Organizational and Physician Perspectives about Facilitating Handheld Computer Use in Clinical Practice: Results of a Cross-Site Qualitative Study
- Affiliations of the authors: Division of Health Services Management and Policy, School of Public Health, The Ohio State University (ASM, SBS); Departments of Pediatrics (ASM) and General Internal Medicine (MAM), College of Medicine and Public Health, The Ohio State University, Columbus, OH
- Correspondence and reprints: Ann Scheck McAlearney, ScD, MS, Division of Health Services Management and Policy, The Ohio State University, 1583 Perry Street, Atwell 246, Columbus, OH 43210-1234; e-mail: <mcalearney.1{at}osu.edu>
- Received 24 February 2005
- Accepted 12 May 2005
Abstract
Objective To describe strategies that 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 HHCs 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.
Footnotes
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The authors are extremely grateful to the Center for Health Management Research for funding this research and to the organizations and informants who participated in this study. They also thank research associates Tracy Bryan and Sarah Hoshaw for their work with transcribing, data analysis, and literature reviews.
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Preliminary findings from this research were peer reviewed and presented at the 2004 AcademyHealth Annual Research Meeting, San Diego, CA (June), the 2004 Academy of Management Annual Research Meeting, New Orleans, LA (August), and the 2004 INFORMS Conference, Denver, CO (October).
