Theme Section: Computers in the ICU Revisited: An Expert Roundtable, April 2005, Chicago, IL
Mobile computing in critical care

https://doi.org/10.1016/j.jcrc.2006.12.007Get rights and content

Abstract

Handheld computing devices are increasingly used by health care workers, and offer a mobile platform for point-of-care information access. Improved technology, with larger memory capacity, higher screen resolution, faster processors, and wireless connectivity has broadened the potential roles for these devices in critical care. In addition to the personal information management functions, handheld computers have been used to access reference information, management guidelines and pharmacopoeias as well as to track the educational experience of trainees. They can act as an interface with a clinical information system, providing rapid access to patient information. Despite their popularity, these devices have limitations related to their small size, and acceptance by physicians has not been uniform. In the critical care environment, the risk of transmitting microorganisms by such a portable device should always be considered.

Introduction

Computing technology is essential in optimizing access to information and integration of clinical data in critical care [1], and handheld computers provide an increasingly popular interface. Handheld computers are used by 40% to 50% of physicians in the United States [2] and by more than 50% of physicians younger than 35 years in Canada [3]. With the rapid evolution in this technology, including improved memory capability, processing power, and wireless connectivity, handheld devices have the potential to become an important component of an integrated knowledge access system [1], [4], [5]. They offer a portable platform for point-of-care clinical reference and patient management in the intensive care unit (ICU) [6].

Section snippets

Hardware options

Handheld computers have several benefits distinguishing them from desktop and laptop computers [7]. They are easily portable and turn on immediately without the delay of a booting process. Potential disadvantages include the small screen size and difficulty experienced by some users with data entry using handwriting recognition systems or small keyboards [8].

Two operating systems dominate the market, namely, Palm Operating System (Palm OS) (PalmSource Inc, Sunnyvale, Calif) and Microsoft Pocket

Roles for handheld computers

Handheld computers' initial roles in the medical field included scheduling and access to medical reference texts. A wide variety of roles have subsequently emerged, including patient data management, access to medical literature and guidelines, clinical research, and for tracking educational experience [5], [9].

Barriers to handheld devices

Although use of handheld computers is increasing among physicians, their use is certainly not uniform and has not reached the level of acceptance of conventional computers. The advantages of mobility necessitate a small form factor, which limits screen size, memory capacity, and computing speed. Although images can be displayed on handheld devices, these are not adequate for medical diagnostic purposes. The Palm OS does not support multitasking, allowing only 1 application to be opened at a

Infection control and handheld devices

Transmission of infection in the ICU by contact with computer keyboards has been demonstrated [24] and the possibility of transmission by handheld devices clearly needs to be considered. Colonization of handheld computers with skin organisms is very common [25], and some pathogens may survive for days or weeks on plastic surfaces, increasing the risk of disease transmission [26]. Handheld devices can be effectively disinfected by cleaning with alcohol [27], but an awareness of the potential

Conclusion

Information technology is essential to enhance the efficacy and reliability of health care provision. Although in many situations a desktop computer may be preferable, handheld computing technology is a potentially important component of future integrated information management systems.

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