Challenges to Physicians' Use of A Wireless Alert Pager

Pagers, personal data assistants (PDAs) and other devices that have wireless connectivity are becoming a popular method for delivering patient related information to medical decision makers. Although medical informatics research has emphasized the design, and implementation of pagers as event notification mechanisms, researchers have not paid as much attention to how this technology impacts medical work. We present a case study of physicians in a Surgical Intensive Care Unit (SICU) using wireless alert pagers. The pagers provide a variety of alphanumeric clinical alert messages and are widely used by SICU physicians. However, the use of the pagers has created unanticipated challenges to the physicians' traditional work practices. These challenges include: (1) flattening of hierarchical workflows, (2) coping with information overload and missing context, and (3) lack of feedback. These challenges are tied to both the specific technical design of the system and the traditional structure of medical work.

[1]  Wanda J. Orlikowski,et al.  Learning from Notes: organizational issues in groupware implementation , 1992, CSCW '92.

[2]  Pamela Jordan.  Basics of qualitative research: Grounded theory procedures and techniques , 1994 .

[3]  M M Shabot,et al.  Real-time wireless decision support alerts on a Palmtop PDA. , 1995, Proceedings. Symposium on Computer Applications in Medical Care.

[4]  R. Gardner,et al.  Nurses, pagers, and patient-specific criteria: three keys to improved critical value reporting. , 1995, Proceedings. Symposium on Computer Applications in Medical Care.

[5]  R. Felciano,et al.  Optimizing physician access to surgical intensive care unit laboratory information through mobile computing. , 1996, Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium.

[6]  Michael M. Wagner,et al.  Mobile workers in healthcare and their information needs: are 2-way pagers the answer? , 1998, AMIA.

[7]  Enrico W. Coiera,et al.  Communication behaviours in a hospital setting: an observational study , 1998, BMJ.

[8]  Michael M. Wagner,et al.  Preferences of interns and residents for E-mail, paging, or traditional methods for the delivery of different types of clinical information , 1998, AMIA.

[9]  Elske Ammenwerth,et al.  Mobile information and communication tools in the hospital , 2000, Int. J. Medical Informatics.

[10]  M. Michael Shabot,et al.  Wireless clinical alerts for critical medication, laboratory and physiologic data , 2000, Proceedings of the 33rd Annual Hawaii International Conference on System Sciences.

[11]  M. Michael Shabot,et al.  Wireless clinical alerts for physiologic, laboratory and medication data , 2000, AMIA.

[12]  E. Coiera.  When conversation is better than computation. , 2000, Journal of the American Medical Informatics Association : JAMIA.

[13]  Raymond G. Duncan,et al.  Secure remote access to a clinical data repository using a wireless personal digital assistant (PDA) , 2000, AMIA.

[14]  K. Major,et al.  Wireless Clinical Alerts and Patient Outcomes in the Surgical Intensive Care Unit , 2002, The American surgeon.