Jerry Fahrni

The Impact of Mobile Handheld Technology on Hospital Physicians’ Work Practices and Patient Care: A Systematic Review¹

The Journal of the American Medical Informatics Association
Mirela Prgomet, Andrew Georgiou, Johanna I Westbrook

Abstract

The substantial growth in mobile handheld technologies has heralded the opportunity to provide physicians with access to information, resources, and people at the right time and place. But is this technology delivering the benefits to workflow and patient care promised by increased mobility? The authors conducted a systematic review to examine evidence regarding the impact of mobile handheld technology on hospital physicians’ work practices and patient care, focusing on quantification of the espoused virtues of mobile technologies. The authors identified thirteen studies that demonstrated the ability of personal digital assistants (PDAs) to positively impact on areas of rapid response, error prevention, and data management and accessibility. The use of PDAs demonstrates the greatest benefits in contexts where time is a critical factor and a rapid response crucial. However, the extent to which these devices improved outcomes and workflow efficiencies because of their mobility was largely absent from the literature. The paucity of evidence calls for much needed future research that asks explicit questions about the impact the mobility of devices has on work practices and outcomes.

Of the 2,292 articles reviewed by Prgomet et al, only 13 were used in the analysis for the paper. The inclusion criteria tree can be viewed at the JAMIA website. While the information reviewed in the paper can be considered grossly out-of-date by technology standards, there remain a few pearls that can be applied to a mobile pharmacy model.

According to the article, handheld devices can:

- promote faster treatment through earlier notification, assessment, and interpretation of data
- facilitate interprofessional communication
- serve as an information and decision support tool (clearly the most widely accepted use for handheld devices by pharmacists)
- reduce medication errors
- facilitate hospital-based documentation of, and accessibility to, patient data

The authors of the paper quickly identify what I feel is one of the biggest reasons for using handheld devices in a decentralized pharmacy practice model; they “possess the advantages of being portable and allowing access to information anywhere and at any time.” Unfortunately, this advantage comes with price. According to the article the handheld’s “smaller screens are designed for individual use which can make collaboration difficult and they present challenges in easily viewing and entering data. The limitations and potentially error-inducing features of computer screens, which may include limiting a full overview of patient information, or hiding important information behind menus, will be exacerbated on a PDA screen.” I agree with this assessment, which is why the statement by the authors that they “sought to include tablet computers in the review but found no studies investigating this mobile handheld technology that met the review criteria, further demonstrating the dearth of research on this topic” is even more disturbing. I’ve experienced the same inability to find information while searching for literature to support tablet pc use by pharmacists in the clinical setting. In my opinion, the adoption of the tablet pc is the next logical step in developing a platform for the mobile pharmacist.

1. Prgomet M, Georgiou A, Westbrook JI. The Impact of Mobile Handheld Technology on Hospital Physicians’ Work Practices and Patient Care: A Systematic Review. JAMIA 2009; 16:792-801

The PDF version of the JAIMA article is available as a free download here.