" (Wales and Zabrek, 2003) Full integration with hospital servers of these devices is required to realize the full benefits of these devices. These mobile devices "facilitate the entry of data for storage and processing at the servers. By storing hospital data on servers rather than on the mobile devices, a number of advantages are realized. One is that servers, unlike mobile devices, have prodigious amounts of storage capacity. In addition, if data is stored on the servers, security is enhanced. If the mobile computer is lost or stolen, there is less concern that sensitive patient data will fall into unauthorized hands, and information technology staff can centrally manage hospital information including that displayed on PDAs, smartphones, and tablet computers. With data centralized on servers, it is possible for physicians to access data in realtime by simply requesting it with whatever device they happen to have, such as a handheld computer or cell phone, and viewing the requested data on the same or different device. For example, using a wireless Pocket PC handheld, a physician could request X-ray images. But because the handheld computer's screen is too small for proper viewing, the server could deliver the images to a nearby PC with a large monitor or to a Tablet PC available at a nearby nurse's station." (Wales and Zabrek, 2003)

In the local area network (LAN) computers and servers are connected through wire enabled connections with computers remaining stationary however, the wireless local area network (LAN) enables communication between computers through use of radio waves. The Wireless LAN has been installed at George Washington University and has enabled physicians to access hospital data from all locations in the hospital including "...elevators, patient rooms, and hospital corridors." (Wales and Zabrek, 2003) Wales and Zabrek report that George Washing University Hospital "...uses a telemetry system that transmits patient vital signs to hospital databases that are immediately available to mobile-device-toting physicians. The presence of these wireless systems has even affected the physical layout of the hospital..." (2003) Traditional nursing stations at George Washington University Hospital have been eliminated and replaced with "cart mounted wireless laptops to access medical records, digitized S-rays, and MRIs." (Wales and Zabrek, 2003)

The Pocket PC handheld enables transmission of patient vital signs and even enables stethoscopes to interact with the computer through a Handheld STG displaying and recording sounds of the heart and lungs for analysis by medical personnel. Wales and Zabrek report that the New Federal requirements relating to privacy of patients, HIPAA, effective as of April 15, 2003 is a law that "...mandates that physicians, nurses, pharmaceutical representatives, hospitals, and anyone or anything else involved in the delivery of patient information must comply or face stiff fines (up to $10,000 per infraction) and other penalties. In addition, the Federal government and insurance companies are working together to assure correct coding of evaluations and medical procedures. This will reduce fraud, and, when properly used, allow for correct reimbursement to physicians and hospitals that have been underpaid because of failure to charge for services rendered due to code ignorance or omission. Mobile devices with appropriate software will allow health care workers and institutions to stay in compliance with these new regulations and allow for fair and appropriate reimbursement for services rendered." (Wales and Zabrek, 2003)

IBM reports development of a mobile health toolkit that is useful in tracking patient's vital health signs and in reducing the health risk of the patient. The IBM report states: "From a technology standpoint, clinical information systems are a number one priority, especially as the demand for better quality of care and fewer errors increases. These systems help improve the overall efficiency of the clinical development process - particularly clinical trials - which consumes a vast amount of time and resources. When clinical development is inefficient, valuable investment expense is wasted and precious time is lost. Ultimately, profit potential and a company's competitive advantage are compromised." (IBM, nd)

The National Computing Centre report entitled: "Wi-Fi and VoIP in Healthcare - Everyone Wins" relates the fact that Patientline and Premier Managed Payphones recently installed phone systems in NHS trusts. Voice over IP is presently being installed in NHS hospital and promises "lower costs and simplified maintenance and support." (Bearne, 2005) Bearne states that hospitals are installing "more complex applications that really fire the imagination. Birmingham Heartlands Hospital was recently runner-up in the Wireless Broadband Innovation Awards for its Wi-Fi/RFID-based patient tracking and asset management system. A Proxim Wi-Fi network was installed in...

Daconi, the installer, has developed an application that automatically displays all information relevant to a patient on clinicians' PDAs, tablet PCs and computer screens at each point on the surgical journey. The system cuts down on errors and helps to track and control patients with infectious diseases." (Bearne, 2005)
Efficiency is the primary focus at Birmingham's Heartland Hospital according to David Morgan, consultant Ear, Nose and Throat surgeon who states that "Litigation costs are starving the NHS of funds. Our current paper process is error prone, technology is available now which can help reduce human error and improve operating room theatre efficiency. These improved efficiencies translate into saving more lives, reducing costs and significantly improving the patient experience." (Bearne, 2005) the uses of specialized wireless applications are many including orders from the kitchen for management of hospital assets.

A publication of ICT Results entitled: "Reducing Medical Errors Through Mobile Technologies" states that "between 10 and 15% of all hospital admissions are subject to medical errors, omissions or malpractice. and, according to the U.S. Institute of Medicine more people die due to medical errors each year than from car accidents, breast cancer or AIDS. Shocking as this may be, even more alarming is the fact that the majority of medical errors are preventable." (ICT Results, 2003) Reduction of medical errors is the primary goal of MOBI-DEV, which is a project funded by the European Commission under the ICT program - developer of mobile devices for the healthcare industry. This system is "structured around the use of PDAs enabled with a natural language recognition system and a tool for electronic signature, linked to hospital information systems via UMTS/GPRS and Bluetoo/wifi wireless technologies..." (ICT Results, 2003)

The conclusions stated after trials of the devices in medical centers in Greece, Spain and Italy state: "Errors, omissions and inconsistencies often occur during the transcription of medical prescriptions, data about administering drugs, or from the dual prescription of conflicting medications due to a lack of on-hand information," Ricci notes. "MOBI-DEV can help solve these problems and that is obviously crucial for patients." (ICT Results, 2003) Reports from trials run at the University of Rome Tor Vergata, the Instituto de Salud Carlos III in Madrid and at the Kritos Medical Center in Rhodes, Greece state using the system has the potential to "significantly reduce errors and omissions..." (ICT Results, 2003) Italy Informa representative Roberto Ricci is noted as having stated: "Our evaluations are in line with widely recognized international data showing that the use of mobile devices can reduce error rates." (ICT Results, 2003)

The work published by the Research Information Web site entitled: "Mobile Data Could Help Medicine" reports deployment of mobile technology in the UK and states that medical staff use of PDAs in the United States has "increased by 47% between 2001 and 2002 and has grown steadily since then." (2005) the study 'Taking the Pulse' (2004) conducted by Manhattan Research states findings that "40% of all U.S. physicians use a PDA, compared with 35% in 2003." (Research Information, 2005) Additionally stated in the findings is: "the top activities performed on a PDA by all U.S. physicians (in order) are personal and professional scheduling, accessing a drugs reference database, accessing online information, writing clinical notes and mobile email access." (Research Information, 2005) of the physicians who presently do not use PDAs, fifty percent are interested in the PDA. However, there are differences among age groups as older physicians are "skeptical about the benefits that these technologies will bring." (Research Information, 2005) Overcoming the resistance of physicians to the use of PDAs include the challenges of: (1) funding; (2) user resistance; (3) lack of awareness of PDA content; (4) user support; (5) more user-friendly content; and (6) making the potential reduction of costs and errors understood among healthcare professionals and organizations.(Research Information, 2005; paraphrased)

It is reported by the Institute of Medicine Study in 1999 "...that an estimated 98,000 deaths occurred annually due to medical errors in U.S. hospitals and that 7,000 of these deaths involved medication errors. The same study estimated that the associated economic burden of medication administration errors was approximately $77 billion. In addition, results from national surveys of hospital leaders indicate an increased need for information technology solutions that address patient safety and reduce errors in medication administration." (Healthcare Solution Overview, nd) Remote patient monitoring is…