The application of mobile computing

The application of mobile computing
and technology to health care services
Khawar Hameed
School of Computing, Staffordshire University, Stafford, Beaconside ST18 0DG, UK
Mobile computing and technology is becoming prevalent in many aspects of private life and
public services. This paper presents a discussion of the technology and its application in
context of the UKs health care service, and outlines some potential benefits that may result
from its integration into existing information systems and architectures. The additional
component of mobility is believed to provide value to health care services, information
systems and ultimately the patients experience.
2003 Elsevier Science Ltd. All rights reserved.
1. Introduction
In the opening statement by the United Kingdoms Secretary of State on implementing the National Health Service Plan (NHS, 2001) it is said that implementing
the plan will ‘‘make the NHS a modern public service meeting modern public expectations’’. In addition to expectations of medical service provision, based upon
modern healthcare practice, the issue of expectations for information provision and
management is key. Modern expectations of this go far beyond the type of information provision and management associated with conventional information systems and technology.
It is also stated that the creation of more effective processes relies on quality information, modern information, and communication technology, and that building
the information core is vital. The information core can be seen as the heart of any
organisation or system. The fundamental building blocks that support the information infrastructure are, therefore, of great importance and relevance.
E-mail address: [email protected] (K. Hameed).
0736-5853/03/$ – see front matter 2003 Elsevier Science Ltd. All rights reserved.
PII: S 07 3 6 – 5 8 5 3 ( 02 ) 0001 8 – 7
Telematics and Informatics 20 (2003) 99–106
Technology provision to support a modern society with demanding expectations
has resulted in rapidly evolving information systems that attempt to satisfy those
demands. The creation of such systems is based upon a kind of symbiotic relationship where technology facilitates new means, and opens up new horizons. In
return, and in context of adopted technology, the expectations, requirements and
demands of society further fuel the development. As such, the fundamental building
blocks of information systems are constantly being enhanced, or new ones identified,
to enable this development. As we enter the new millennium, technology support is
such that we are on the brink of entering a true information age, where technology
integration will be key in all aspects of social, economic and political systems.
In building an information core to satisfy the modern needs of a given application
domain, such as primary health care, it is essential that the correct components or
building blocks are used to satisfy those modern expectations. In doing so, potential
benefits to be realised include gaining a competitive edge and the provision of an
enhanced service––both in terms of scope and quality.
Technological developments have resulted in an additional fundamental component, or building block––mobility. Mobility, in this sense, refers to the application of
mobile computing and technology to support mobile working practices. In other
words, enabling a style of work and information access that one would normally
associate with a fixed location, or enhancing existing mobile working practices.
2. An overview of mobile computing
Before outlining the application of mobile computing and technology to aspects
of health care, the following section outlines some key characteristics and directions
of mobile computing. The purpose is not to provide specific details of technology,
but to provide a holistic appreciation of the existence and implication of mobile
Mobile computing can be broadly described as computing technology, comprising
software, hardware and communications specifically associated with mobility (Zaslavsky and Tari, 1988). In other words, a form of technology that is not fixed and is
capable of being portable. Typical and popular materialisations of the hardware
include palmtop computers, laptops and mobile telephones, with more sophisticated
devices integrating and combining functionality. The communications infrastructure
comprises technology that enables mobile devices to connect and communicate over
a network or directly with each other using wired or wireless technology, or a
combination of both. Mobile applications are specifically written for use on mobile
devices and these may be general applications or domain specific. The combination
of mobile technology allows access to networks and resources in a manner previously
associated with fixed location computing, and this has led to the flexibility of exploring and adopting new ways of working to achieve corporate goals and objectives. As a supporting technology, computer systems provide a range of benefits
associated with an application domain. As computer systems become mobile,
opportunities for transforming working practices associated with an application
100 K. Hameed / Telematics and Informatics 20 (2003) 99–106
domain into mobile working practices are created, thereby retaining and expanding
the benefits associated with technology application. There is a recognition that access
to technology resources from a range of locations or whilst in transit is necessary
(Kleinrock, 1996; Kleinrock, 2000) and becoming increasingly important. Accordingly, the demand for mobile computing and networking solutions has increased
(Agrawal and Famolari, 1999). Given these factors, mobile computer systems are
becoming an accepted part of the technology and information systems infrastructure
within organisations.
The adoption of mobile technology for personal use through to corporate application is evident and increasing. For example, the late 1990s saw a boom in the
mobile telecommunications market as the cost of owning and running a digital
mobile telephone became far less than ever before. This wireless digital telecommunications technology has become commonplace and is being fuelled further by
decreasing ownership costs, greater technical capability (Agrawal and Famolari,
1999; Weinberger, 2000), and wireless mobile applications such as on-line mobile
banking. Personal digital assistants (PDAs) are almost as commonplace now as were
Filofaxes in the eighties. The reach of mobile technology is touching and embracing
the entertainment industry as MP3 and DVD formats and players have rapidly
become commonplace, allowing individuals to experience mobile multi-media entertainment. Vehicle manufacturers are specifying global positioning system (GPS)
technology as standard, bringing real time navigation to private vehicle owners as
well as to public transport. From a commercial perspective, the adoption and use of
mobile technology for service and applications provision has obvious benefits in
terms of gaining competitive advantage––mobile telephony and the Internet are the
fastest growing businesses in the telecommunications market (Guardini et al., 2000).
Tables 1 and 2 (Ovum, 2001) show predicted adoption of technology and information access by location and method by 2006. In this prediction the existence of
mobile computing is significant.
Table 1
Information access by location
Access location Number of users (million)
Home users 732
Work users 198
School users 143
Mobile or wireless users 543
Table 2
Information access by method
Access methods Number of users (million)
Internet PCs 549
Internet enabled TVs 134
Mobile phones and PDAs (microbrowsers) 705
Other internet devices 161
K. Hameed / Telematics and Informatics 20 (2003) 99–106 101
The mobile technology artefact base has developed significantly in recent years
due to increases in the range of software and hardware platforms. The range of
hardware, software and operating systems available or under development illustrates
this. The type of hardware devices to support mobile computing is wider than ever
before. This includes notebook computers, palmtop/handheld computers, PDA
systems, GPS, digital mobile phones, portable DVD players and MP3 players. This
is evidence that the IT industry is investing seriously in mobile computing technology. Estimations regarding technology prevalence indicate a 50% increase in the
proliferation of wireless Internet access and related technologies over the next two
years and the availability of wearable mobile computers and embedded mobile
computers in 2007 (Gartner, 2001).
The development of mobile computing can be seen as one of evolution as well as a
revolution. An examination of the industry and its products shows the movement
towards mobile computer systems through the development and transition from one
platform environment to another. Specifically from mainframe to mini, from mini to
micro, from micro to notebook, and from notebook to palmtop, and there is evidence that the industry itself is shifting position in preparation for the mobile revolution. Within the last five years the digital wireless communications infrastructure
around the globe has improved dramatically in anticipation of supporting mobile
technology and communications. Not only is mobile technology part of a technological revolution, it will revolutionise the way in which technology is applied in all
aspects of life. This will result in a mobile generation where nothing less than fully
integrated mobile technology and systems will be expected as the norm.
3. Mobile computing and health care
There is great emphasis and acknowledgement of modern information and communication technology, with a vision for the future in which this technology plays an
essential role in the delivery of the NHS plan. It is forecast in the plan that implementation will, ‘‘give people a health service fit for the 21st Century’’ (NHS, 2001). As
the secretary of state has outlined, patients can expect to see differences in the delivery
of healthcare information delivered through a range of channels. As mobile computing proliferates at a rapid pace, it is likely that this technology will be a key channel
in the delivery of that information. The application of mobile computing to healthcare has typically not been as extensive that of other technologies, such as medical
imaging. However, developments in mobile computing and communication have now
enabled this technology to be applied in ways previously unseen (Istepanian, 1999;
Shimuzu, 1999). This has enabled platform independent distribution of medical applications and information, particularly in the areas of paramedical and other frontline support (Murakami, 1994; Bukhres, 1998; Menier, 1999). Developments in
wireless communications technologies and the move to hand-held mobile devices is
also forcing a re-evaluation of existing technology infrastructures within healthcare
(Moore, 2001). Moreover, as society becomes increasingly mobile in almost all aspects of life, the expectation and requirement for a supporting healthcare service will,
102 K. Hameed / Telematics and Informatics 20 (2003) 99–106
no doubt, increase in parallel. This will be within context of normal social distribution
(such as terrestrial communities) through to extensions of those communities in nonterrestrial environments such as water and air (Anogianakis and Maglavera, 1997).
Table 3 extracted from (NHS, 2001) shows a subset of commitment, achievements
and benefits relating to the development of IT in the NHS. Whilst reference to the
application of mobile computing and technology may be inferred or implicit in these,
a fourth column outlining the specific benefits of mobile computing has been added.
As the global infrastructure for communication has evolved, so has the demand
for information, both in terms of information provision and information consumption. To be disconnected in a connected world creates a divide between the
information rich and the information poor. The NHS, as an information provider,
has used typical technologies for the distribution and presentation of information.
For example, the Internet as an underlying transport technology, and web-browsing
software for the visualisation of information. The benefits to the NHS as an information provider are associated with the rapid sharing of information, ranging from
the provision of faster communication between parties through to the provision of
access for specific healthcare information, e.g. evidence-based and clinical guidelines.
The power and associated benefits of information provision are widely acknowledged, as are the demands for such a provision. As the underlying technology
changes from fixed location to mobile, the mechanisms for mobile information
dissemination become pertinent.
As the NHS plan requires information, applications and services to be delivered in
new ways and through new systems (NHS, 2001) mobile computing and technology
can, and will, provide an effective vehicle for the realisation of this goal.
Table 3
The role and benefits of information systems and mobile technology in the NHS
Commitment Achievement Benefit Additional benefits
To support patient care
through electronic
Four heath communities are piloting electronic health records to
share patient information across health and
social care. A further 13
NHS sites are focusing
on the delivery of
patient care in a range
of settings, from NHS
Direct to mental health
or cancer care
A persons health
record will be available
at the time they are seen
and will hold a complete and up to date
summary of their clinical history or current
condition. This work is
essential to developing
national standards for
electronic records
A persons health
record will be available
at the time of consultation, irrespective of the
location of that consultation. Quality of
off-site service and
information will be
To remove the contractual requirement for
GPs to maintain paper
From October 2000 the
terms of service for GPs
have been amended to
allow them to maintain
all or part of their
patient records on a
computer system
GPs can now provide
the full benefit of running a paperless practice
The benefits of a
paperless office can be
extended and adapted
for a diverse range of
working practices in
terms of location and
K. Hameed / Telematics and Informatics 20 (2003) 99–106 103
In order for services within the NHS to function effectively, information needs to
be captured, ingested and integrated. There are many points of data capture, normally associated with fixed location services e.g. patient registration or consultation
at a general practice, with some points of data capture being of a more mobile nature, e.g. visiting care workers in the community, or capture of patients conditions
by doctors ‘‘on call’’. As society becomes increasingly mobile, there will be a need for
the points of data collection to diversify to cater for this mobility. The mechanisms
for information collection in a mobile society, therefore, also become pertinent.
Currently, 90% of patient contacts with the NHS are through primary health care
(NHS, 2001). Given the volume of this type of contact, the supporting infrastructure
to support primary health care is, therefore, of significance––particularly the infrastructure that enables workers to provide a direct and effective patient-centred service. The evolution of flexible primary care services, such as Care Trusts, Personal
Medical Services and ‘‘walk-in’’ centres can be extended by the adoption of mobile
computing which can facilitate new methods of service delivery within, and outside
of, these platforms. As an extreme example, the concept of a walk-in centre can be
entirely reversed to a ‘‘walk-out’’ system where workers are equipped to provide a set
of health care services away from the normal base of provision.
Table 4
Example applications of mobile computing to primary health care
Mobile technology usage Benefits
The use of mobile terminals by primary health
care workers at points of service provision (on or
The effective portability and usage of electronic
patient records and history improving the quality
of contact
Data can be captured using standard formats and
templates, with a local electronic knowledge base
to guide data entry, enhancing the quality and
accuracy of the captured data
Remote mobile access to information services for
primary health care workers
Access to common and consistent decision support systems to enable the best diagnosis, thereby
enabling consistently high standards
Enhancing support for distributed and remote
electronic learning across a range of personnel
using multi-media resources
The effective dissemination of information pertaining to good practice
Transmission of data from remote locations to a
central system using mobile communications
Immediate transfer and integration of patient
information into the information system thereby
ensuring the integrity of complete patient information and improving co-ordination between
PHC teams
Mobile portals for information access Patient access to NHS information services for
self-care, irrespective of time or location
The use of mobile devices by patients Facilitation of telecare and telemedicine allowing
the remote capture of data (e.g. periodic remote
monitoring of blood pressure)
104 K. Hameed / Telematics and Informatics 20 (2003) 99–106
Whilst it would be unrealistic to discuss the complete and extreme mobilisation of
health care services and personnel, it is realistic and feasible to discuss the adoption
of mobile computing and technology to a sub-set of services and personnel. Table 4
outlines some examples of mobile computing and its application to primary health
care. In context of on-going development of electronic patient records (EPRs) and
electronic health records (EHRs), with the full and complete implementation of
EPRs targeted for 2005, the re-evaluation of the concept and implementation of
EPRs in context of patient, practitioner and process mobility also becomes relevant.
It can be seen from the above that the use of mobile and wireless technology can
result in new opportunities, both technical and non-technical, for enhancing many
aspects of the fundamental processes that govern the successful operation of a system
such as the health service. Whilst use of the technology can result in significant
benefits, its adoption is liable to encounter constraints based upon philosophical
changes to working practices, and practical constraints of systems integration and
economic justification. This would be anticipated from any supporting technology
but more so from mobile and wireless technology because of the manner in which it
can radically alter the way in which a system functions.
4. Summary
This paper has presented a holistic view of mobile and wireless technology, and
examples of its application in the health service. There is no doubt that that mobile
and wireless technology is permeating into many aspects of life, including the health
service, and will continue to do so both through choice and requirement. It is also
recognised that the wireless Internet and the new generation of wireless devices will
play a key role as health care technology. The power and potential of mobile and
wireless computing is now being realised in many sectors of private and public sector
services. In the case of health care, the adoption of the technology can be seen as
adding value to key process and information systems supporting the delivery services
where ultimately it is the patients that benefit. The demands of a modern health care
service and expectations of patients will, no doubt, continue to fuel its adoption.
Agrawal, P., Famolari, D., 1999. Mobile Computing in Next Generation Wireless Networks. Paper
presented at the 3rd International Workshop on Discrete Algorithms and Methods for Mobile
Computing and Communications, Seattle, WA, USA, 20August 1999.
Anogianakis, G., Maglavera, S., 1997. The MERMAID Project Intranet: Mixing Satellite and Terrestrial
Communications for Achieving ‘‘Healthcare for All’’. Paper presented at the IEE Colloqium on EUs
Initiatives in Satellite Communications, 8 May 1997.
Bukhres, O., Mossman, M., Morton, S., 1998. Mobile medical database approach for battlefield
environments. The Australian Computer Journal 30(2), 87–95.
Gartner, 2001. Future Technology––whats on Gartners radar screens. Computing, Jan/Feb 2001.
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Guardini, I., DUrso, P., Fasano, P., 2000. The role of internet technology in future mobile data systems.
IEEE Communications Magazine 38 (11), 68–72.
Istepanian, R.S.H., 1999. Hybrid Signal Processing for Next Generation Wireless Telemedicine Systems.
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Kleinrock, L., 1996. Nomadicity: anytime, anywhere in a disconnected world. Mobile Networks and
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Kleinrock, L., 2000. Nomadic computing and smart spaces. IEEE Internet Computing 4 (1), 52–53.
Menier, J.A., 1999. A Virtual Machine for a Functional Mobile Agent Architecture Supporting
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Moore, S.K., 2001. Unhooking medicine (wireless networking). IEEE Spectrum 38 (1), 107, 108, 110.
Murakami, H., Shimizu, K., Yamamoto, K., Mikami, T., Hoshimiya, N., Kondo, K., 1994. Telemedicine
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