Doctors’ Concerns of PDAs in the Ward Round Situation

 

 Buy Article Permissions and Reprints

Summary

Background: Healthcare professionals in hospital care increasingly use small-screen handheld computers. Studies that have investigated doctors’ concerns about handheld usage have mainly focused on technical, organizational and performance issues. Very few have looked at the effects of Personal Digital Assistants (PDAs) on the interaction between physician and patient.

Objective: The aim of this study was to explore the effects of PDA usage on the physicians’ prescription work, their concerns about using it in point-of-care situations, and the effects on the patient-physician dialog.

Methods: We used a qualitative and comparative approach where 14 physicians each carried out four simulated ward rounds in which they modified the medication of patient actors using a paper-based medical chart and three versions of a PDA-based system. We analyzed ward round video recordings, semi-structured interviews with the doctors, and focus group using approaches based on ethnomethodology and grounded theory.

Results: Physicians used PDA and paper differently. Physicians’ actions, as well as their non-verbal communication, were less transparent and clear for the patient when using a PDA. Doctors were worried about distractions from the handheld device and about a negative impact on the physician-patient conversation. In general, physicians were more comfortable with paper, but preferred PDA because it offered an undo function and reduced the need to memorize drug names and dosages by providing concrete alternatives in the user interface.

Conclusions: Despite the many benefits, PDA usage at the point-of-care comes with the increased risk of distractions for physicians and can cause a negative patient experience. Designers of point-of-care systems need to be aware of, and address, the problems with handhelds and learn from the attributes and access capabilities of paper charts.

• References

• 1 Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med 2003; 348: 2526-2534.
  CrossrefPubMedGoogle Scholar
• 2 Barrett JR, Strayer SM, Schubart JR. Assessing medical residents’ usage and perceived needs for personal digital assistants. Int J Med Inf 2004; 73: 25-34.
  CrossrefPubMedGoogle Scholar
• 3 Beck RS, Daughtridge R, Sloane PD. Physician- patient communication in the primary care office: a systematic review. The Journal of the American Board of Family Practice 2002; 15 (01) 25-38.
  PubMedGoogle Scholar
• 4 Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997; 277: 553-559.
  CrossrefPubMedGoogle Scholar
• 5 Teutsch C. Patient-doctor communication. Medical Clinics of North America 2003; 87: 1115-1145.
  CrossrefPubMedGoogle Scholar
• 6 Committee on Quality of Health Care in America, Institute of Medicine: Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press; 2001
  PubMed
• 7 Dagnone RV, Wilson R, Goldstein DH, Murdoch J, Rimmer MJ, Van Den Kerkhof EG. How do patients perceive electronic documentation at the bedside?. J Healthc Qual 2006; 28: 37-44.
  PubMedGoogle Scholar
• 8 Frankel R, Altschuler A, George S, Kinsman J, Jimison H, Robertson NR. et al. Effects of exam-room computing on clinician-patient communication: a longitudinal qualitative study. J Gen Int Med 2005; 20: 677-682.
  CrossrefPubMedGoogle Scholar
• 9 Houston TK, Ray MN, Crawford MA, Giddens T, Berner ES. Patient Perceptions of Physician Use of Handheld Computers. AMIA Annual Symposium proceedings; 2003 pp 299-303.
  PubMedGoogle Scholar
• 10 Warshawsky SS, Pliskin JS, Urkin J, Cohen N, Sharon A, Binztok M. et al. Physician use of a computerized medical record system during the patient encounter: a descriptive study. Computer Methods and Programs in Biomedicine 1994; 43: 269-273.
  CrossrefPubMedGoogle Scholar
• 11 Davis FD, Bagozzi RP, Warshaw PR. User Acceptance of Computer Technology: A Comparison of Two Theoretical Models. Management Science 1989; 35: 982-1003.
  CrossrefPubMedGoogle Scholar
• 12 Ilie V, Slyke CV. Paper Versus Electronic Medical Records: The Effects of Access on Physicians’ Decisions to Use Complex Information Technologies. Decision Sciences 2009; 40: 213-241.
  CrossrefPubMedGoogle Scholar
• 13 Lane SJ, Heddle NM, Arnold E, Walker I. A review of randomized controlled trials comparing the effectiveness of handheld computers with paper methods for data collection. BMC Medical Informatics and Decision Making 2006; 6 (01) 23.
  CrossrefPubMedGoogle Scholar
• 14 Dahl Y, Svanaes D, Nytro O. Designing Pervasive Computing for Hospitals: Learning from the Media Affordances of Paper-Based Medication Charts. Pervasive Health Conference and Workshops; 2006 pp 1-10.
  PubMedGoogle Scholar
• 15 McAlearney AS, Schweikhart SB, Medow MA. Doctors’ experience with handheld computers in clinical practice: qualitative study. Brit Med J 2004; 328 (20) 1162-1165.
  CrossrefPubMedGoogle Scholar
• 16 Alsos OA, Svanæs D. Interaction techniques for using handhelds and PCs together in a clinical setting. Proceedings of Nordi CHI, ACM New York, NY, USA; 2006 pp 125-134.
  PubMedGoogle Scholar
• 17 Dahl Y, Svanæs D. A comparison of location and token-based interaction techniques for point-of-care access to medical information. Pers Ubi Comp 2007 pp 1-20.
  PubMedGoogle Scholar
• 18 Lee TT. Patients’ perceptions of nurses’ bedside use of PDAs. CIN 2003; 25: 106-111.
  PubMedGoogle Scholar
• 19 Lu YC, Lee JK, Xiao Y, Sears A, Jacko JA, Charters K. Why don’t physicians use their personal digital assistants?. AMIA Annual Symposium Proceedings; 2003 pp 405-409.
  PubMedGoogle Scholar
• 20 Alsos OA, Dahl Y. Toward a best practice for laboratory-based usability evaluations of mobile ICT for hospitals. Proceedings of Nordi CHI, ACM New York, NY, USA; 2008 pp 3-12.
  PubMedGoogle Scholar
• 21 Svanæs D, Alsos OA, Dahl Y. Usability testing of mobile ICT for clinical settings: Methodological and practical challenges. Int J Med Inform 2009. Epub Jan 30, 2009
  PubMedGoogle Scholar
• 22 Pascoe J, Ryan N, Morse D. Using while moving: HCI issues in fieldwork environments. ACM Transactions on Computer-Human Interaction (TOCHI) 2000; 7: 417-437.
  PubMedGoogle Scholar
• 23 Shneiderman B, Plaisant C, Cohen M, Jacobs S. Designing the User Interface: Strategies for Effective 200 O. A. Alsos et al.: Doctors’ Concerns of PDAs in the Ward Round Situation Human-Computer Interaction. 5th ed. Addison Wesley; 2009
  PubMedGoogle Scholar
• 24 Tufte ER. The Visual Display of Quantitative Information, 2nd edition. Graphics Press; 2001
  Google Scholar
• 25 Melby L. Prat, penn og papir: En sosiologisk analyse av medisinsk informasjonsbruk i en mobil praksis [Talk, pen and paper. A sociological analysis of use of medical information in a mobile setting]. Doctoral Thesis, Norwegian University of Science and Technology, Faculty of Social Sciences and Technology Management; 2007
  PubMedGoogle Scholar
• 26 Glaser BG, Strauss A. The Discovery of Grounded Theory: Strategies for Qualitative Research. Aldine Transaction; 1967
  Google Scholar
• 27 Heath C, Hindmarsh J. Analysing interaction: Video, ethnography and situated conduct. Qualitative Research; 2002 pp 99-121.
  PubMedGoogle Scholar
• 28 Del Piccolo L, Mazzi M, Saltini A, Zimmermann C. Inter and intra individual variations in physicians’ verbal behaviour during primary care consultations. Social Science & Medicine 2002; 55 (10) 1871-1885.
  CrossrefPubMedGoogle Scholar