Indeed, 65 percent of tech-savvy physicians surveyed this year are concerned that mobile computing devices could raise the risk of infection, according to a study on point-of-care computing from Spyglass Consulting Group (Menlo Park, Calif.). That is up from 25 percent who mentioned this potential hazard in a 2005 Spyglass report on mobile healthcare technology.

This, according to Spyglass, should necessitate policies for use of handheld devices in the presence of patients. “Existing computing devices should leverage temporary infection barriers to prevent cross contamination, including keyboard condoms and Ziploc bags. New computing devices should be water-resistant and made of anti-microbial plastics,” the report says.

The problem of mobile devices spreading infections may be less acute than perceived, however, since fixed computers, many with multiple high-resolution displays, are becoming more prevalent at the point of care. “Now we see that there’s been a migration away from mobile,” says Gregg Malkary, Spyglass Consulting’s managing director.

In 2005, Malkary thought that personal digital assistants (PDAs) and smartphones would catch on for such tasks as charge capture, e-prescribing, bedside charting, and even viewing of radiological images. “There was a lot of hype a few years ago,” Malkary says. “But [for physicians today] it’s purely a communications device.”

Malkary says that hospital networks are “saturated,” with traffic from wireless data, voice, and now radio-frequency identification systems, so the reliability and speed of untethered links may suffer. “There’s nothing like a wired connection,” he notes.

And despite improvements in wireless speed and a reduction of “dead spots” within facilities, the fact remains that the screen on most handhelds remains too small for regular clinical tasks. “It’s applicable when a larger form factor isn’t available,” Malkary says.

At least one of the physicians surveyed argued that it could be a useful tool for intensivists, where a few minutes could mean the difference between life and death for the patient if the doctor happens to be off-site at the time. “I thought that was a very compelling story, but it’s an isolated case,” Malkary says.

“That being said, the tablet PC does seem to have a home in the ambulatory environment. It’s kind of a dead-cat bounce in hospitals, though,” Malkary explains, because physicians tend not to like toting the machines around for an entire shift and because few healthcare applications have the digital “smart forms” that really differentiate the tablet from desktop and laptop computers.

He reports many tablets sitting unused on hospital shelves. “It really doesn’t connect well with workflow,” Malkary says.

Tablets may be more useful in an ambulatory setting because doctors can set the computers down more frequently without fear they will be stolen, but the machines cost more than other PCs, and physicians in private practice usually are dipping into their own pockets for hardware.

Malkary also says that computers are changing the dynamic of a physician-patient encounter. One clinical administrator at a Midwestern academic medical center says, “Patients are not used to seeing physicians use computers during an exam or treatment. Many older patients with chronic diseases or ailments would find this behavior rude and socially unacceptable.”

Spyglass interviewed 100 physicians, 96 of whom were male, and all of whom described themselves as technically competent, so the results likely are not fully representative of the nation’s physician population. The survey pool, however, is split between hospital-based and office-based doctors, and covers 21 specialties.

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