This study demonstrates the feasibility of using an electronic knowledge translation system to provide high quality, regularly updated medical reference information from a central academic centre to multiple peripheral users. User acceptance of this technology was not uniform, with just over half of the participants using their handheld devices to access information on a regular basis. Nevertheless, the availability of point-of-care access to information may have improved the quality of clinical decision-making.
Although mobile computing devices have potential beneficial roles to play in clinical medicine, few publications describe formal evaluation of this technology [13
]. Because the present study was an early hypothesis-generating evaluation of this technology, multiple quantitative and qualitative outcomes were measured. We generated novel data on the use of handheld devices in a clinical situation, but the study has several limitations. The number of physicians involved was relatively small, with a significant proportion not utilizing the technology. The allocation of clinical scenarios was not randomized, because they were allocated predominantly to avoid using the same scenario at the same site and time point. However, the analysis performed compared participants who used the handheld with those who did not; because it was not known which participant would use the handheld at the time of allocation of scenarios, potential bias was minimized. Furthermore, the scenarios appeared to be equivalent in difficulty because no difference was noted when scores for the individual scenarios were compared. A confounding factor in the study was the outbreak of SARS (severe acute respiratory syndrome) from March to May 2003, which had a significant impact on the study ICUs [17
]. Participants were advised to avoid using their handhelds during patient contact because of the potential to transmit infection, and this affected continuity of the study. Had we not encountered this event, utilization might have been higher.
The lack of universal acceptance of this technology is not surprising and may be due to a number of factors, including inadequate training and the lack of familiarity with the technology [18
]. Training is essential when introducing handheld computing technology [19
] and, although all users underwent a training programme, the surveys and focus groups indicated a need for improvement. Familiarity with handhelds is increasing, with 33% of all Canadian physicians and 53% of under 35-year-olds using these devices in 2003, but these levels of utilization remain relatively low when compared with use of the internet, at 88% [21
]. Increasing familiarity with the technology will probably increase acceptance of such a system. Other potential barriers to use of the handheld system may be addressed by the rapidly developing technology, including improved screen resolution, ease of data entry and wireless connectivity. Acceptance may be increased through the development of an all-in-one package on the handheld, allowing additional functionality such as decision support, billing, electronic prescribing and communication.
The study demonstrated the potential role of an updateable handheld information system for knowledge translation in critical care. Rapid access to current clinical guidelines may be a valuable component of a comprehensive solution to reducing error and improving efficiency. Information access may be most beneficial in areas without full-time critical care physicians, particularly given the current imbalance between demand and supply with critical care physicians, which is expected to worsen [9
]. Recent recommendations highlight the importance of leveraging information technology to standardize practice and promote efficiency in critical care [10
]. Handheld information access alone is unlikely to change clinical practice, but it should be considered a component of an electronic knowledge translation system. In many situations other media, such as desktop or tablet computers, may be preferable for information access.
Although the study was carried out in a critical care environment, such a system is probably applicable to other specialties in which clinicians are mobile and may not have ready access to a desktop computer (for example, anaesthesia, emergency medicine, home care). This study provides insight into the potential impact of this technology in improving health care outcomes [14
]. Nevertheless, further study that builds on our findings is essential to determine how these new technologies can best be incorporated into the patient care setting.