Mobile information and communication tools in the hospital

doi:10.1016/S1386-5056(99)00056-8

International Journal of Medical Informatics

Volume 57, Issue 1, January 2000, Pages 21-40

https://doi.org/10.1016/S1386-5056(99)00056-8 Get rights and content

Abstract

Mobile information and communication systems in clinical routine have the potential to greatly improve communication, facilitate information access, eliminate double documentation, and increase quality of patient care in the long run. Projects to date have focused, for the most part, on highly specialized applications of the mobile computer. In our research project, ‘Cooperative Problem Solving in Health Care’, we have, among other things, designed a multifunctional mobile information and communication assistant. A prototype version of this system was implemented. This article outlines the close-to-reality evaluation of our prototype in a 1-week simulation study in a Heidelberg University hospital. We describe methods, aims, design and results of the simulation study, as well as discuss our methodology and the results we have obtained. We argue that the diverse requirements of different professional groups cannot be fulfilled by a single multifunctional device and propose, therefore, a ‘multi-device mobile computer architecture’. Finally, we present consequences for the future computing infrastructure.

Introduction

Physicians and nurses are highly mobile in their daily hospital routine, moving frequently between wards, outpatient clinics, diagnostic and therapeutic departments, conference rooms and operating theatres. Their manifold information and communication needs at any number of locations and at all times of day and night are difficult to satisfy. Costly clinical workstations, which require additional allotment of valuable space, though often used, are not always accessible.

Current patient record information for example is not always available during doctors’ rounds. Current literature available in the library or at the clinical workstation can not be directly accessed at patient bedside. New orders or diagnoses noted during rounds must be transferred to the patient records or a clinical workstation at a later time.

It is not only because of their mobility, but also due to their distinct patient care responsibilities that communication is so important for physicians and nurses. We feel that both direct and indirect communication require support through information and communication tools. More often than not, physicians and nurses are very difficult to reach by telephone directly. Indirect communication devices such as pagers fail to provide detailed information on the reason for a call and its urgency. They are disruptive and, particularly when repeated contact attempts must be made, cause communication delay.

The use of the mobile computer in clinical hospital routine has great potential to solve at least a part of these problems and to fulfill information and communication needs in health care. The mobile computer can support both communication and information processing, where an appropriate infrastructure is available [1], [2]. Yet its development and its use in clinical practice is still rare. Research projects to date have dealt predominantly with isolated application fields of mobile tools, such as mobile access to medical knowledge [3], [4], [5], mobile documentation [6], [7], [8], mobile access to patient information [9], [10], [11] and mobile communication [12], [13].

The aim of our research project, ‘Cooperative Problem Solving in Health Care’, has been the development of a general mobile information and communication tool architecture in health care. At the beginning of 1997 (see Ref. [14]), we conducted a preliminary study which examined application fields for mobile computers in the hospital. Based on its results, we then conceptualized and prototypically realized a mobile multifunctional digital assistant for information processing and communication. In order to test this concept and the available technology in as realistic a setting as possible, we carried out a simulation study at the end of 1997. Physicians and nurses from the university hospitals of Heidelberg, general practitioners and nurses — 31 professionals in total — took part.

Section snippets

Study aims

During the simulation study in Heidelberg, an interdisciplinary research team tested the prototypical mobile information and communication assistant in a close-to-reality study with genuine users, but employing simulated patients. We studied a variety of research questions, whereby the following criteria were of particular interest: security, legality, reachability management, application scenarios, ergonomics and user acceptance. For a detailed description of all research questions, see Ref.

The Heidelberg hospital information system

The Heidelberg university hospital has 14 clinics and 62 medical departments with 117 wards and a total of 1732 beds, 70 outpatient units and 31 operating theatres and an additional outpatient theatre.

In approximate figures, 50 000 inpatients and 250 000 outpatients are treated at the hospital yearly, 20 000 operation reports are written, 250 000 physicians’ reports drawn up and more than 1 million findings established (laboratory, radiology findings, etc.). Some 6.3 million pages are generated

Mobile prototype technology and functionality

The mobile digital assistant is based on an Apple Newton 2000, measuring 20×12 cm² and weighing 660 g, and an attached GSM¹ — mobile telephone. Speech and data communication is realized by D1-Netz². Fig. 1 shows the hardware used.

Prior to the study, the department of medical equipment carried out extensive testing, which revealed that mobile telephones do not interfere with medical equipment when a safety margin of 2 m is

Method

To answer the questions outlined in Section 2, we designed a simulation study, in which test users are observed while working with prototypical technology in a close-to-reality environment. The simulation study is not an experiment. It does not allow a complete evaluation of technical systems, but rather aims to obtain design proposals for a new technology from experts in the field and from future users. For details, see Refs. [20], [21].

Rather than simply conduct laboratory studies, we asked

Results

Our results are presented according to the questions listed in Section 2. Evaluations and information taken from the 16 physicians who completed the questionnaire and took part in the interviews (from 17 participants) are presented first. We then present the compiled results for participants from outpatient care⁴

The results

As the results show, the test persons found need, for the most part, for mobile computer implementation in clinical routine. In this chapter, we summarize the three main fields of application — mobile communication, mobile information access, and mobile documentation.

Mobile communication in clinical routine provides two possibilities: direct and indirect communication (through message leaving). Information exchange in an interdisciplinary working team can thus be substantially facilitated, and

Consequences for the future computing infrastructure

Based on the results of the simulation studies, consequences for the future computing infrastructure can be drawn, taking into account mobile computers.

A multi-device architecture for the integration of mobile computers

The simulation study shows clearly that requirements for mobile computers and for application fields can be very different. For example, a mobile computer to be used for mobile communication should be small, easy to use, and have a long lasting battery; a mobile computer, however, which will be used for information processing, requires adequate display size and convenient data input tools (‘The display is too small and the mobile computer too big — this is a dilemma. It’s one or the other.’).

Conclusion

As the single term ‘information and communication technology’ suggests, communication and information processing are becoming one. This development is leading to new opportunities in cooperation, to change of workflow, and to new organization structures in hospitals.

The results of the simulation study show that the majority of the participants sees a place for mobile information and communication tools in the workplace. Medical personnel would welcome speedier access to information, the

Acknowledgements

The research project ‘Cooperative problem solving in health care through the use of semantically indexed documents’ is funded by the German Research Association (Deutsche Forschungsgemeinschaft-DFG) under the grant HA 1438/6. We are most grateful to the staffs of the University Hospital and of the outpatient sector in Heidelberg for their active participation in this project. Thanks also to the reviewers and to Andrew Grant, Quebec, for their valuable comments on this paper and the English

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View full text

Mobile information and communication tools in the hospital

Abstract

Introduction

Section snippets

Study aims

The Heidelberg hospital information system

Mobile prototype technology and functionality

Method

Results

The results

Consequences for the future computing infrastructure

A multi-device architecture for the integration of mobile computers

Conclusion

Acknowledgements

Gen. Hosp. Psychiatry

Int. J. Med. Inf.

Co-operative problem solving with personal mobile information tools in hospitals

Methods Inf. Med.

An integrated approach for mobile information processing in hospitals

Finding and applying evidence during clinical rounds: the ‘evidence cart’

J. Am. Med. Assoc.

Pocket-sized electronic clinical referencing

MD Comput.

An evaluation of mobile computing for information access at the point of care

Biomed. Instrum. Technol.