title: mHealth Clinic Appointment PC Tablet: Implementation, Challenges and Solutions.
abstract: BACKGROUND
  Patients requiring daily intravenous (IV) home parenteral nutrition (HPN) would benefit from in-home professional observation to improve self-care, to assess, detect and prevent serious complications.
  
  
  OBJECTIVE
  The study aims are to assess the viability and utility of conducting mobile healthcare (mHealth) videoconference assessments with patients managing lifelong daily 12-hour IV nutrition infusions in their homes. The challenges and solutions to implementing mobile personal computer (PC) tablet based clinic appointments are described.
  
  
  METHODS
  A wireless Apple iPad Mini™ mobile touch-screen tablet computer with 5 mega-pixel camera was loaned to patients. Each tablet had Polycom RealPresence software and a fourth generation (4G) mobile telecommunications data plan. These supported audio-visual mobile videoconferencing encrypted connections between health professionals in their offices and HPN patients and their family members in their homes. Patients' and professionals' evaluations of their mHealth clinic experiences are collected.
  
  
  RESULTS
  Patients (mean age = 41.9, SD = 2.8 years) had been prescribed 12-hour home parenteral nutrition (HPN) infusions daily due short bowel disorders. Patients had been on HPN from 1 to 10 years (M=4, SD=3.6). Evaluation of clinic appointments revealed that 100% of the patients (n=45) and the professionals (n=6) indicated that they can clearly hear and easily see one another. The mHealth audio-visual interactions were highly rated by patients and family members. Professionals highly rated their ability to obtain a medical history and visual inspection of patients. Several challenges were identified and recommendations for resolutions are described.
  
  
  CONCLUSIONS
  All patients and professionals highly rated the iPad mHealth clinic appointments for convenience and ease of communicating between homes and offices. An important challenge for all mHealth visits is the clinical professional's ability to make clinically accurate judgments about what they observed and heard from the patients. Following our solutions for obtaining clear visuals with the iPad can improve ability to make clinical assessments.
authors.affiliation: Professor, School of Nursing and Preventive Medicine & Public Health Department, University of Kansas Medical Center.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Smith
authors.affiliation: Research Associate Professor, Director, Center for Telemedicine and Telehealth, Interim Associate Vice Chancellor, Institute for Community Engagement, University of Kansas Medical Center.
authors.forename: Ryan
authors.initials: R
authors.lastname: Spaulding
authors.affiliation: Research Associate Professor, School of Nursing, University of Kansas Medical Center.
authors.forename: Ubolrat
authors.initials: U
authors.lastname: Piamjariyakul
authors.affiliation: School of Nursing, University of Kansas Medical Center.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Werkowitch
authors.affiliation: Interventionist, School of Nursing, University of Kansas Medical Center.
authors.forename: Donna Macan
authors.initials: DM
authors.lastname: Yadrich
authors.affiliation: Systems Coordinator, Center for Telemedicine and Telehealth, University of Kansas Medical Center.
authors.forename: Dedrick
authors.initials: D
authors.lastname: Hooper
authors.affiliation: Research Assistant, School of Nursing, University of Kansas Medical Center.
authors.forename: Tyson
authors.initials: T
authors.lastname: Moore
authors.affiliation: Professor and Medical Director of Liver Transplantation, Department of Gastroenterology and Hepatology, University of Kansas Medical Center.
authors.forename: Richard
authors.initials: R
authors.lastname: Gilroy
keywords: Mobile clinic appointment; Wireless health care access; mHealth