Mobile Technology to Enhance Patient Care:
“We’re lost but we’re making good time” (Yogi
Mobile computing can provide a path to improved real
time, information-driven clinical care. But most nurses do not yet
actively use mobile information technology for their core work.
The critical issues that affect nursing use of information systems
are not technical, but social.
Typically, potential new users resist the adoption
of any/all information technology because they see the use of these
systems as a threat to themselves and the status quo. Resistance
to change is a natural human behavior, but there are additional
factors at play in the nursing profession which impede the adoption
1) An aging population of nurses who have had little or no training
in the use of information technology 1.
2) Insufficient technical training at the baccalaureate level
3) A false perception among nurses that IT is “dehumanizing”
4) Misconceptions about hardware functionality.
Opposition to point-of-care computerized clinical
support is commonly ascribed to technical barriers, such as a lack
of features. This misconception has caused much of the discussion
in nursing circles to focus on the technical barriers to wide spread
acceptance of mobile clinical support systems.
Technical barriers to nursing acceptance of mobile
computing did, in fact, exist in the early models of handheld devices.
Often cited shortcomings were/are:
a) Small and/or difficult to read screens
b) Poor data entry due to the lack of a keyboard
c) Insufficient memory
All of these concerns have been addressed by the manufacturers
of handheld devices.
a) Screen resolution has improved and will continue to do so. Moreover
the newly introduced color screens have effectively eliminated the
b) Data Entry Solutions:
c) Mass storage for handhelds is now available: Packing one Gigabyte
(GB) of data storage capacity on to a disk the size of a quarter.
IBM's Microdrive can hold up to:
1,000 high-resolution photographs
1 thousand 200-page novels
18 hours of high-quality digital audio music.
Price is another issue often cited as a barrier to adoption.
However with each stage of computing since the advent of the mainframe
in the 1960s, the number of users has been successively greater.
Prices of handheld computers are an order of magnitude less than
the PC, just as the PC is an order of magnitude less than the minicomputer.
The lower prices will enable handhelds to eventually reach substantially
more users than the PC, just as the lower PC prices enabled the
PC to reach substantially more users than the minicomputer.
The large data sets like: ePocrates qRx
, present untapped information sources and clinical tools
The utility and clinical relevance of software
applications will be the key to winning nurses over to
Personal Digital Assistants (PDAs) are replacing
the multiple reference books and ragged patient index
cards that have fought for pocket space for so long.
software solutions are the key to nursing acceptance
Is Nursing Use/Acceptance Required?
The benefits of mobile computing for physicians are now being realized
and are being published in the literature. However to realize the
full potential of this powerful clinical support system, the entire
healthcare team must adopt mobile computing. Maintaining dual (computerized
and paper based) systems to accommodate those who refuse to use
the new technology can increase costs by 130% to 240%
An even more compelling reason is the opportunity presented by
handheld computing to enhance patient safety and care.
recently published report by investigators at Brigham and Women's
Hospital states: 50% of physicians using ePocrates qRx handheld
drug reference guide avoided one or more serious adverse drug events
Over 90% of clinicians surveyed reported that it took them 20
seconds or less to find information
80% said that ePocrates qRx improved their drug knowledge
83% said that their patients were better informed as a result
54% reported higher levels of satisfaction with their medical
Nursing Advances in Mobile Computing
Nurses are putting aside their fears and misconceptions about mobile
information technology and are acknowledging the emergence of personal
digital assistants (PDAs) as devices that are becoming increasingly
important in patient care.
RNpalm introduces the first nursing specific Palm OS software
and launches the world's first website dedicated to the use of
PDAs in nursing
4) United States:
5) United Kingdom:
This site is in its early stages but Colin tells us that he will
be adding to it at a steady rate over the coming weeks/months.
Only six moths ago it was difficult to find any information on
the use of PDAs in nursing, now articles are starting to appear
in the press:
Handheld computers are the next step in the evolution of computing,
the Mobile Information Age has arrived. Its time for all members
of the heathcare team to embrace this new technology... resistance
is futile :)
1) Reader Response:
"Ken, your editorial about involving more nurses
in the use of handheld technology, especially the Palm Pilot type
of technology, is generally right on target. Access to clinical
and scientific information when it is needed is going to be more
and more important as knowledge expands and work loads increase.
However, I take exception to the point about the aging nurse population
being a barrier to acceptance. This same point was made about the
general adoption of computer technology by nurses when such technologies
were being introduced. But, there was no supporting evidence for
this stereotype. In fact, as studies were done, the age and educational
background of nurses were not influential factors. Experienced nurses,
who tend to be older, are a tougher customer because they have been
through the "fads" and they can rapidly determine what will help
them. If a technology obviously provides a benefit, older nurses
are more likely to be able to integrate it into practice because
they are more experienced."
Milholland Hunter, PhD, RN
Independent Practice in Informatics
K&D Hunter Associates, Inc.
SC, Barret GO. Automated ambulatory medical records systems: An
orphaned technology. In J Tech Assessment in Healthcare 1992; 8;