Physicians\u27 use of the personal digital assistant (PDA) in clinical decision making

Purpose: This study examined how frequently attending physicians and physicians in training used personal digital assistants (PDAs) for patient care and explored physicians\u27 perceptions of the impact of PDA use on several areas of clinical decision making. Setting/Subjects: The 108 participants included 59 attending physicians and 49 physicians in training from teaching hospitals in Tennessee, Florida, Alabama, Kentucky, and Pennsylvania. Methodology: Respondents completed a questionnaire designed to explore PDA use in a clinical setting. Results: Eighty-seven percent of the respondents reported PDA use for patient encounters. Fifty-five percent of respondents reported frequent use, and 32% reported occasional use of a PDA for patient care. Of the frequent PDA users, 85% said PDA use had influenced their overall clinical decision making and 73% mentioned treatment alterations specifically. Approximately 60% of the participants reporting occasional PDA use indicated that the PDA had influenced their overall clinical decision making, while 54% specifically mentioned a change to their patient\u27s treatment plan. Discussion/Conclusion: Attending physicians and physicians in training who used a PDA during patient encounters perceived that even occasional PDA use had an impact on their clinical decision making and treatment choices. Health sciences librarians are perfectly positioned to provide PDA training and assistance not only to physicians who are frequent PDA users, but also to those who are occasional users

How residents and interns utilise and perceive the personal digital assistant and UpToDate

<p>Abstract</p> <p>Background</p> <p>In this era of evidence-based medicine, doctors are increasingly using information technology to acquire medical knowledge. This study evaluates how residents and interns utilise and perceive the personal digital assistant (PDA) and the online resource UpToDate.</p> <p>Methods</p> <p>This is a questionnaire survey of all residents and interns in a tertiary teaching hospital.</p> <p>Results</p> <p>Out of 168 doctors, 134 (79.8%) responded to the questionnaire. Only 54 doctors (40.3%) owned a PDA. Although these owners perceived that the PDA was most useful for providing drug information, followed by medical references, scheduling and medical calculators, the majority of them did not actually have medical software applications downloaded on their PDAs. The greatest concerns highlighted for the PDA were the fear of loss and breakage, and the preference for working with desktop computers and paper. Meanwhile, only 76 doctors (56.7%) used UpToDate, even though the hospital had an institutional subscription for it. Although 93.4% of these users would recommend UpToDate to a colleague, only 57.9% stated that the use of UpToDate had led to a change in their management of patients.</p> <p>Conclusion</p> <p>Although UpToDate and various PDA software applications were deemed useful by some of the residents and interns in our study, both digital tools were under-utilised. More should be done to facilitate the use of medical software applications on PDAs, to promote awareness of tools for evidence-based medicine such as UpToDate, and to facilitate the application of evidence-based medicine in daily clinical practice.</p

Group differences in physician responses to handheld presentation of clinical evidence: a verbal protocol analysis

<p>Abstract</p> <p>Background</p> <p>To identify individual differences in physicians' needs for the presentation of evidence resources and preferences for mobile devices.</p> <p>Methods</p> <p>Within-groups analysis of responses to semi-structured interviews. Interviews consisted of using prototypes in response to task-based scenarios. The prototypes were implemented on two different form factors: a tablet style PC and a pocketPC. Participants were from three user groups: general internists, family physicians and medicine residents, and from two different settings: urban and semi-urban. Verbal protocol analysis, which consists of coding utterances, was conducted on the transcripts of the testing sessions. Statistical relationships were investigated between staff physicians' and residents' background variables, self-reported experiences with the interfaces, and verbal code frequencies.</p> <p>Results</p> <p>47 physicians were recruited from general internal medicine, family practice clinics and a residency training program. The mean age of participants was 42.6 years. Physician specialty had a greater effect on device and information-presentation preferences than gender, age, setting or previous technical experience. Family physicians preferred the screen size of the tablet computer and were less concerned about its portability. Residents liked the screen size of the tablet, but preferred the portability of the pocketPC. Internists liked the portability of the pocketPC, but saw less advantage to the large screen of the tablet computer (F[2,44] = 4.94, p = .012).</p> <p>Conclusion</p> <p>Different types of physicians have different needs and preferences for evidence-based resources and handheld devices. This study shows how user testing can be incorporated into the process of design to inform group-based customization.</p

House officer procedure documentation using a personal digital assistant: a longitudinal study

BACKGROUND: Personal Digital Assistants (PDAs) have been integrated into daily practice for many emergency physicians and house officers. Few objective data exist that quantify the effect of PDAs on documentation. The objective of this study was to determine whether use of a PDA would improve emergency medicine house officer documentation of procedures and patient resuscitations. METHODS: Twelve first-year Emergency Medicine (EM) residents were provided a Palm V (Palm, Inc., Santa Clara, California, USA) PDA. A customizable patient procedure and encounter program was constructed and loaded into each PDA. Residents were instructed to enter information on patients who had any of 20 procedures performed, were deemed clinically unstable, or on whom follow-up was obtained. These data were downloaded to the residency coordinator's desktop computer on a weekly basis for 36 months. The mean number of procedures and encounters performed per resident over a three year period were then compared with those of 12 historical controls from a previous residency class that had recorded the same information using a handwritten card system for 36 months. Means of both groups were compared a two-tailed Student's t test with a Bonferroni correction for multiple comparisons. One hundred randomly selected entries from both the PDA and handwritten groups were reviewed for completeness. Another group of 11 residents who had used both handwritten and PDA procedure logs for one year each were asked to complete a questionnaire regarding their satisfaction with the PDA system. RESULTS: Mean documentation of three procedures significantly increased in the PDA vs handwritten groups: conscious sedation 24.0 vs 0.03 (p = 0.001); thoracentesis 3.0 vs 0.0 (p = 0.001); and ED ultrasound 24.5 vs. 0.0 (p = 0.001). In the handwritten cohort, only the number of cardioversions/defibrillations (26.5 vs 11.5) was statistically increased (p = 0.001). Of the PDA entries, 100% were entered completely, compared to only 91% of the handwritten group, including 4% that were illegible. 10 of 11 questioned residents preferred the PDA procedure log to a handwritten log (mean ± SD Likert-scale score of 1.6 ± 0.9). CONCLUSION: Overall use of a PDA did not significantly change EM resident procedure or patient resuscitation documentation when used over a three-year period. Statistically significant differences between the handwritten and PDA groups likely represent alterations in the standard of ED care over time. Residents overwhelmingly preferred the PDA procedure log to a handwritten log and more entries are complete using the PDA. These favorable comparisons and the numerous other uses of PDAs may make them an attractive alternative for resident documentation

Medical student case presentation performance and perception when using mobile learning technology in the emergency department

Hand-held mobile learning technology provides opportunities for clinically relevant self-instructional modules to augment traditional bedside teaching. Using this technology as a teaching tool has not been well studied. We sought to evaluate medical students&amp;rsquo; case presentation performance and perception when viewing short, just-in-time mobile learning videos using the iPod touch prior to patient encounters.Twenty-two fourth-year medical students were randomized to receive or not to receive instruction by video, using the iPod Touch, prior to patient encounters. After seeing a patient, they presented the case to their faculty, who completed a standard data collection sheet. Students were surveyed on their perceived confidence and effectiveness after using these videos.Twenty-two students completed a total of 67 patient encounters. There was a statistically significant improvement in presentations when the videos were viewed for the first time (p&#x200A;=&#x200A;0.032). There was no difference when the presentations were summed for the entire rotation (p&#x200A;=&#x200A;0.671). The reliable (alpha&#x200A;=&#x200A;0.97) survey indicated that the videos were a useful teaching tool and gave students more confidence in their presentations.Medical student patient presentations were improved with the use of mobile instructional videos following first time use, suggesting mobile learning videos may be useful in medical student education. If direct bedside teaching is unavailable, just-in-time iPod touch videos can be an alternative instructional strategy to improve first-time patient presentations by medical students

Language Barriers in Health Care Settings: An Annotated Bibliography of Research Literature

Provides an overview of resources related to the prevalence, role, and effects of language barriers and access in health care

Impact of a brief faculty training to improve patient-centered communication while using electronic health records

Objective Despite rapid EHR adoption, few faculty receive training in how to implement patient-centered communication skills while using computers in exam rooms. We piloted a patient-centered EHR use training to address this issue. Methods Faculty received four hours of training at Cleveland Clinic and a condensed 90-minute version at the University of Chicago. Both included a lecture and a Group-Objective Structured Clinical Exam (GOSCE) experience. Direct observations of 10 faculty in their clinical practices were performed pre- and post-workshop. Results Thirty participants (94%) completed a post-workshop evaluation assessing knowledge, attitude, and skills. Faculty reported that training was important, relevant, and should be required for all providers; no differences were found between longer versus shorter training. Participants in the longer training reported higher GOSCE efficacy, however shorter workshop participants agreed more with the statement that they had gained new knowledge. Faculty improved their patient-centered EHR use skills in clinical practice on post- versus pre-workshop ratings using a validated direct-observation rating tool. Conclusion A brief lecture and GOSCE can be effective in training busy faculty on patient-centered EHR use skills. Practice Implications Faculty training on patient-centered EHR skills can enhance patient-doctor communication and promotes positive role modeling of these skills to learners

Artificial Intelligence Service Agents: Role of Parasocial Relationship

Increased use of artificial intelligence service agents (AISA) has been associated with improvements in AISA service performance. Whilst there is consensus that unique forms of attachment develop between users and AISA that manifest as parasocial relationships (PSRs), the literature is less clear about the AISA service attributes and how they influence PSR and the users’ subjective well-being. Based on a dataset collected from 408 virtual assistant users from the US, this research develops and tests a model that can explain how AISA-enabled service influences subjective well-being through the mediating effect of PSR. Findings also indicate significant gender and AISA experience differences in the PSR effect on subjective well-being. This study advances current understanding of AISA in service encounters by investigating the mediating role of PSR in AISA’s effect on users’ subjective well-being. We also discuss managerial implications for practitioners who are increasingly using AISA for delivering customer service

The Impact of Technology Attitudes and Skills of Rural Health Clinic Nurses on the Level of Adoption of Electronic Health Records in Mississippi

The evolution of health information technology continues to reform the delivery of efficient, safe, and equitable healthcare in the United States. One such example is the emergence of electronic health records (EHRs) and the discerning emphasis placed on using this technology in meaningful ways. While the integration of EHRs into daily practice impacts all healthcare professionals, nurses remain a prominent driver in the successful adoption and usage of these systems. It is therefore imperative to understand the impact of nurses’ technology attitudes and skills on the level of EHR adoption in Mississippi. This quantitative study examined the technology attitudes and skills of rural health clinic nurses on the level of adoption and meaningful use (as defined by CMS) of electronic health records. Approximately 44 rural health clinic nurses (or those serving in a rural health clinic nursing capacity) participated in a survey that solicited demographic information, healthcare facility information, electronic health record information; and information regarding the technology skills, and technology attitudes of the respective participant. The findings show no significant relationships between current stage of EHR meaningful use and rural health clinic practice ownership; nor do factors that impede or facilitate the diffusion process significantly differ by practice ownership. Findings also indicate that the technology attitude of a nurse is not significantly impacted by (1) the age of the nurse, (2) the number of years of nursing experience, or (3) the current stage of EHR meaningful use at the nurses’ respective rural health clinic. Results of the study indicate that Mississippi’s rural health clinics are at varying levels of EHR meaningful use with some clinics still at a level of no adoption. In addition, technology attitudes of rural health clinic nurses still remain low. As evidenced by technology attitude scores, clinic nurses lack confidence in using technology and in the technology itself. Training should be focused on the application of health information technologies to increase nurses’ self-confidence and understanding of effective use. Further, administrators and practice owners should involve nurses throughout the adoption lifecycle to ensure nurses are a vital component in the development and integration of EHRs

ETSU Medical Residents\u27 Clinical Information Behaviors, Skills, Training, and Resource Use.

Information is a powerful tool for enabling physicians to provide quality healthcare for their patients. Information use in the clinic is a skill that must be learned. If medical residency programs fail to impart this skill, then patients will suffer. The residents of the ETSU Quillen College of Medicine were surveyed as to their use of clinical information. Of the 217 residents of the 2005-2006 class who were surveyed, 105 returned the survey for a return rate of 48%. The clinical faculty was also surveyed in order to measure the responses of the residents against that of their instructors. ETSU residents frequently had a new information need in the clinic. The majority of the time they did not seek an answer, but when they did they were often successful in finding an answer. Therapy information was the most frequently sought after type of information. Most residents used the Quillen College of Medicine Library, but not at a desirable rate. Residents stated that information obtained from the library was helpful in caring for their patients. The most frequent source of information used by residents was electronic resources and the greatest barrier to the use of information was time. The majority of residents were PDA users, with Palm devices being the primary platform. The residents rated their PDA skills and evidence-based medicine skills as above average. Few were LoansomeDoc users. The majority of residents received information training from clinical faculty and from librarians and rated it highly. Residents indicated a desire for more training and the majority indicated that they would like a clinical medical librarian for their program. They rated the library service of the Quillen College of Medicine and the area teaching hospitals highly. Residents used Google and the Web frequently. PubMed was rated as a valuable resource. Online journals and the UpToDate database were important electronic resources for the residents. ETSU residents have many excellent resources and training opportunities in place. However, for ETSU residents to go out into community practice as true Infomasters an upgrading of their information training should be undertaken