, we believe for the first time, to create an auto-trigger mechanism for the real-time evaluation of the conditions. This solution provides our investigators with the capacity to administer efficient assessments that are dynamically customized to reflect participants' behaviors without the need for any post-production programming.

Behavioral Research↗
PubMed2004

Portable computing in psychiatry.

Personal digital assistants (PDAs) or handheld computers have become more popular in the practice of medicine. These devices have implications for psychiatric practice, and this paper reviews various published articles describing their use. The literature demonstrates their use in document editing, patient tracking, accessing medical information and drug reference guides, prescription writing, and medical education. Security on these devices is covered, and the value and increasing implementation of PDAs in psychiatry is discussed.

Computers, Handheld↗
PubMed1999

Using a hand-held computer to collect data in an orthopedic outpatient clinic: a randomized trial of two survey methods.

OBJECTIVES: In a randomized study, the authors examine how data can be collected at the point of care. Specifically, examining to what extent handheld computer data collection systems introduce bias or increase respondent difficulty. METHODS: Volunteers were randomized to 1 of 2 survey methods: the hand-held computer or a paper and pencil form of similar content. Differences between group scale scores were compared using the Wilcoxon (rank sum) test. RESULTS: The hand-held computer system produced comparable scores to paper and pencil surveys. However, there was evidence of lower internal consistency reliability with the handheld computer. CONCLUSIONS: This study demonstrated the comparability of the hand-held computer methodology to the paper and pencil methodology in obtaining survey information in an ambulatory clinic. The hand-held computer method of survey data collection offers an alternative to paper methods when point-of-care administration is acceptable. Preliminary evidence shows that this method produces comparable results to paper forms.

Adolescent↗
PubMed2004

Computer-aided anthropometry in the evaluation of dysmorphic children.

OBJECTIVE: Although anthropometry is widely regarded as the technique of choice for the evaluation of dysmorphic features among children, it is only rarely used in clinical practice. Possible reasons for this are the limited access of pediatricians to appropriate reference values and the time-consuming way measurements must be plotted onto growth charts. This article describes a computer program that overcomes these problems and greatly facilitates the use of anthropometric measurements in pediatric medicine. DESIGN: A computer program for PalmOS-based, handheld computers that compares entered anthropometric measurements with age- and gender-matched reference values was developed. The software is distributed free of charge and can be downloaded (www.medgen.unizh.ch/abase/). RESULTS: The ABase software contains age- and gender-matched reference values for 18 anthropometric measures frequently used for the evaluation of dysmorphic children. The proband's age is automatically calculated from the entered birth date and can be corrected for prematurity. Entered measurements are compared with the internal reference values; the results are displayed as percentile ranks or z scores and are plotted on digital growth charts. CONCLUSIONS: The presented software makes anthropometric reference values easily accessible on the ward or in the clinic and greatly reduces the time needed to plot the measurements onto growth charts. This should promote more widespread use of anthropometry in pediatric medicine.

Anthropometry↗