Lessons Learned from a Handheld Implementation

Written in response to some other classmates’ funding proposal abstract…

Funding is requested to provide PDA technology to each undergraduate nursing student as a means to access current medical information instead of textbooks which are outdated as soon as they are put to press.

Phyllis and Mary Ann,

This is an exciting project!

Speaking with some experience with large scale handheld implementations, I’d like to share some of the “lessons learned” from the project I managed in the Newport-Mesa USD. Hopefully these things can help you as you begin your funding proposal; though Newport-Mesa issued handhelds to middle school students, and you are talking about adult nursing students, I believe many of the same issues will still be relevant. Here, in a nutshell, are the issues we share when we speak on this project…

Desktop Software – Most handhelds, particularly Palm OS handhelds, were designed to work for one person using one desktop computer. Hotsynching to a desktop computer is essential not only to synchronize data with the computer (and other remote sources), but also to back up the data on the handheld, which in most cases will be lost if and when the handheld runs out of power. Unfortunately, it is a significant logistical challenge to hotsynch multiple users with multiple computers, particularl under Windows and Mac OS 9, which require that the user have full administrative access to the machine. (With OS X, at least an ordinary user can use the program, and their data will be saved in their home directory.)

Existing Network Infrastructure – If you chose to synchronize users data with a network home directory or with a web server, your network backbone will be important. (And even if you chose to synch with the local machines, these machines must be in good working order, or else all of the data on the handhelds is in jeopardy.)

Technical Support – When Newport-Mesa USD started their project, they sited research which suggested that handhelds require 1/3 the tech support of a laptop. Still when they implemented 1200 handhelds (the equivalent of 400 laptops), no new technical support personnel were hired the first year! This was rectified the second year. The ideal (and rarely, if ever, met) industry standard would be 50 ordinary computers per technician… and many schools operate at something more like 400 machines per technician… in which case they should have hired at least one technician. In the end they hired two. Also, even if you are providing for technical support of the handhelds, don’t forget you also need sufficient technical support for the additional drain on the desktop machines and the network infrastructure.

Peripherals – This shocked me… but most people still want to print, even if they all have computers that can beam each other! You will want to consider what peripherals will be needed for your handhelds. Will the nursing students ever need to print? If their handhelds do not have cameras will they need a way to get pictures onto their handheld? Etc.

Logistics and Scheduling – Unless you plan on hiring a large support staff, there is no way you can roll out all of your handhelds at once. They need to be charged (and how many can you plug in at once?), loaded with whatever software the nurses need, and assigned (presumably) a profile name unique to each nurse (so that they are not assigning these on their own – making it difficult for you to know whose handheld is whose, and whose data is whose). We started with a far too aggressive roll out schedule. In the end, two of us could do about 180 or so every two days. One day was for prep, and one was for the roll out and first training.

Human Resources – You will likely need a technician (or two) to support the project, and an educational technologist, preferably with nursing knowledge (perhaps this would be one of you) to handle program development and trainings. HR departments are usually slow moving beasts, so leave plenty of time in your timeline to find and hire these people before your roll out.

School Culture – The concerns that others have brought up about resistance from some nurses cannot be exaggerated… and don’t be caught thinking only of the nursing students… what of the nursing teachers who must instruct them using the handhelds? The resistance of teachers to the N-MUSD project was the biggest surprise, and the biggest challenge.

Administrative Support – Needless to say, I hope, this is imperative to overcoming any of the issues listed above. Ideally, the administrator should use a handheld, and “get it.”

Games – It should come as no surprise that without being taught how, middle school students all learned how to get games on their handhelds. But, don’t think your nurses won’t do the same… so did our middle school teachers. Have a policy for this, but for heaven’s sake, don’t ban games. This won’t work, and you can’t police it. And, I suspect you don’t want that sort of adversarial relationship with your staff and students. Consider offering a policy of ethical discretion. Perhaps it is ok for them to play games during their break, or on the bus, even though it would wholly inappropriate to be playing a game while inspecting a patient!

Well, there are many more lessons we learned from this project, but these are the ones I share most often . I hope I have articulated them in an effective way here, and of course, I hope they help. ;)