Help Design a better Mobile Clinical Assistant device

CuriousMe · Oct 30, 2010

I'm a third year, nursing student, not an RN yet. I have used two different tablet convertibles (Lenovo X41, & X 61) for my pre-reqs as well as for my BS program. I don't use my tablet clinically, because even with it's relatively small size and weight...it's annoying to carry around....and I don't want to leave it laying around (for security and privacy reasons).

I'd love a tablet that fits in a lab coat pocket, and has a stylus. Touch screen is fine and all, but my handwriting is bad enough when I have a pen, I don't want to try and write with my finger or type on a virtual keyboard.

Aceso · Oct 30, 2010

Hi CuriousME,

Thanks for the quick response!

I think that's really interesting what you say about the stylus. Honestly I was originally planning on the device not using a stylus at all. I find myself thinking about the simplicity of say, the ipad which was designed to not use a stylus as opposed to a more complicated interface like the Lenovo you mentioned... But I'm not the one that will be using this device, so my opinion doesn't really count as much as yours!

I know styluses are sometimes used for signatures. What are some other instances where they are useful in clinical use?

red2003xlt, LPN · Oct 31, 2010

Are you building the physical device or the app?

Note: I built ERP prototypes for 10 years before leaving the IT world for Nursing.

CuriousMe · Oct 31, 2010

Hi CuriousME,
Thanks for the quick response!
I think that's really interesting what you say about the stylus. Honestly I was originally planning on the device not using a stylus at all. I find myself thinking about the simplicity of say, the ipad which was designed to not use a stylus as opposed to a more complicated interface like the Lenovo you mentioned... But I'm not the one that will be using this device, so my opinion doesn't really count as much as yours!
I know styluses are sometimes used for signatures. What are some other instances where they are useful in clinical use?

Honestly, one of my biggest disappointments with the iPad is that it doesn't have a stylus (really now, who's ever heard of a pad that you can't write on?). Even I...a very poor nursing student, would have scrounged up cash for one if I could annotate what I was reading on it (yes, I know you can use a virtual keyboard....but only if you're sitting somewhere with the iPad either on a table or on your lap....it's much easier and more intuitive to jot notes to the side of the articles as I read). Not having a stylus is fine if the device was only intended for entertainment....but, to work, I want to have the ability to write. Perhaps I'm just spoiled with the best of both worlds now....the complete intuitiveness of a pen, with all the advantages of digital.

As far as what I would use a stylus for....anything I'd use a pen for. I currently keep a folded piece of paper in my pocket....my Brain...just shorthand notes of patient specifics (notes from report, specifics I want to keep an eye on for a patient, upcoming events that I want to remember...whatever I need for that patient). I'd love to be able to actually jot this on the same device I'm using for everything else instead of my folded paper. Even with a chart in my hands, this consolidated shorthand note, would be a whole lot quicker for me to glance at, then to pull up the patients chart on the device.

Additionally, I'm assuming there'd be references and resources available through this device? Drug Books, policy & procedures for the facility, etc. Again, if you're holding the device in one hand, it's a whole lot easier to write whatever my search parameter is, then to try and type it one handed....or put the device down to type two handed.

But hey...the iPad is obviously an incredibly popular form factor (it is beautiful). It's just my opinion that a stylus makes a tablet device much more functional.

Oh, and the two models you mentioned, while they both look very durable....if they were a bit smaller and lighter, they could be put in a labcoat pocket. Which could mean less potential drops...so maybe they wouldn't need to be as bulletproof and heavy.

Just my .02

Peace,

CuriousMe

nerdtonurse?, BSN, RN · Oct 31, 2010

Hi, I'm a nurse who used to do computer engineering (MS in Computer Science). First, define the scope. You say you want to use it for medical records. Are you talking about data entry in the form of, say, an initial physical assessment, where you would have the need for a lot of free texting? Charting a patient update? Do you want to incorporate giving meds? Most facilities use scanners to scan meds and patient bracelets, so your device would need to be able to scan a patient's bracelet. Are you talking more about entering data which could be entered clicking on radio buttons? You're going to need some way to incorporate both buttons and free text. Do you just mean non-interactive lookup (like viewing a CT/x-ray or lab result)? What do you want it to do? And for whom? The needs of a nurse like me who works in ICU are very different from the needs of a nurse who works in Peds, OB, ER or OR. Define the scope, define the user, define the intent, define what your device can do in terms of making our job easier or faster. Before you guys do anything, I'd suggest shadowing nurses in your area of interest and seeing what they complain about. Fix what they complain about, and they'll fight to get your device bought.

In terms of footprint, I don't want anything larger than the standard thigh or smock scrub pocket -- if it's an iPad, it's going to walk the minute I put it down and turn my back. I love a ToughBook, but it's simply too heavy to lug around all night unless it's on a cart, and we've already got those, they're called COWs (computer on wheels). If it's the size of a Nook or Kindle, that fits into the pockets, and calms my worries about PHI walking out the door and me getting fired over it. Kindle has a keyboard. The new nookColor has a touch screen. Your average age for your users if they are RNs is about 47 -- too small, and there's going to be vision issues, so a PalmOS or iTouch is just a little too small for intensive data entry. Plus, think about how many times you've seen people going nuts looking for a lost phone or TV remote. Small is bad. So I'd rethink the hardware.

Another issue: this is something I need to be able to clean, throughly. Otherwise, it turns into one big source of bacterial transmission. We usually use Cavi-wipes, so whatever your pick in terms of hardware has to be able to withstand a good Cavi wipe down. Plus, if it's in a pocket or on a bedside table, it needs to take getting an accidental splash of body fluids. In other words, can I get blood/urine/vomit or stool off of this thing without ruining it? What if my patient knocks over his orange juice and gets that all over it? Can it take the hit? Put some rubber bumpers on it, it's going to get dropped onto tile/cement floors and possibly stepped on. I'd go for an e-ink over a backlit screen, I think they can be built tougher, but I'm not 100% sure on that.

The data entered or reviewed will need to be transmitted safely -- there's been horror stories of people sitting in parking lots and snatching PHI being transmitted via Wifi. So whatever you pick, you've got to not only have secure tunnels for data transmission, you're going to need some really, really good password protection on board the device itself. I'd also plant a "smart bomb" on the device -- 4 failed logins, and it automatically sends a panic email saying "deny all traffic from this MAC address" and then erasing its hard drive to prevent PHI from getting loose in the wild. Medical records always have addresses, SS numbers, and all kinds of data that a identity thief would just have a party with. You're also talking about upping the potential simultaneous instances going into whatever server/database the hospital's using. If you go from 200 concurrent users to 2000, you're going to make your customer have to buy more equipment, buy a more expensive user license (or possibly an entirely new database product) and beef up their network to use their product. Don't forget that side of the house.

Also, the servers in these hospitals reboot; the device would need to be able to hold the data in the event of a sudden outage without losing it. Our shifts are 12 hours long. Don't get something that dies after 8 hours of intense use, or has to charge for 12 hours at a pop.

Make it a bright color. We've got tympanic thermometers that are gray, sleek, and futuristic looking. They also blend in with the desks, the counters, and the equipment in the patient rooms. It's not fun to have to stop at 3 am and have the whole unit trying to hunt down the thermometers because there's not enough visual contrast to easily see them. You don't want to have to put on the bright lights in a patient's room at 3 am because you can't find equipment. People get grumpy.

At the end of a shift, I've been on my feet and moving for 12 hours. If your device is heavier than a pound, it's going to feel like 10 pounds.

Hope that helps. Private message me if you want to talk, and good luck. I remember doing my graduate project. I recommend it as a weight loss regimen, because I was so worried and stressed out that I lost 20 pounds.

Editorial Team / Admin · Nov 1, 2010

Thank you for your efforts, Aceso. :)

Aceso · Nov 4, 2010

Hi, sorry for the delay. The thread got pulled temporarily because it was thought it was intended for commercial purposes. Thanks so much to Dianah for helping get everything resolved.

CuriousMe: How much of the notes from reports or otherwise are generally the same kinds from time to time. By that I mean could many of these be condensed to something like a drop-down list of options? ex. Symptom A is : [better] [worse] [same]. Two finger (or stylus) taps and you've entered data without wasting time writing out the same thing each time. That also would allow for easier tracking and graphing of many types of information over time. I do realize this would not work in every instance but would it be reasonable for the majority of the time?

Also many similar types of devices I've seen that have styluses have them tethered with a wire to keep them from getting lost. What if you could just use any pen you had in your pocket (unchecked or with the cap on)? One less thing to worry about loosing.

nerdronurse: I'll be certain to keep in mind size and color. I think the reason so many medical devices are white is that they perceived as cleaner. I hadn't considered visibility though, I don't see why certain colors wouldn't be able to read as clean also.

I tend to agree with you on size as well. Too small and it will be hard to read, find, and keep from walking off.

As far as weight, the ipad weighs 1.6 lbs. I can't see why this would have to weigh much more than that.

As for cleaning, I've already given that a lot of thought. I'm probably going to spec the device as charging through induction. This is the same way many electric toothbrushes charge. It requires no metal contacts and is entirely watertight. The palm pre cellphone also charges this way. Between wi-fi, bluetooth, and RFID I honestly don't see any reason to have any openings at all on the device. I would think that should make cleaning about as easy as it can be.

By the way, I won't actually be making a working prototype, but a non-functional model and set of interface mockups. I'm focusing on the ergonomics and aesthetic of the device as well as the interactions user's have with it. I'm designing for the ideal interaction, but still being realistic. It won't just be a "magic" box,but this gives me a bit of freedom with the technology it uses. For the scope of this project, I won't worry about wifi snoopers or other more technical issues.

Also for anyone interested you can follow my progress with this project here: Aceso.tumblr.com

Thanks!

Aceso · Nov 4, 2010

Thanks again Dianah, I really appreciate your help!