High-Tech/High-Care

T E C H N O LO G Y By Brad Sherrod RN, MSN, and Wes Wood RN, BSN, MHA

Tablet computers: technologys prescription for nursing

Adopting new technology is integral to the fulfillment of a healthcare organizations goals and its ability to move forward with strategic plans. Nursing has a natural and key role in evaluating and implementing new technology that will be used in the healthcare setting. Handheld mobile computing devices, such as personal digital assistants (PDAs) and tablet computers, have the power to transform the practice of nursing.

tions, determining drug-to-drug interactions, locating laboratory values, and performing calculations. Nevertheless, because of the size of the processor and small amount of available memory, most PDAs arent good for electronic medical record charting. The size of the font is also an issue for screen readability.

History of the handheld

Handheld devices are relatively new technology. In the early 1990s, nurses began to use these devices because of their ability to store software programs that aided nurses in assessing and diagnosing patients. As the cost of handheld devices decreased, while their functionality and memory increased, these devices became more useful to healthcare practitioners.1 The term handheld computer, which evolved during the late 1990s, describes the functionality of these devices, which act as minicomputers complete with a processor, memory, and software applications. By 2001, 26% of physicians were using PDAs in their practice.2 Within 3 years, physicians handhelddevice usage increased to 57%.3 More nurses in education and advanced practice use handheld mobile computing devices than in the general bedside nursing population.4 Handheld devices have limited memory and capabilities due to their size. Theyre great for using with software related to assessing medica-

Bigger and better

Computer engineers identified a need for a new product that was a cross between the PDAs portability and traditional laptop functionality. Hence, tablet computers were designed to fit into this technological niche. Tablet computers are one of the newer handheld mobile computing devices on the market. Typically smaller in size and more portable than traditional laptops, tablets are larger than pocket computers. Tablet computers have thin designs with screen sizes that range from 12 to 14

inches with a weight of 4 to 4.5 pounds. Though tablet computers can be smaller than traditional laptops, the devices dont lose any functional qualities or memory. Tablet computers have unique functions that make them ideal for mobility. By twisting and folding over the screen, the laptop becomes a handheld tablet. Users can hold the lightweight, ergonomic device in their right or left hand by switching the screen view with the touch of a button. Many healthcare institutions across the country currently use computers on wheels (COWs), which are traditional laptops built into carts. These devices can be bulky and cumbersome to use. The tablet computers unique option enables the user to be extremely mobile and still have the functionality, speed, and software of a traditional laptop computer while not being tied to a large cart. The size of the device is also an advantage in decreasing the clutter of the COWs on the nursing units and improving a units aesthetics.

Embracing technology
The nursing profession needs to decentralize its approach from the traditional means of communication, which involves bringing the needed information closer to the point of servicethe bedside. Tablet computers and other handheld devices may play a role in this transition. This decentralization creates a wealth of new possibilities, such as the availability of previ-

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ously desk-bound resources that can now be found in an electronic format quickly and easily. Decentralization also decreases the nurses reliance on memory and

it takes to retrieve that information.1 As an organization migrates to a handheld mobile computing device, its imperative to evaluate the products functionality and effectiveness

Nursing has a key role in evaluating and implementing new technology.

fosters an environment that encourages continuous use of electronic informational materials to improve patient outcomes. Patient chart information can be available at the nurses fingertips, increasing the availability of pertinent knowledge about patients and their status while decreasing the length of time in improving daily processes, especially when seeking to justify the expense. Process changes are difficult and must have end-user support and buy-in from the beginning. Buy-in is a precursor to effective deployment and device usage. One way to gain user buy-in is to invite those wholl work with the devices

regularly to join early discussion groups and evaluate the devices to assess functionality and ease of usage for daily operations. End users must be able to witness the functionality and process improvements first hand, before reporting back to their peer group. Its key for stakeholders to believe that the technology is going to be useful to their daily work environment.5,6 The initial learning curve is noted as the largest hurdle to overcome during the implementation phase of handheld mobile computing devices.

Clinical usage
In 2005, Forsyth Medical Centers (FMC) emergency department (ED), Winston-Salem, N.C., decided to

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High-Tech/High-Care
implement a portable tablet computer to enhance the role of the ED supervisor. With 90,000 annual patient visits, ED supervisors at FMC are extremely busy overseeing patient flow, admission processes, and staffing. They need the ability to be mobile, yet close to important information. The tablet computer gives the supervisor the mobility required to stay connected to the hospitals operating system and bed control program while moving through the department and assisting staff where necessary. The ED supervisors have come to depend on the tablet, naming the device Nellie. In 2006, administrators at High Point Regional Health System, High Point, N.C., decided to restructure the admission processes. The admitting process allowed multiple staff members to place patients on units, so a centralized process to streamline patient placements was needed. Nursing supervisors were given the task to perform admissions for the hospital, since they have knowledge of staffing levels, hospital census, and patient acuity for nursing units that have available beds. The task would not allow nursing supervisors to be stationary at a traditional desktop computer; they needed a way to stay mobile and connected to the hospitals operating systems while performing rounds, responding to codes, and other functions of their role that kept them out of the office. A tablet computer was the perfect solution. Both facilitys users agree that the tablet computer softwares sticky note feature can be used to make quick notations during busy shifts, which can be stored until needed to relay clear communication to oncoming shifts, physicians, or patients families. There were some disadvantages noted by the users at both facilities. The most frequent disadvantage was related to system downtime. The downtime was seldom specific to the tablet computer, but was most often related to one of the hos-

Advantages and disadvantages

Both facilities found similar advantages to using a tablet computer. (See Key tablet computer advantages and disadvantages. ) Through wireless technology, the tablet computer can be connected to the bed placement system from anywhere in the facility, allowing the user to remain informed of bed availability

Handheld mobile computing devices can transform nursing practice.

and potential discharges. The device allows supervisors to access electronic documentation and patient information to make informed decisions regarding a patients acuity level and admitting status. The portability and functionality of the tablet computer also allows users to connect to the hospitals main operating network, facility email, and meeting schedules. Users can also create data collection tools for easy use. The ED supervisors at FMC developed a log to track ED patients that were being admitted, and included the diagnosis, type of bed, bed status, and attending physician. pitals operating systems experiencing scheduled or nonscheduled downtime. Another challenge included battery life. Both groups of users were so mobile that they had little time to charge the device during a shift. The battery must be exchanged one to two times per 8-hour shift. Its important to note that extra batteries are needed, so that their replacements are readily available, so the users mobility or performance isnt impeded. For those unfamiliar with the tablet computers associated equipment, using the stylus and touchscreen keyboard presents challenges. It takes a little time to get comfortable using the stylus with the touch-screen keyboard. Users have found that with practice, training, and time, the on-screen keyboard is the most efficient means of entering information. The tablet computer does have a screen writing function, but it often presents challenges with character recognition due to different individual writing styles.

Key tablet computer advantages and disadvantages

Advantages User mobility Device size and portability Ergonomic design Software functionality Disadvantages Network downtime Battery life Initial learning curve for stylus usage

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Measuring effectiveness
Theres a need for further studies to gain an understanding of how using tablet computers in the healthcare setting affects patient outcomes and nursing processes. In the aforementioned two facilities, tablet computers enabled supervisors to have timely and accurate information electronically available to facilitate decisions on patient placements, thus decreasing patient wait times and length of stay. This technology also helped nurses easily retrieve pertinent information as the patients condition warranted. These devices have the potential to be used for patient education purposes, via interactive software applications or online video streams about a certain condition or surgery that affects patients and their families. Tablet computers, PDAs, and other handheld mobile computing devices can transform nursing practice. Nursing administrators can work with information technology specialists to remain informed about advancements that can assist staff members in their practice and improve patient outcomes. As the face of nursing changes, increasing numbers of generation X and Y employees are bringing new uses of modern technology to the healthcare setting from the outside environment. Nursing administrators need to encourage and promote the exploration of these technologies to make nursing more efficient and safe. Investing in these expenditures for the technologys practicality and functionality in assisting with daily processes can result in return on investment.
References 1. Thompson BW. The transforming effect of handheld computers on nursing practice. Nurs Admin Quart. 2005;29(4):308314. 2. Degroote SL, Doranski M. The use of personal digital assistants in the health sciences: Results of a survey. J Med Lib Assoc. 2004;92(3): 341-348. 3. Survey. Docs PDA use still limited. Mobile Health News. 2005;13(5):28. 4. Newbold SW. New uses for wireless technology. Nurs Pract. 2004;29(4):45-46. 5. McCoy S. Planning for mobile devices: A systems approach. Nurs Manage. 2005;36(3):15-18. 6. McLane S. Designing an EMR planning process based on staff attitudes toward and opinions about computers in healthcare. Comp Nurs. 2005;23(2):85-92. About the authors Brad Sherrod is director of nursing and patient throughput at High Point Regional Health System, High Point, N.C. Wes Wood is nurse manager at Forsyth Medical Center Emergency Department, Winston-Salem, N.C.

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