Evidence for handheld electronic medical records in improving care: a systematic review

BACKGROUND: Handheld electronic medical records are expected to improve physician performance and patient care. To confirm this, we performed a systematic review of the evidence assessing the effects of handheld electronic medical records on clinical care. METHODS: To conduct the systematic review, we searched MEDLINE, EMBASE, CINAHL, and the Cochrane library from 1966 through September 2005. We included randomized controlled trials that evaluated effects on practitioner performance or patient outcomes of handheld electronic medical records compared to either paper medical records or desktop electronic medical records. Two reviewers independently reviewed citations, assessed full text articles and abstracted data from the studies. RESULTS: Two studies met our inclusion criteria. No other randomized controlled studies or non-randomized controlled trials were found that met our inclusion criteria. Both studies were methodologically strong. The studies examined changes in documentation in orthopedic patients with handheld electronic medical records compared to paper charts, and both found an increase in documentation. Other effects noted with handheld electronic medical records were an increase in time to document and an increase in wrong or redundant diagnoses. CONCLUSION: Handheld electronic medical records may improve documentation, but as yet, the number of studies is small and the data is restricted to one group of patients and a small group of practitioners. Further study is required to determine the benefits with handheld electronic medical records especially in assessing clinical outcomes

Developing a Cohort Web Application: Real-time Monitoring of Breastfeeding Indicators

Investing in the development of methodologies for timely intervention in breastfeeding practices that provide improved indicators and prolong breastfeeding duration positively impacts the health of women and children. Aim: To develop children cohort data capture interface of a national reference institution for high foetal, neonatal and child risk from birth, covering all hospitalisation up to the second year of life for real-time monitoring of breastfeeding indicators and prevalence. Methods: Four primary criteria were considered: data security (specific permissions for different profiles and encryption of sensitive data), researcher time streamlining, data quality and construction of data export auxiliary tools. Results: A web-based tool for data collection using a mobile device or computer was developed. The tool successfully allowed the ongoing collection for a defined population cohort of measures related to breastfeeding: maternal factors, child-related factors, health service issues, nipple use, introduction of fluids and other processed foods, as well as breastfeeding practice. Conclusion: The developed product enables the validated extraction and collation of data from existing electronic records and other sources for the monitoring of breastfeeding practices. Such data can be used to refine guidelines and individual behaviour to maximise the benefits of breastfeeding and  avoid early weaning

Tablet computers for recording tuberculosis data at a community health centre in King Sabata Dalindyebo Local Municipality, Eastern Cape: a proof of concept report

Background: Data at primary healthcare (PHC) clinics are handwritten in registers by nurses for submission to the District Health Information System (DHIS). Compared to pen and paper, data capture, using handheld computers, has fewer errors, is more efficient and is readily accepted by users. This study describes the process of developing a tablet computer programme to capture data, and explores nurses’ experiences of using tablets at a community health centre.Method: OpenDataKit® was used to design XForms for touchscreen entry. Data for tuberculosis screening were captured by nurses on Android® 9.7-inch tablets over a week. Their experience was explored by means of a focus group interview.Results: Data were recorded for 24 patients and seamlessly transferred for analysis. Nurses thought that the tablets were easy to use and saved time. They would be happy to use tablets in preference to pen and paper. They  expressed a desire to extend the use of tablets to other areas of their work.Conclusion: Tablet computers were readily accepted by the nurses. They are a feasible alternative to pen and paper for recording data at point of care. This tablet-based system could be used to transfer PHC data directly to the DHIS.Keywords: analysis, clinic data, computers, Eastern Cape, primary health care, tablet, tuberculosis dat

The Design and Evaluation of Personalised Ambient Mental Health Monitors

Mobile and environmental sensing technology can be used to assess human behaviour and mental health trajectories outside of laboratories and in ecologically-relevant settings. To achieve maximum benefit, the set of equipment and the monitoring patterns must be personalised to respect individual needs and fit into individual lifestyles. We have developed a sensor network infrastructure for mobile phones and homecare using a rule-oriented programming architecture to monitor the activity signatures of people with Bipolar Disorder (BD). We believe that the use of this rule-based paradigm within the network for a mental health setting to be a contribution of this work. We are evaluating the effectiveness of the technology in an ongoing technical trial with control participants as a precursor to studying the effectiveness of the system for use with people with BD. In this paper, we report the design and development of the monitoring system along with preliminary findings from the technical trial of the system, and discuss future developments

Mobile Crowdsensing for the Juxtaposition of Realtime Assessments and Retrospective Reporting for Neuropsychiatric Symptoms

Many symptoms of neuropsychiatric disorders such as tinnitus are subjective and vary over time. Usually, in interviews or self-report questionnaires, patients are asked to report symptoms as well as their severity and duration retrospectively. However, only little is known to what degree such retrospective reports reflect the symptoms experienced in daily life some time ago. Mobile technologies can help to bridge this gap: mobile self-help services allow patients to record their symptoms prospectively when (or shortly after) they occur in daily life. In this study, we present results that we obtained with the mobile crowdsensing platform TrackYourTinnitus to show that there is a discrepancy between the prospective assessment of symptom variability and the retrospective report thereof. To be more precise, we evaluated the real-time entries provided to the platform by individuals experiencing tinnitus. The results indicate that mobile technologies like the TrackYourTinnitus crowdsensing platform may go beyond the role of an assistive service for patients by contributing to more accurate diagnosis and, hence, to a more elaborated treatment

Accelerating and improving survey implementation with mobile technology: Lessons from PMA2020 implementation in Lagos, Nigeria

Large-scale nationally representative surveys have traditionally been implemented using paper surveys, necessitating secondary steps of data entry and management after data collection. Errors occurring during data collection or entry may not be rapidly identified. The Performance Monitoring and Accountability (PMA2020) project implementation in Lagos, Nigeria demonstrates four advantages to integrating mobile technology into survey implementation. First is the rapidity of data collection; data collection lasted six weeks from mapping/listing to final collection – and, since completed surveys are uploaded to a cloud-based server, identification of errors can occur in near real-time. Second, time-stamping and GPS marking allow for improved quality assurance. Third, the inclusion of GPS coordinates creates new opportunities to analyze relationships of distance with use of health services. Fourth, PMA2014/Lagos utilized a 10% resample of households to validate data collection allowing for rapid identification of questionable data and quality control

The effectiveness of M-health technologies for improving health and health services: a systematic review protocol

BACKGROUND: The application of mobile computing and communication technology is rapidly expanding in the fields of health care and public health. This systematic review will summarise the evidence for the effectiveness of mobile technology interventions for improving health and health service outcomes (M-health) around the world. FINDINGS: To be included in the review interventions must aim to improve or promote health or health service use and quality, employing any mobile computing and communication technology. This includes: (1) interventions designed to improve diagnosis, investigation, treatment, monitoring and management of disease; (2) interventions to deliver treatment or disease management programmes to patients, health promotion interventions, and interventions designed to improve treatment compliance; and (3) interventions to improve health care processes e.g. appointment attendance, result notification, vaccination reminders.A comprehensive, electronic search strategy will be used to identify controlled studies, published since 1990, and indexed in MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, the Cochrane Library, or the UK NHS Health Technology Assessment database. The search strategy will include terms (and synonyms) for the following mobile electronic devices (MEDs) and a range of compatible media: mobile phone; personal digital assistant (PDA); handheld computer (e.g. tablet PC); PDA phone (e.g. BlackBerry, Palm Pilot); Smartphone; enterprise digital assistant; portable media player (i.e. MP3 or MP4 player); handheld video game console. No terms for health or health service outcomes will be included, to ensure that all applications of mobile technology in public health and health services are identified. Bibliographies of primary studies and review articles meeting the inclusion criteria will be searched manually to identify further eligible studies. Data on objective and self-reported outcomes and study quality will be independently extracted by two review authors. Where there are sufficient numbers of similar interventions, we will calculate and report pooled risk ratios or standardised mean differences using meta-analysis. DISCUSSION: This systematic review will provide recommendations on the use of mobile computing and communication technology in health care and public health and will guide future work on intervention development and primary research in this field

Handheld computers for self-administered sensitive data collection: A comparative study in Peru

<p>Abstract</p> <p>Background</p> <p>Low-cost handheld computers (PDA) potentially represent an efficient tool for collecting sensitive data in surveys. The goal of this study is to evaluate the quality of sexual behavior data collected with handheld computers in comparison with paper-based questionnaires.</p> <p>Methods</p> <p>A PDA-based program for data collection was developed using Open-Source tools. In two cross-sectional studies, we compared data concerning sexual behavior collected with paper forms to data collected with PDA-based forms in Ancon (Lima).</p> <p>Results</p> <p>The first study enrolled 200 participants (18–29 years). General agreement between data collected with paper format and handheld computers was 86%. Categorical variables agreement was between 70.5% and 98.5% (Kappa: 0.43–0.86) while numeric variables agreement was between 57.1% and 79.8% (Spearman: 0.76–0.95). Agreement and correlation were higher in those who had completed at least high school than those with less education. The second study enrolled 198 participants. Rates of responses to sensitive questions were similar between both kinds of questionnaires. However, the number of inconsistencies (p = 0.0001) and missing values (p = 0.001) were significantly higher in paper questionnaires.</p> <p>Conclusion</p> <p>This study showed the value of the use of handheld computers for collecting sensitive data, since a high level of agreement between paper and PDA responses was reached. In addition, a lower number of inconsistencies and missing values were found with the PDA-based system. This study has demonstrated that it is feasible to develop a low-cost application for handheld computers, and that PDAs are feasible alternatives for collecting field data in a developing country.</p

Context Aware Mobile Knowledge Management System in Healthcare

Clinical practitioners need to have the right information, at the right time, at the right place; which is possible by mobile healthcare. It is not only important for them to have the right information, but they have to manage this right information with proper knowledge, which requires the skills for efficient knowledge management in a mobile healthcare setting. Utilization of mobile devices in healthcare to share knowledge may not only improve the decision taking time, but also reduces the medical errors and costs involved. Need for this information sharing may often be required across various hospital staff that play variety of roles (as practitioners, nurses, administrative staff etc.) and works in multiple schedules (work shifts: night, day etc.), resulting in need for proper ‘context aware’ knowledge. This research paper is an attempt to develop a context aware model which can help the healthcare organizations in efficiently practicing the knowledge management in a context based mobile healthcare setting