Handheld Devices—The mobile clinician

The expansion in the use and utility of handheld devices is a trend that shows no sign of abating soon. What is relatively new over about the last 5 years is the convergence of light-weight computers and telecommunications devices. This has important implications for clinicians who may need to connect to EHR systems anytime, anywhere to optimize the care they provide their patients. Wireless technology offers the possibility of remote access from almost any location in the country or world. There are still some significant issues for broadband access in some areas in the U.S., usually rural, where broadband infrastructure is not yet developed or excessively costly.

Increased adoption of EMR/EHR technology by clinicians in ambulatory and hospital settings will spur the decision to use hard-wired or wireless devices to access clinical systems. Hard-wired approaches may be faster and more secure but usually require a fixed base of operations. Wireless devices, on the other hand, are often carried from room to room or site to site. Currently the most popular hardware choices for those using wireless connections are laptops and tablet style designs. The capabilities of handheld devices, such as smart phones, have advanced rapidly and are supplanting other types of hardware in a number of situations.

Those who round on patients in the hospital need to access the hospital information system to write orders and clinical notes and to check labs, x-rays, and other results. Administrative functions also need to be accessed to bill for professional services and perhaps to check formularies and eligibility. The clinician may have the option of using the hospital network infrastructure or public telecommunications to connect. Outside the hospital, clinicians need to communicate with nursing staff, check results, submit orders, and prescribe medicines. They may also want to communicate with patients and other clinicians via (secure) email. Interestingly, from a security standpoint, cell phones offer the possibility of providing two factor authentification.

A wide range of developers are working to make necessary functions available in small handheld devices. Some are clinicians with programming interest and expertise. Others are large, well-established vendors. The race is certainly on to provide the richest capabilities in the smallest devices. The desire to provide full functionality for effective use during clinical activities in a phone-like device presents a true challenge. This is especially true when one considers the limitations imposed by small screen size, requirements to provide access to a variety of applications, and the need for good readability in a wide variety of working and lighting conditions.