budgets in the U.S. health care industry have historically been low but are expected to grow to $39.5 billion through 2008 [ 10]. Our findings suggest that knowing more about the actual benefits derived from UA by studying use at the work process level may spark increased acceptance. At the same time, UA is not without meaningful adoption and usage issues [ 8]. This is especially true in health care contexts [ 12].

We selected medical units employing UA for various tasks at the point of care in three hospitals. Technologies supporting UA were lightweight computers mounted on carts to allow mobility (see the accompanying figure). Table 1 provides hospital characteristics and summarizes our data collection. The data was collected post-implementation, when UA had been operational in each unit for at least three months. We interviewed nurses, managers, and information systems personnel at each hospital. ^{Mobile UA cart.} We summarize the findings before discussing our recommendations:

UA provides nurses with essential information at the point of care. UA reduces nurses’ charting time and anxiety, enabling them to stay longer with patients and chart multiple patients simultaneously. UA helps nurses create comprehensive, readily accessible records for any authorized personnel to review in real time. This relieves them from having to communicate patient information orally. Even though UA may promote reduced socialization among nurses, which people external to the context may perceive as an impediment to acceptance, it is balanced by the efficiency improvements in the work process (such as decreased time for task completion and less congestion at central computing points). Vital information can be difficult to transmit even among willing parties. UA increases in value when systems facilitate detailed records-keeping, reduce charting time, and enhance readability. Consider the following quote from a triage nurse:

“The main benefit...is that you can look up information about their previous care—how many times they have been here for the same complaint—as you triage. Some don’t want to tell you that they are HIV patients, so when you review their history you can see that... [UA] makes the triage process quicker. [Before UA] by the end of the day, your hand’s cramping. You

forget some things or can’t read what you wrote, which can cause you to make mistakes.”

UA automates the documentation and knowledge inquiry portion of the work process. It also informs in that it provides nurses and intended medical personnel with extensive mutual awareness of the situation in which they are involved [ 4]. UA supports more timely and efficient information analysis in negotiations between medical personnel concerning aspects of the care-delivery process. For example, in medication administration, if a nurse believes the prescription to be erroneous or not effective, the nurse can enter an inquiry in the system to more efficiently alert the physician and pharmacists via an integrated messaging system. This process is less convoluted and time-consuming than the use of manual records.

Benefits and limitations influencing acceptance of UA.

Primary benefits that promote acceptance are:

 

• Reduced time required to validate questionable drug prescriptions and medical interventions, which can delay patient care;

• Greater ability for nurses (and subsequently the hospital) to defend against accusations of, and liability for, negligent care;

• Easier and timelier quality assurance for processes and verification associated with patient care; and

• Greater ability for registration personnel and nurses to maintain patient confidentiality by silently reviewing existing information. Also, UA can offer resources of needed information for situated action. For example, nurses can better negotiate with patients to comply with medication regimens by using the system as a medium at the point of care. As a nursing informatics director reports:

 

“You can use the computer system to be a part of the [patient and caregiver] relationship. You develop interfaces with graphics that the doctor [or nurse] can use to better explain conditions to the patient. For example, you can create a graph of depicting how a patient’s blood sugar is not under control based on historical data. You can show them and ask: ‘What are they doing? Are they not taking the medication?’ Or you can say, ‘You are doing very well on this weight reduc-