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Handheld Computers in Clinical Practice: Implementation Strategies and Challenges

Ann Scheck McAlearney, ScD, Ohio State University
Sharon B. Schweikhart, PhD, Ohio State University
Mitchell A. Medow, MD, PhD, Ohio State University

Hospitals and health systems are under pressure to create a digital environment for patient-care delivery while physicians are increasingly expected to take advantage of innovative clinical technology developments.  New insight and strategies can help health care executives leverage their investment in information technologies while enhancing the value of those investments at the clinical care delivery level.

In the context of developing a digital patient care environment, handheld computers stand out as an emerging means for physicians to bring information resources to their clinical practice.  Handheld computers such as PDAs, handhelds, and Palm Pilots® are functionally flexible, customizable, and easily portable to facilitate their use at the point of care.  Such devices offer convenient access to information and hold promise for innovative applications in the future.  However, objective information about the use of handhelds in a clinical environment is often difficult to obtain in the vendor-driven environment of healthcare information technology.  There is also little guidance available to administrators who want to implement and encourage the use of this and other information technologies by their clinicians.  To address these issues, Dr. McAlearney and her colleagues investigated the use of handheld computers:

  • by organizations, as a critical component of their clinical information management strategy, and
  • by physicians bringing electronic medical record capabilities to the point of care.

Over the course of a comprehensive study involving nearly 150 respondents, the research team interviewed 67 organizational representatives as part of eight organizational case studies and also conducted nine focus groups.  Focus group participants included 55 physicians, 15 other clinicians (physician assistants, dieticians, physical therapists, and pharmacists), and 10 other organizational informants.

During interviews, both organizational and physician participants reported that they expected handheld computers to become more useful and ubiquitous in the future.  Commonly cited uses included patient data access, pharmaceutical reference, guideline dissemination, medical calculator functions, and scheduling.  Their suggestions for more innovative uses of the devices included provider-directed patient education; data acquisition, and distribution of such databases as formularies, consultant physician information, and pharmacy phone numbers.  Most physician-informants who were already using handheld computers expressed in gaining additional benefits from the technology, but both frequent users and non-users of handheld computers expressed concern about device reliability, technical support, and personal dependence on the device.

Informants were also queried about the strategies and tactics used by hospitals to integrate handheld computers into their patient care delivery practices.  Researchers found that organizational support fell into three broad categories: active promotion, facilitation and support for broad-based applications and devices; active support for niche applications; and passive support for individual users.  Not surprisingly, the greater the investment in capital and information technology support, the more likely it was that physicians’ handheld computer use could be leveraged for organizational purposes.

The researchers’ findings yielded recommendations to assist health system decision-makers reduce barriers to the broad adoption and utilization of handheld computers by physicians in clinical practice.  Recommendations to senior management, IT professionals, clinical leaders, and medical directors included:

  • tailoring training for handheld computer use to meet the diverse range of technical experience and aptitudes presented by individual physicians;
  • leveraging the enthusiasm of “power users” of handheld computers to encourage those physicians less familiar with or reluctant to use the technology;
  • supporting a 24/7 help desk offering non threatening, one-on-one support;
  • working with interested clinicians to devise creative ways to collect data about patient care and outcomes and to appropriately provide information to health care providers in the form of databases, guidelines, and patient education materials;
  • creating a “handheld-friendly” organizational environment to attract and retain providers who will also be effective users of other clinical information technologies.

Lessons from this research are also easily adaptable to the implementation and promotion of other information technology projects aimed at improving clinical practice through the use of emerging developments in clinical technologies.

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