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First published May 19, 2005 as JAMIA PrePrint; doi:10.1197/jamia.M1816
Journal of the American Medical Informatics Association 2005;12(5):568-575
© 2005 American Medical Informatics Association

A more recent version of this article appeared on September 1, 2005
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Submitted on February 24, 2005
Accepted on May 12, 2005

Organizational and Physician Perspectives about Facilitating Handheld Computer Use in Clinical Practice: Results of a Cross-Site Qualitative Study

Ann Scheck McAlearney MS, ScD1*, Sharon B. Schweikhart PhD2, and Mitchell A. Medow MD, PhD3

Affiliation of the authors: 1 Division of Health Services Management and Policy, School of Public Health, The Ohio State University, Columbus, OH; Department of Pediatrics, College of Medicine and Public Health, The Ohio State University, Columbus, OH; 2 Division of Health Services Management and Policy, School of Public Health, The Ohio State University, Columbus, OH; 3 Department of General Internal Medicine, College of Medicine and Public Health, The Ohio State University, Columbus, OH

* To whom correspondence should be addressed.

Objective To describe strategies organizations select to support physicians' use of handheld computers (HHCs) in clinical practice, and to explore issues about facilitating HHC use.

Design A multidisciplinary team used focus groups and interviews with clinical, administrative, and information technology (IT) staff to gather data from 161 informants at seven sites. Transcripts were coded using a combination of deductive and inductive approaches to both answer research questions and identify patterns and themes that emerged in the data.

Measurements Answers to questions about strategies for HHC support and themes about 1) how to facilitate physician adoption and use, and 2) organizational concerns.

Results Three main organizational strategies for HHC support were characterized among sites: 1) active support for broad-based use, 2) active support for niche use, and 3) basic support for individual physician users. Three high-level themes emerged around how to best facilitate physician adoption and use of HHCs: 1) improving usability and usefulness, 2) promoting handheld computers and device use, and 3) providing training and support. However, four major themes also emerged related to organizations' concerns about HHC use: 1) security-related concerns, 2) economic concerns, 3) technical concerns, and 4) strategic concerns.

Conclusion An organizational approach to HHC support that involves individualized attention to existing and potential physician users rather than one-size-fits-all, organization-wide implementation efforts was an important facilitator promoting physician use of HHCs. Health care organizations interested in supporting HHC use must consider issues related to security, economics, and IT strategy that may not be prominent concerns for physician users.




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