Challenges in the Implementation of a Mobile Application in Clinical Practice: Case Study in the Context of an Application that Manages the Daily Interventions of Nurses

Abstract

Background: Working in a clinical environment requires unfettered mobility. This is especially true for nurses who are always on the move providing patients' care in different locations. Since the introduction of clinical information systems in hospitals, this mobility has often been considered hampered by interactions with computers. The popularity of personal mobile assistants such as smartphones makes it possible to gain easy access to clinical data anywhere.

Objective: To identify the challenges involved in the deployment of clinical applications on handheld devices and to share our solutions to these problems.

Methods: A team of experts underwent an iterative development process of a mobile application prototype that aimed to improve the mobility of nurses during their daily clinical activities. Through the process, challenges inherent to mobile platforms have emerged. These issues have been classified, focusing on factors related to ensuring information safety and quality, as well as pleasant and efficient user experiences.

Results: The team identified five main challenges related to the deployment of clinical mobile applications and presents solutions to overcome each of them: (1) Financial: Equipping every care giver with a new mobile device requires substantial investment that can be lowered if users use their personal device instead, (2) Hardware: The constraints inherent to the clinical environment made us choose the mobile device with the best tradeoff between size and portability, (3) Communication: the connection of the mobile application with any existing clinical information systems (CIS) is insured by a bridge formatting the information appropriately, (4) Security: In order to guarantee the confidentiality and safety of the data, the amount of data stored on the device is minimized, and (5) User interface: The design of our user interface relied on homogeneity, hierarchy, and indexicality principles to prevent an increase in data acquisition errors.

Conclusions: The introduction of nomadic computing often raises enthusiastic reactions from users, but several challenges due to specific constraints of mobile platforms must be overcome. The ease of development of mobile applications and their rapid spread should not overshadow the real challenges of clinical applications and the potential threats for patient safety and the liability of people and organizations using them. For example, careful attention must be given to the overall architecture of the system and to user interfaces. If these precautions are not taken, it can easily lead to unexpected failures such as an increased number of input errors, loss of data, or decreased efficiency.

Keywords: computers, handheld; equipment design; hospital information systems; mobile health; nurses; pilot projects; user-computer interface.

Figure 1

HUG nurses’ workflow according to different devices.

Figure 2

Comparison of device sizes (GALAXY S, GALAXY Note and GALAXY Tablet).

Figure 3

Communication architecture between mobile applications and existing CIS.

Figure 4

Intervention management interface on a computer screen in the HUG CIS and on the mobile device application.

Figure 5

Expansion of an hierarchical item of the mobile interface.

Figure 6

Hierarchical navigation through PRN drugs.

Figure 7

Steps to select the relevant interventions.

Figure 8

Screen for the selection of the rooms in the care unit.

Figure 9

Screen for the selection of the patients in the rooms.

Figure 10

Indexicality indicators of every intervention item.