Lecturer in Health Informatics
University of Wales
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.
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.
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.
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)
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Ward JP, Gordon J, Field MJ, Lehmann HP. Communication and information technology in medical education. Lancet 2001;357:792-6.
- 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.
- Perkins NA, Murphy JE, Malone DC,Armstrong EP.Performance of drug–drug interaction software for personal digital assistants. Ann Pharmacother 2006;40:850-5.
- 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.
- 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.
- 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.
- 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.