Get Smart
Mobile technology streamlines documentation and helps nurses deliver more efficient, higher quality care

By Jessica M. Scully
January 16, 2004

Mobile computing technology, including smart phones and personal digital assistants, is becoming more common in health care facilities as physicians, nurses and administrators put the technology to use, according to a new study.

Spyglass Consulting Group of Menlo Park, Calif., performed a study, "Healthcare Without Bounds: Trends in Mobile Computing," released in November. The group interviewed 100 physicians, nurses and administrators.

Nurses who use the technology say it helps them work more efficiently and provide a higher quality of care. Yet nurses agree with the findings of the study: A number of roadblocks still stand in the way of mobile computing being used more widely.

The market for mobile computing in health care was $50 million in 2002, and is expected to grow to $1.2 billion by 2006, according to the study. That growth is fueled by a renewed focus on patient safety, said Gregg Malkary, managing director of Spyglass.

"It was kind of the carrot that the industries needed in order to focus more on clinical IT [information technology]," he said.

Other factors in the increased demand were concerns over a shortage of health care workers and a desire to maximize staff hours by being more efficient, Malkary said.

Only about 5 percent of the people interviewed were nurses. They were interested in using the technology, especially for documentation, Malkary said.

"A lot of them feel kind of inundated with the documentation they do," he said. "Nurses often have to wait 'til the end of the shift to write. If they have the way to do it as they go, this could significantly improve their efficiency."

The Central Coast Visiting Nurses Association and Hospice in Monterey, Calif., and Lehigh Valley Hospital in Allentown, Pa., are two facilities offering this option.

Before nurses at the Visiting Nurses Association head out for home visits, they download their daily schedules and patient charts from the main server into a handheld computer about half the size of a laptop, said Larry Garrett, MA, director of clinical services at the association.

"Nurses can do more and see more patients in a day than if they were handwriting," he said.

At Lehigh, nurses use laptops wheeled into patient rooms to record vital signs, intake and output, medication administration, IVs and pain assessment.

"The impetus certainly is to streamline documentation for our nursing staff, that's part of having tools and resources close to them, so they don't always have to come to a central location to do their documentation," said Terry Capuano, MSN, senior vice president for clinical services.

Nurses who use the technology say they prefer it.

"I wouldn't want to go back to the way we had things," said Debra Peter, RN. "It has so many advantages and it makes the delivery of care so much safer."

But this kind of use doesn't appear to be widespread. Only 5 percent of the hospitals interviewed for the study were using the full capacity of the technology, including e-prescribing and patient data management, according to the study.

Administrators in the study said a number of roadblocks, including whether clinicians would adopt the technology, the difficulty of getting it to mesh with existing technology and concerns over patient privacy limited their use.

Nursing experts, including Carol Bickford, Ph.D., RN and a senior policy fellow in the department of nursing practice and policy at the American Nurses Association, say additional hurdles must be cleared.

Bickford said that simply using the technology efficiently is an issue.

"You can take the PDA down the hallway and have the staff utilize it as a way to make the staff input vital signs," she said. "But if they have to do significant maneuvering to do that, that's not the best use of the employee time or the technology."

Bickford said even simple questions, like how nurses would carry around the technology, still need to be answered.

"One of the things we always talk about is the splash factor: Does it fall into a bathtub or commode?" she said.

Despite the concerns, many nurses seem interested in having their own PDA to use as a reference tool.

Some nursing colleges even require students to have PDAs. At Drexel University in Philadelphia, the cost of a PDA is figured into each student's mandatory lab fee. The students have five reference texts on their PDAs, and the texts are updated regularly.

Having the PDAs helps students learn, said Gloria Donnelly, Ph.D., RN, FAAN, dean of the Drexel College of Nursing and Health Professions.

"You just can't teach them everything in the classroom, you can't expect them to carry everything around in their head, it's too dangerous."

She thinks this is the wave of the future.

"In the old days, every nurse had a bandage, scissors, a watch and a couple of other things," she said. "The PDA is like the bandage and scissors. It's always in your pocket in case you need to access information."

Students also like the technology and say they'll use it in their professional careers.

"It's a valuable source of information, it carries so much and it's very lightweight and portable," said Dan Rupert, a BSN student at Drexel. "I see it as extremely valuable, as do most of my classmates."

The use of personal PDAs for reference extends outside the classroom, according to Deborah Burger, RN, president of the California Nurses Association and a nurse at Kaiser Permanente in Santa Rosa, Calif.

Burger said she sees many nurse practitioners and critical care nurses using the technology. Like administrators in the study, Burger has some concerns about patient privacy if the new technology is used for individual patient information. But she can see how a PDA can be a useful reference tool.

"When you see some of these reference manuals, they're huge," she said. "To be able to put them in a small Palm Pilot and pull it up quickly makes a difference."

Burger said the association planned to offer PDAs at a discounted price to members.

For more information or to purchase a copy of the Spyglass Consulting Group study, visit www.spyglass-consulting.com/spyglass_whitepaper.html or contact Gregg Malkary at gmalkary@spyglass-consulting.com.