Wireless, handheld devices are becoming increasingly
popular in health care settings, but the full
potential of their role in patient-specific decision
support remains to be achieved. This article
presents a multicriteria framework for choosing
technologies apropos to handheld and ubiquitous
decision support architecture. This framework
is illustrated through architectural middleware
choices made in the context of a podiatry and
diabetes care network. Performance issues are
found to be very important in the handheld
space, and minor aspects of connectivity and
other constraints drive significant changes in
choices of architectural approach. The resulting
architecture employs layers, including serialized
objects, XML payloads, event notification, Web
services, and dynamic class loading, with the mix
varying among the system interfaces. The overall
recommendation is that organizations wishing to
fully exploit mobile technology must use a flexible
policy and pursue a process of technology choice
that is scenario-based and iterative to take into
account discoveries from prototyping and fieldtest
experience.