Adopting Mobile Technology to Enhance Patient Care:

Issues and Status of Nursing Use and Attitudes

“We’re lost but we’re making good time” (Yogi Bera)

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 of IT.

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 complaint.

b) Data Entry Solutions:

  • On Screen Keyboard alternatives such as the FITALY Keyboard

  • Advanced handwriting recognition software: CIC's Jot



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 for nursing.

The utility and clinical relevance of software applications will be the key to winning nurses over to mobile computing.

Personal Digital Assistants (PDAs) are replacing the multiple reference books and ragged patient index cards that have fought for pocket space for so long.

compelling 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% 2.

An even more compelling reason is the opportunity presented by handheld computing to enhance patient safety and care.

A 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 per week

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 care


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.

1) Korea:

2) Australia:

3) Canada:

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."

Kathleen Milholland Hunter, PhD, RN

Independent Practice in Informatics

K&D Hunter Associates, Inc.

2) Schoenbaum SC, Barret GO. Automated ambulatory medical records systems: An orphaned technology. In J Tech Assessment in Healthcare 1992; 8; 598-609

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