Review of Handheld Applications for Healthcare

Dari AlHuwail
Software Engineer & Scholar
Mobile Medical Computing
P.O.Box 34437, Adaliya 73255
dari.alhuwail@gmail.com

ABSTRACT
Handhelds and smart Personal Digital Assistants’ (PDAs) use and
2. REVIEWED ARTICLES
applications have been growing exponentially. Their mobility and
increasing computing power have made them attractive for use in
2.1 Design, feasibility, and acceptability of an
daily life. Many electronic applications on such devices have been
developed for healthcare and life sciences. Educational use for intervention using personal digital assistant-
medical and health profession students have been suggested [1]. based self-monitoring in managing type 2
The goal of this paper is to overview three examples of how
handhelds and PDAs are used in a healthcare context. This article
diabetes
combines three review articles published at Mobile Medical
Computing Online journal. 2.1.1 Article Summary
Can PDA's enhance behavioral adherence to a self-management
Categories and Subject Descriptors intervention for type-2 diabetes patients? The study concluded
J.3 [Life and Medical Sciences]: Health. that coupling PDAs with type-2 diabetes self-management
interventions was acceptable by a majority of study participants
and that it enhanced the adherence to self-management
General Terms interventions. PDA-based self-management interventions may be
Management, Measurement, Performance, Design, useful for type-2 diabetes patients.
Experimentation, Human Factors, Verification.

Keywords 2.1.2 Research Design & Methodology

Handhelds, PDA, Diabetes, Type-2, Self-management
Interventions, MCI, Identification, Geolocation, Emergency,
Communication, Monitoring, ADE
1. INTRODUCTION
Technology has come a long way in advancing many fields,
especially the field of life sciences and medicine. In many
instances, dependence on such technology has become vital and
critical for faster, safer, and better-quality patient care. In 2002,
50% of ePocrates1 users reported prevention of 1-2 drug errors
per week [2]. Many clinicians are adopting handheld mobile
devices in their clinical practice for many practical reasons such
as mobility and instant access to information on the go. It was
reported that more than half of young medical doctors, under the
age of 35, were using PDAs in their clinical practice [3]. It’s very
clear that handhelds and mobile computing technologies adoption
in the healthcare field are on the rise and will continue to do so.
This article will overview 3 examples of how handhelds and
PDAs are used in a healthcare context. The first example is of
using PDAs for self-monitoring in managing type-2 diabetes
through special software. The second example is of using various
mobile computing technologies in identifying and tracking
disaster victims in mass casualty incidents. The last example is
that of using PDAs for voluntary medical reporting of potential
adverse drug events in hospitals by clinical staff.
1
medical software applications for PDAs used as a reference for
drug-drug interactions, medical dictionary, etc …
TYPE: Randomized controlled trial.
VALIDITY: Some participants were given older generation PDAs
that lost dietary entries when the device was not recharged in a
timely fashion. Time recording was not facilitated by the software
and therefore it did not allow for timeline analysis.
ENVIRONMENT: Combination of scheduled visits and
educational sessions at an academic research facility at the
University of Pittsburgh and at community settings when
participants employed the intervention in their daily lives.
2.1.3 Research Question
Can PDA's enhance behavioral adherence to a self-management
intervention for type-2 diabetes patients?
The research aimed to determine the acceptability and
effectiveness of PDA-based self-management interventions for
type-2 diabetes and whether such an approach reduced
information processing burdens for patients.
2.1.4 Patient/Problem/Population Definition
PROBLEM: Patients with chronic diseases, like type-2 diabetes,
face challenges from informational and behavioral standpoints.
POPULATION: 18 years of age or older with a diagnosis of type-
2 diabetes.
TYPE: Evaluation of patient education for self-management
intervention.

2.1.5 Intervention
PDAs were given to the intervention group. PalmOne
Tungsten/E2 PDAs preloaded with BalanceLog® software by
MircroLife were handed out to patients at random. The PDA tool
helped the intervention group keep track of their dietary intake,
manage their activity log, and visualize the progress in their self-
management intervention goals.
Over a period of six months, participants from both control and
intervention groups were invited to educational self-management
intervention sessions specific to type-2 diabetes.
2.1.6 Comparisons
The research compared PDA-based self-management intervention
of type-2 diabetes with that of the same self-management
interventions of type-2 diabetes but without PDAs.
PDAs were preloaded with dietary and activity management
software and participants were given Social Cognitive Theory
(SCT)-based group counseling. The control group was given
SCT-based group counseling with a lay diabetes journal.
The authors compared their results with that of others, Burke et al.
(2006) and Yon et al. (2007), and had comparable participation
rates with that of one research study by Glanz et al. (2006).
2.1.7 Outcomes
The research found that 87.9% of participants thought that PDAs
were useful in monitoring activities; 84.8% felt that the
application was easy to use; and 69.7% thought the feedback
graphs were easily interpreted. Overall, 82% reported that they
will keep using the PDA tools after the study concluded.
This 5-year study had 151 randomized participants with 129
individual (85%) completing their 6-month assessment.
2.1.8 Application of Results to Patient Care
PDA-based self-management interventions of type-2 diabetes
have proven helpful and yielded a high adoption rate by
participants. This approach may be a practical answer for
mastering diabetes self-management interventions and changing
behaviors related to diet and exercise.
2.1.9 Further Areas for Research
Explore using the same PDA approach for interventions of other
chronic diseases that require close diet and exercise monitoring.
Additionally, extend the research to other handheld devices such
as mobile phones and portable MP3 players.
Moreover, include a younger age group: 12 to 18 years old since
this age group may use handheld devices, like mobile phones and
MP3 players, extensively.
2.2 Identifying and tracking disaster victims:
state-of-the-art technology review
2.2.1 Article Summary
This article reviews the latest identification and tracking
technologies for Mass Casualty Incidents (MCIs) communication
- specifically for expediting the processes for identifying, locating,
and caring for victims. No technology was recommended per se
since the article aimed to raise awareness of the technologies that
have potential to improve MCI communication. Further research
is needed for emergency "systems that work seamlessly to
identify, geolocate, and communicate time-critical information to
rescue workers and family members."
2.2.2 Research Design & Methodology
TYPE: Review of electronic publications examining technologies
for disaster victim identification and tracking.
VALIDITY: Only a few publications reviewed were research-
based studies that reported on tests of simulated disaster or
emergency situations. Non-research sources were included, such
as newspapers, presentations, television transcripts, and technical
reports.
2.2.3 Eligibility Criteria and Search Methodology
Electronic databases were searched for relevant articles. The
databases included MEDLINE, CINAHL, SOC INDEX,
PsycINFO, Web of Science, and Cochrane Trails and Reviews.
Both existing and evolving technologies were included in the
literature review process. Only English language publications that
had the keywords “technology” and “identification systems” or
“tracking systems” were included. Technologies used for tracking
equipment were not included. Sixty-two publications were
selected. All publications selected were categorized by type of
technology type and then publication format.
Non-research resources were also reviewed for the latest, cutting-
edge technologies. Such sources included newspapers,
presentations and technical reports. No grey literature was
included.
2.2.4 Analysis
Qualitative analysis with abstraction for comparative analysis.
2.2.5 Assessment of Methodology Quality
The author excluded commercial tracking/identification
technologies that limited their analyses and findings. Non-
research sources may introduce bias if they serve to market a
technology. Additionally, the author acknowledges a shortage in
research-based literature addressing specific technologies.
2.2.6 Research Question
What are the latest identification and tracking technologies that
could potentially improve Mass Casualty Incidents (MCIs)
communication to expedite the process of identifying, locating,
and caring for victims?
2.2.7 Technologies reviewed
Barcodes, Biometrics, Forensic odontology, Geographical
information systems (GIS), Global positioning systems (GPS),
Personal digital assistants (PDAs), Radio frequency identification
(RFID), Robotics, Smart cards, Wireless communication devices,
and Wireless Internet.
2.2.8 Outcome
HIGHLIGHTS: The lack of a system for evacuating pets (i.e.,
household animals) is a leading cause of emergency evacuation
failure. Coupling wireless and geospatial technologies in MCI
digital systems may have the greatest impact.
GENERALIZABILITY: There is insufficient information
regarding cost, feasibility, and sustainability of such technologies
during non-disaster moments. This calls for further critical
evaluation.
2.2.9 Application of Results to Patient Care
Integrating the reviewed technologies into MCI operations shows
potential to ease and streamline the process of identifying/tracking
victims, providing safe medical care and shelter, and reuniting
victims with their loved ones.
2.2.10 Further Areas for Research
Future research could review electronic social networking
platforms like Facebook, Twitter and Google Latitude for systems
design.
2.3 Review: Use of a handheld computer
application for voluntary medication event
reporting by inpatient nurses and physicians
2.3.1 Article Summary
For enhancing hospital safety monitoring, can handheld tools
assist in reporting voluntary medication event reports at inpatient
wards? This study found that handheld-based reporting tools
offer better recording of potential Adverse Drug Events (ADE)
than traditional safety monitoring systems. They offer
convenience, mobility, privacy, and point-of-care reporting. These
tools may complement hospital safety monitoring systems for
safer patient care.
2.3.2 Research Design & Methodology
TYPE: Controlled trial.
VALIDITY: Potential bias due to the participant recruitment
process - as noted by authors. The clinicians who participated in
the study did so on a voluntary basis, which may suggest prior
experience or preference for using handhelds and handheld-based
reporting tools. No data was collected from clinicians who choose
not to participate in the study.
ENVIRONMENT: Inpatient medical wards at four university-
affiliated teaching hospitals.
2.3.3 Research Question
For enhancing hospital safety monitoring, can handheld tools
assist in reporting voluntary medication event reports at inpatient
wards?
2.3.4 Patient/Problem/Population Definition
PROBLEM: Underreporting of inpatient medication events.
POPULATION: Resident physicians, attending physicians, and
nurses.
TYPE: Clinical research.
2.3.5 Intervention
PDA with a handheld Medication Event Reporting Tool (MERT)
for medication reporting at inpatient medical wards. Collected
data included user identification, time stamp, type and severity of
the incident, and the stage at which the incident was reported.
MERT is a custom application coded in Visual Basic and built on
an AppForg platform. It was loaded and operated on Palm Zire™
21 handheld computers. Via a hotsync conduit, all data collected
from participants were uploaded to a centralized server database
on a weekly basis for the duration of the study.
2.3.6 Comparisons
Physicians and nurses were recruited to carry the MERT-installed
handhelds for a one-week interval. Participants had the
opportunity to participate in more than one interval as long as the
hospital's staffing assignments permitted them to do so.
Additionally, Demographics, professional experience, and
education level data were collected by the software through the
initial sign-in process. MERT could be launched at any given
moment the participant desired.
At the beginning of each shift, daily workload information was
collected. Randomly and in a repetitive manner throughout the
day, participants' ecological work dynamics - such as work
activity and stress - were also surveyed and reported separately.
Statistical calculations were performed using SPSS version 12.0.
Statistical comparisons were completed as 2-tailed tests, using an
alpha level of 0.05 for determining significance. Student's t-tests
and chi-square test of proportions were also performed.
2.3.7 Outcome
Sixty-nine percent of potential Adverse Drug Events (ADEs) were
recorded by the tool prior to administration of medication, while
27% of the events resulted in no perceptible injury to the patient
after medication administration. The tool has surpassed other
monitoring systems, like MEDMARX ® - an online database of
medication and adverse drug reactions - that captured only 35% of
potential ADEs.
2.3.8 Application of Results to Patient Care
The results of this study support that MERT-enabled handhelds
may help healthcare providers augment their hospital safety
monitoring systems to prevent adverse drug reactions and to offer
a safer healthcare delivery environment.
2.3.9 Further Areas for Research
Examine the scalability and integration of handheld tools for
complementing hospital event reporting systems. Future studies of
deploying MERT-enabled handhelds are needed in order to
examine if such tools are scalable and sustainable while
improving medication incident detection in clinical practice.
3. CONCLUSION
Handhelds and mobile computers have many practical uses for
medical and health applications. PDA-based self-management
interventions may be useful for type-2 diabetes patients. GPS,
GIS, and RFID technologies can be very handy in the
management of Mass Casualty Incidents for identifying,
geolocating, and communicating time-critical information to
rescue workers. Handheld-based reporting tools on PDAs offer
better recording of potential Adverse Drug Events than traditional
safety monitoring systems. They offer convenience, mobility,
privacy, and point-of-care reporting. Such tools may complement
hospital safety monitoring systems for safer patient care.
4. ACKNOWLEDGMENTS
D. AlHuwail thanks Prof. Kassem Saleh, Dr. Mohammad Al-
Ubaydli, Mr. Jeffery Loo and ePocrates for their support.
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