Abstract

The purpose of this study was to develop MobileNurseTM; a prototype of mobile nursing information system using PDA; it was used for retrieving patients information such as, physicians’ orders and test results at anywhere or anytime. We tested it in clinical settings. It enable nurses to provide point-of care by reducing time-consuming, redundant paperwork, therefore, ultimately, it will improve the quality of care.

Introduction

In the past dozens of years, progress in the development of computer technology has been remarkable. The features of this progress is active, collaborative, intelligent, and mobile. Computer has played an increasingly important role in diverse areas of industry.

Health Care is one of the last industry yet to undergo complete computerization. Although we currently call up laboratory results, order tests, and bill patients using computerized systems, many facilities are still using age-old manual methods for recording clinical information and physicals, nursing notes, assessment, and treatment plans.

Furthermore, with the wealth of technical improvement in health care, the need for information technology innovation is increasing, not only in use of computer-based patient record, but also in enabling infrastructures to support health information interchanges. There are many new technologies which are being developed to improve the efficiency and productivity of nursing staff. Nursing information system is useful for decision support, point-of-care documentation, interagency and interdisciplinary communication.

Timely access to data related to the patient at hand is critical, especially, in health care environment requiring rapid clinical decision making. In addition, patients seek information which are about their conditions. Therefore, systems that enable nurses to share information with patients at any time are also needed, regardless of place.

The purpose of this study was to develop a prototype of mobile nursing information system: it was used for retrieving medical orders and test results and it will also be able to connect and interchange with the hospital information system in terms of patients data.

This paper will presents the development of MobileNurseTM, mobile computing system; clinical trial of MobileNurseTM; and future directions.

Development of MobileNurseTM

PDA is abbreviation of Personal Digital Assistant. It is capable of handling several personal functions such as a memo, address, schedule and also can interface with a personal computer. Its size is small enough to handheld.

There are diverse kinds of models of PDAs and Cellvic is one of them. It has been made by JTEL; which is the company that specializes in mobile computing systems.

Our ultimate goal was to implement mobile computing system which communicate with HIS; Hospital Information System, directly. We have divided the framework of development into two stages; First, to implement the interactive system between PDA and Mobile Support System. MSS is a unit server located at the nursing station, it stores and communicates patient data with PDA. Second, to interface PDA with HIS. We assumed that MSS was interchanging with HIS and focused on sharing and interchanging of patient data between MSS and PDA. In this study, we performed the first phase experiment. Figure 1 represents the mobile computing environment and the picture which is in a dotted line indicates our research framework.

PDA communicates with HIS via MSS. We developed autosynchronization module to interchange updated information between PDA and MSS consistently. If you placed PDA on the cradle which is connected MSS, autosynchronization is executed.

Our subjects were followings:

• Collection and analysis of user requirement

• Design of database of both PDA and MSS

• Development of application program

• Clinical trial of the system

Graphical presentation of developmental process of MobileNurseTM is shown in Figure 2.

MobileNurseTM consists of four modules(Figure 3); Patient Information Management, Medical Order Check, Nursing Recording, and Nursing Unit Care Plan. Each module has submenus. Patient Information Management module shows the patients list and displays individual demographic information of patients. Medical Order Check module is help nurse to check physician’s orders. Nursing Recording module consists of nursing notes, vital sign recording, checking fluid intake/output of patient, pain assessment, and results of special nursing treatment. Nursing Unit Care Plan module consists of submodules such as discharge, clinical test, consultation, blood transfusion, operation, transfer, and diet.

MobileNurseTM user interface is shown in Figure 4.

MobileNurseTM provides nurses with useful functions, for example, like as followings:

• Automatizing vital signs graph(Figure 5)

• Calculating total amount of fluid intake/output

• Pain Assessment Tool

• Online retrieval of physicians’orders and test results

• Nursing records at bedside

MobileNurse in Clinical Trial

We tested MobileNurse at the Clinical Trial Center, Seoul National University Hospital, Korea. Six registered nurses volunteered and performed nursing care for four stimulating patients with MobileNurseTM..

We used a pentium PC as mobile supporting system which supported and communicated data with PDA. During the clinical trial, physician’s order was entered into MSS by doctors and the information was interchanged between MSS and PDA when the autosynchronization was activated. Nurses were able to refer patient data with PDA at any time or any place, if necessarily.

We have surveyed nurses’ opinions about the MobileNurseTM with a semi-structured questionnaire. It consisted of 4 parts; questions about individual experience in computer, questions focusing on user convenience, questions about MobileNurseTM, open questions

All six nurses have replied that it was helpful to check physician’s order and laboratory results at bedside. However, they indicated that PDA was inconvenient for user to see a full view of patients’ data because its screen was small rather than PC’s.

Nurses’ opinions after clinical trial are summarized as following:

Positive response:

• Portable and ease to use

• Beneficial to nursing care

• Available as worksheet, or Kardex

Negative response:

• Being difficult to write down characters or numbers on PDA with pen

• Some modifications are required on function and user interface of program

Discussion and Future Direction

A recent survey of health care organizations found that almost 30% have automated the documentation process with computer-based patient records. This trend is expected to continue, because the minimum time for gathering and entering computerized documentation is less than the minimum time for handwritten documentation. Considering that nurses spend up to 50% of their time documentation patient information, the computerization of these tasks is essential.

There are some reports similar to this paper. The research by Mcbride et al. demonstrated the comparability of the paper and pencil methodology in obtaining survey information in an ambulatory clinic. As a result, the handheld computer method produced comparable scores to paper and pencil surveys.

Wayne Memorial Hospital introduced a handheld point-of-care computer for use on three madical-sugical inpatient units. System documentation includes admission data, shift assessment, nurses notes, plans of care, nursing interventions, and discharge summaries. Nurses surveyed indicated that they spent less time charting and worked fewer overtime hours after implementation of a system. It also permitted physicians to view patient data any time from their offices with computer links to the network.

We convince that MobileNurseTM reduce time-consuming, redundant paperwork, consequently it enable nurses to be more time with patients and to provide ‘hand on’ care. In clinical trial, we found that this system is useful for not only clinical environment, but also diverse setting and health care environment such as community nursing.

The future development issues in MobileNurseTM is in the following:

• Functional enhancement by installing wireless modem on PDA

• Implementation nursing manuals and protocols on PDA

In addition, a PDA is useful for Evidence-based Medicine; The fundamental concept underlying Evidence-based Medicine is that medical decision must ultimately have a rational basis, and must rest on the results of objective, rigorously conducted scientific experiment.

With use of PDA in clinical environment, nurses can be more time with patients and provide ‘hand on’ care right by reducing time-consuming, redundant paperwork, therefore, ultimately, it will improve the quality of care.

References

1. Zolot JS. Computer-based patient records. Am J Nurs 1999; 99(12): 64.

2. Dillon TW, McDowell D, Salimian F, Conklin D. Perceived ease of use and usefulness of bedside-computer systems. Computers in Nursing 1998; 16(3): 151-156.

3. Bowles KH. The barriers and benefits of nursing information systems. Computers in Nursing 1997; 15(4): 191-196.

4. McBride JS, Anderson RT, Bahnson JL. Using a hand-held computer to collect data in an orthopedic clinic: A randomized trial of two survey methods. Medical Care 1999; 37(7): 647-651.

5 Woods, G. (2000, February). PalmPilot Tools for EBM [www document]. URL http://www3.mtco.com/glwoo

1Sookyung Hyun, RN, BSN, 2Jinwook Choi, MD, Ph.D, 3Jonghoon Chun, Ph.D, 4Sang-goo Lee, Ph.D, 5Donghoon Shin, Ph.D, 3Daihee Kim, BS, 5Seungjong Lee, 4Donggyu Kim, MS.

1College of Nursing, Seoul National University, Korea, 2College of Medicine, Seoul Natinal University, Korea, 3Division of Computer Science & Engineering, Myongji University, Korea, 4Department of Computer Science, Seoul National University, Korea, 5JTEL Co. Ltd.

This original research paper was the basis of a poster presentation presented at the AMIA 2000 Annual Symposium

Click to view a copy of the paper as it was presented on Nov 6,2000 in Los Angles.