Handheld devices: making a difference in healthcare

Tony Paget
Lecturer in Health Informatics
University of Wales
Swansea
UK

The term “handheld devices in healthcare” brings to mind an array of instruments made of stainless steel and with deadly contours. Here, however, the devices also known as Personal Digital Assistants (PDAs), palmtop computers or pocket PCs and their applications are the focus. All these terms are used fairly interchangeably but tell us a little of the background. The PDA was essentially an electronic diary with limited function; the palmtop (as opposed to the laptop) reflects the size of the machine and probably relates to one of the leading suppliers (eg, Palm Inc). The latter name, while also the name given to a Windows- based operating system, also best describes what is basically a very small computer. The term pocket PC is used in the remainder of the article, although no preference for a particular brand is implied. Recently a kind of hybrid between a pocket PC and a desktop has found some application in healthcare. The tablet PC is essentially a flat device typically measuring about  25x30x5cm and features a much larger screen; like the pocket  PC, it also utilises touchscreen technology, freeing the user from keyboard and mouse.

Health informatics is variously defined, but it is  essentially about getting the right information to the right  person at the right time to improve healthcare. If this is  the case then a more portable means of access to information  may be useful. Health professionals are a mobile group and  often not in a position to access a desk-based computer.  This is particularly true of community workers, of course.     

The pocket PC, however, can do what the title implies and  fits in a pocket. “The handheld can provide a critical mass  of information that is relevant, quickly accessible and in a  coherent format: delivering clinical information at the point of need with a resulting benefit to patient safety.”(1)

Advantages and disadvantages
The advantages of a fully mobile computer in healthcare are fairly self-evident, but there is, of course, a downside.(2) Most of us interact with our computers by inputting through a keyboard/mouse, and the output is via VDU. Both of these items are bulky, and it is the miniaturisation of the PC to pocket size that constitutes the main downside. The screen size is necessarily limited, and the input is either via a very small keyboard or through handwriting on a touch-sensitive screen (or a combination of both). At once this limits the amount of detail that may be presented to the user and makes the inputting of large amounts of text comparatively difficult.(3) These factors define the use to which they may be best put; relatively small amounts of dynamic information, where a limited amount of keystrokes are needed.

Connectivity
Another key feature that has made the pocket PC more  versatile is its ability to connect with a desktop PC and/or  a network. Such connectivity expands the functionality  further, allowing transfer of dynamic data and updates to or from the pocket PC. This can be accomplished via a wired  connection to a PC or wirelessly. Wireless options include:

• Infrared: limited to close proximity (usually less than a  metre) and quite slow transmission speeds.
• Bluetooth: a radio signal with a range of 10–100 metres  with transfer rates of up to three megabits per second (depending on version of device).
• Wi-Fi: (designated IEEE802.11b/g) is a wireless protocol  allowing building-wide wireless networks with transmission rates of up to 54 megabits per  second.
• Telephony: the inclusion of a mobile phone with a modem  in a pocket PC allows countrywide connectivity with claimed  transmission speeds up to two megabits per second.

The potential for use in healthcare is massive. A number of  general areas are included here, but there are many small  projects globally. Individual employees are often using such  devices. Examples of broad areas of application include  those where the positive attributes of the pocket PC are put to best use.

Access to patient records
Facilitating access to individual patient records by mobile  healthcare professionals has clear benefits.(4) A project  tested the use of pocket PCs to access medical records for  health workers working on an outreach scheme within the  community. They found that they minimised the time needed to create a document of care, increasing time for client  contact. The limitations of the smaller pocket PC were also  identified, and a further project will explore the use of  slightly larger tablet PCs.(3) In this example, the pocket  PC was preloaded with the case notes of the clients due to  be seen. Additions made to the records would then be  uploaded to the “master” copy on return to base.  Alternatively, where a wireless network is in operation, the  devices could receive continual updates and also uplink  changes made by users almost synchronously.

Prehospital care
The pocket PC’s ability to receive and transmit data  wirelessly has found practical application with those most  mobile of healthcare professionals, the paramedics. Examples of such an application include the transmission of data gathered early in the treatment of a patient suffering a myocardial infarction. An ECG can be forwarded to a  receiving medic and suitable preparations made. This has  been found to save time, and improve prognosis.(5) The UK  military is piloting such a system where frontline emergency  care is recorded on a pocket PC and transmitted wirelessly  to central records. Where wireless communication is not  possible, a small memory chip is sent on with the casualty.

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Just-in-time education
The notion that healthcare professionals can carry all the  up-to-date information they need to deal with every case has long been open to question. The solution is just-in-time education, where the clinician can access the most  up-to-date evidence base at the bedside at the point of  consultation or treatment.(6) A pocket PC, either preloaded  with a database or with wireless access to web-based  resources, provides a tool for this.(7) The prospect of ready access to a resource that is dynamically updated and can cross-reference instantly is very attractive in the field of prescribing. Basic formularies can accessed, and complex drug interactions can be identified.(8)

The “Swiss army knife” device
Such is the versatility of pocket PCs, it is impossible to  describe all their possible applications in healthcare. They  integrate a large number of functions even without any  addition or modification. For example, a new “out of the  box” model, such as an Xda Exec (O2), has multiple  connectivity, including infrared, Bluetooth, Wi-Fi and  GSM/GPRS/3G telephony, can browse the internet, send and receive emails, make voice and video calls, view video  files, play audio files, word process, access Windows  Outlook (calendar, contacts, email), synchronise with a PC,  take high-resolution images and videos.

These functions can be harnessed in a number of ways to  improve healthcare. Its connectivity could be used as part  of a telehealth system where physiological measurements,  such as blood sugar levels, could be collated and  transmitted onto a monitoring service. A barcode reader can be added to monitor blood transfusion safety by scanning codes on the blood bag, the patient’s ID bracelet and the carers ID badge. They are used as research tools, where field data can be entered into a database.(9,10)

Future developments
Mathew, in respect of mobile technologies, said “even as  health care officials study trends and try to chart the  future, a revolution is steadily gathering speed.  Increasingly, medical practice requires instant access to  accurate information, and because it is possible, it is  becoming necessary”.(11)

It seems that the healthcare sector lags in the application  of mobile devices, but the drivers in this case may well  belong to the health professionals and others who recognise the value of these devices. There are no known European programmes that explicitly plan to roll out such devices, although it is implicit in those of Scandinavia, Germany and England.

The tension between the ease of portability and the ease of  data input/output will resolve itself in two ways. First of  all, the devices will find niche applications where small  amounts of data display and input are congruent. Secondly,  technologies are already emerging that may help “square the circle” of miniaturisation versus usability. Already, a  laser virtual keyboard can be projected onto any surface and linked to a pocket PC. Display technologies may soon present us with a polymer-based VDU that can be rolled up like a piece of paper.

In the near future, another type of handheld computer will  be readily available – Microsoft’s Origami project, which  features a flat device with a larger touchscreen than pocket  PCs but is more compact and light than a tablet PC.  Convergence may also hold the key, where an increasing  number of facilities are available at a single point or  through a single device.

Wireless access to internet and intranets will improve.  Already many buildings are Wi-Fi enabled, and there are  experiments with metro-wide wireless networks such as that set up for free public access in Bristol, UK.(12)

In the fields of ITC and health informatics it is often folly to try to make future predictions, but individuals are voting with their feet and mobile technologies are certain to become part of ubiquitous computing where we will all  have access the information we need at the point it is  needed.

References

1. Honeybourne C,Sutton S, Ward L.Knowledge in the Palm of your hands: PDAs in the clinical setting. Health Info Libr J 2006;23:51-9.
2. Lu YC, Sears A, Jacko JA. A review and a framework of handheld computer adoption in healthcare. Int J Med Inform  2005;74:409-22.
3. Buck DS, Rochon D, Turley JP. Taking it to the  streets: recording medical outreach data on personal digital  assistants. Comput Inform Nurs 2005;23:250-5.
4. Favela J,Rodriguez M, Preciado A, Gonzalez  VM.Integrating context-aware public displays into a mobile hospitalinformation system. IEEE Trans Inf Technol 2004;8:279-86.
5. Sillesen M, Ripa MS, Strange S, et al. [Telemedicine  in the transmission of prehospitalisation ECGs of patients with suspected acute myocardial infarction]. Ugeskr Laeger 2006;168:1133-6.
6. Ward JP, Gordon J, Field MJ, Lehmann HP. Communication and information technology in medical education. Lancet 2001;357:792-6.
7. Fontelo P, Ackerman M, Kim G, Locatis C. The PDA as a portal to knowledge sources in a wireless setting. Telemed J E Health 2003;9:141-7.
8. Perkins NA, Murphy JE, Malone DC,Armstrong  EP.Performance of drug–drug interaction software for  personal digital assistants. Ann Pharmacother 2006;40:850-5.
9. Stinson JN, Petroz GC, Tait G, Feldman BM, Streiner D, McGrath PJ, et al. e-Ouch: usability testing of an  electronic chronic pain diary for adolescents with  arthritis. Clin J Pain 2006;22:295-305.
10. Whalen CK, Henker B, Ishikawa SS, et al. An electronic diary study of contextual triggers and ADHD: get ready, get set, get mad. J Am Acad Child Adolesc Psychiatry 2006;45:166-74.
11. Mathew RJ. A health care revolution in the making:  intelligent mobile solutions.Available from:  http://www.hctproject.com/documents.asp?grID=316&d_ID=2811.
12. Schofield J. The Wi-Fi West: Bristol has gone hi-tech,  with a huge city centre hotspot and web kiosks. The Guardian 2004 Aug 12.