title: 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.
authors.affiliation: Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland. frederic.ehrler@hcuge.ch.
authors.forename: Frederic
authors.initials: F
authors.lastname: Ehrler
authors.forename: Rolf
authors.initials: R
authors.lastname: Wipfli
authors.forename: Douglas
authors.initials: D
authors.lastname: Teodoro
authors.forename: Everlyne
authors.initials: E
authors.lastname: Sarrey
authors.forename: Magali
authors.initials: M
authors.lastname: Walesa
authors.forename: Christian
authors.initials: C
authors.lastname: Lovis
keywords: computers, handheld; equipment design; hospital information systems; mobile health; nurses; pilot projects; user-computer interface
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