User satisfaction and frustration with a handheld, pen-based guideline implementation system for asthma

OBJECTIVE To evaluate clinicians' satisfaction and frustrations with the use of a handheld computer system that implements a guideline for management of childhood asthma exacerbations. SETTING Nine primary-care pediatric practices. DESIGN Survey component of a randomized, prospective before-after trial. INTERVENTION Newton MessagePad outfitted with custom software (called "AsthMonitor") that assists in documentation of clinical findings and provides guideline-based recommendations. RESULTS Overall, 3 users gave strongly positive global ratings while 6 users were neutral. The majority used the documentation functions concurrently with care. Except for recommendations to administer oxygen (which were unsupported by evidence), users found the recommendations appropriate and appreciated the reminders. Seven of 9 participants believed it took more time to document with AsthMonitor. CONCLUSIONS Handheld computers are acceptable to some office-based practitioners to provide guideline-based advice within the context of the clinical encounter.