User satisfaction and frustration with a handheld, pen-based guideline implementation system for asthma

Area of Science:

• Pediatric Medicine
• Health Informatics
• Clinical Decision Support

Background:

• Childhood asthma exacerbations require adherence to management guidelines.
• Integrating clinical guidelines into electronic health records can improve care.
• Handheld computer systems offer potential for real-time decision support.

Purpose of the Study:

• To assess clinician satisfaction and identify challenges with a handheld computer system for childhood asthma management.
• To evaluate the usability and impact of guideline-based recommendations delivered via a mobile device.

Main Methods:

• A randomized, prospective before-after trial was conducted across nine primary-care pediatric practices.
• A handheld computer (Newton MessagePad) with custom software (AsthMonitor) was used to assist documentation and provide guideline recommendations.
• A survey was administered to evaluate clinician satisfaction and experiences.

Main Results:

• Most clinicians (6/9) were neutral, while 3/9 were highly satisfied with the system.
• Users found guideline recommendations appropriate, except for unsupported oxygen administration advice.
• The majority documented concurrently with patient care, but 7/9 reported increased documentation time.

Conclusions:

• Handheld computer systems are a feasible tool for delivering guideline-based advice in clinical settings.
• Clinician acceptance is moderate, with potential benefits in guideline adherence and reminders.
• Addressing documentation time and refining recommendation algorithms are key for broader adoption.