What’s on Your PDA?

By now it should be clear to anyone who’s read MD net guide, or even just glanced at the cover, that the one thing that unites our readers is a deep and abiding love of PDAs. For this edition of Physician’s Forum, we thought it would be interesting to sit down with practicing physicians and find out exactly how they used their PDA, as well as what they saw to be the advantages, limitations, and future of handheld computing in medicine. Illuminating as their answers were, we’d like to hear more on this topic. Write to us at info@mdnetguide.com, and let us know what’s on your PDA, and how you use it; selected responses will be published in a future edition.

About the Participants

Q: Do you currently use a PDA on a daily basis? How often do you have it with you?
What programs do you use regularly?

SP: Yes, I do. I have it with me nearly 24 hours a day, seven days a week. It’s essential in my daily practice, which to me includes delivery of care to patients, interactions with other residents, and my academic responsibilities. I use its calendar features and I use it for the prescription or pharmaceutical database; I have not yet used it for medical record keeping or for billing and coding, because I don’t think that any of the applications that are out there at present are adequate for my needs.

SM: I definitely use my PDA on a regular basis. I primarily use the address book, ePocrates, memo pad, and games. The address book is great for all the numbers I need to do scut work in a timely fashion; having hundreds of phone and pager numbers at my fingertips has saved me countless hours. ePocrates is great, for obvious reasons. The memo pad function is great for when an attending mentions something in passing that needs to be done. Games are a great way to kill time and look productive in lectures.

GSN: I always have it with me. If by chance I forget it, I sense it pretty quickly. The way I mostly use it is as a reference tool. I can look up drug interactions, drug information, and clinical information from sources like the Washington Manual, and so on. Then, of course, I use more basic PDA functions: the calendar, the address book, etc. I’ve been working on my own application that will help generate clinical notes.

SP: I use primarily ePocrates for my prescription database. I use a program called iSilo, which has a text-based database, to get quick facts on orthopedics, or if I need to review disease states or protocols. I also use DocumentsToGo quite often, because I log my patients into the spreadsheet.

GSN: I use the Washington Manual for information, use MosbyRX for drug data, I use a Skyscape internal medicine reference text application called OCMIM, and use an application called SprintDB, a database program, for developing my own application.

What is your all-time favorite PDA application, either clinical or nonclinical?

SP: In my professional life, I find ePocrates to be most useful. It’s a database of prescription and nonprescription drugs, which allows me to quickly find information either based on a drug’s name or (this is especially important for infectious disease care) by the bug that I’m treating. It’s comprehensive, it’s easy to use, and it lets me find the information that I need very quickly and easily; I’m not looking through multiple branches of a database “tree” to find what I want.

SM: ePocrates is very helpful; it’s probably my favorite, as well.

GSN: For me, it’s a tossup among a number of clinical databases, which I use on an everyday basis. I don’t think any physician can remember everything there is to know in medicine; there’s just too much material. I consider my PDA to be like having a medical reference library in my pocket.

SP: I have to say, though, that overall, I think the best product that I have is Vindigo. Vindigo is, in a way, similar to the print publication, the Zagat Guide, but it’s available online. It also does more than just provide basic information about restaurants; it provides directions for you, it provides phone numbers, it provides movie times in local areas. The program can even tell you about major bars and venues for other activities, outside of restaurants. It’s a fantastic program, and what I find most useful in my social life.

Q: What kind of PDA do you use?

SP: I currently use a Palm Pilot, and have since PDAs first came on the market. The Palm OS is OK. I do prefer Windows CE applications, because they just seem like second nature, especially since I’m a PC user, but I haven’t made the jump yet because I’ve found that there aren’t as many programs available for Windows CE as there are for the Palm.

SM: I use a Sony Clie with 16MB of memory.

GSN: I use a Pocket PC. I tend to be a little bit more of a techie, and I like the database applications and the ability to program. I also like the similarity with regular Windows, the ability to use PocketWord, and so on.

Q: What about more advanced applications, such as electronic prescribing, billing, and coding? What are the barriers preventing these from becoming more common applications of handheld technology?

SP: Well, I think, first and foremost, wireless technology has to be readily available to anyone who wants to use it, and I don’t think a lot of hospitals or offices have made that jump yet. I think most offices are still very much paper-based. The digital era in the clinical practice of medicine has not really hit critical mass, at least not yet.

GSN: I would like to be using mine more for tracking hospital charges. One of my colleagues is very good about that, and I just haven’t been, because I haven’t been disciplined.

SM: For billing and coding, the push to adopt the applications would have to come from the hospitals and the insurance companies, and the office staff would have to be properly trained. For prescriptions, using a PDA would have to be easier than scribbling a script on a piece of paper, which right now I don’t believe it is.

SP: There are other limitations, as well. Developers need to find a format that can provide all the information you’re looking for on the small screen of a PDA. Given that, future PDAs may have somewhat larger screen dimensions, in order to be able to access more information on one view.

GSN: In terms of online prescribing, I think that’s down the road a bit, as it’s still much quicker to write a prescription on a piece of paper. With the time demands that physicians are facing, the tools that they are going to use will be those that save time. Again, I think that eventually, in the hospital, Tablet PCs or PDAs that are wirelessly connected to a network will serve as order entry points; there are certainly very compelling advantages to that, because you can check for errors at the point that the order is generated. But right now, in the clinic, in the office, I find it too cumbersome.

Q: Have you observed an increase in PDA usage among your colleagues?

SM: Absolutely. My med school alma mater, MCP Hahnemann University School of Medicine in Philadelphia, now requires third and fourth year students to use PDAs in their rotations, which I think represents the growing wave of doctors who use PDAs in daily practice. My fellow residents often use PDAs for alerting when we change services in the hospital, and for noting do’s and don’ts; frequently called numbers are often beamed between residents.

GSN: I’ve certainly seen it pick up among my colleagues over the past couple of years; most of them using are the basic organizer functions, but many of them are also using drug references like ePocrates. I use a Pocket PC, and there’s not a compatible version of ePocrates, so I use MosbyRX. Most of my colleagues are using Palms right now, probably because of the ease of use factor.

SP: I was reading a recent article that found that 47% of all internists use a PDA on a daily basis. This number is likely to increase. In fact, we have research that is going to be published within three months demonstrating that PDA usage is up to approximately 70% among resident physicians. So the younger doctors, the “next generation” if you will, is definitely picking up on handheld usage.

GSN: There is still a bit of a learning curve, and then some folks may not know where to get this information.

Q: How do you see the Tablet PC fitting into the handheld computing equation?

GSN: I haven’t had a chance to use them, yet, but I think they have a place. One main advantage is that the Tablet PC looks like a clipboard, is the same size as a clipboard, is carried like a clipboard, and is used like a clipboard; it’s something that physicians understand. Second, if you are doing a lot of free text entry on a PDA, you get tired quickly. I think it’s worse with the Palm, because you’re limited to Graffiti, to artificial characters, whereas with a Pocket PC you can use regular handwriting and it interprets it fairly well. However, you don’t have much screen real estate in any case. So I think the Tablet PC has a great deal of potential, particularly as part of a larger enterprise network.

Q: How do you see handheld computers changing the face of health care,
both in the immediate and long-term future?

GSN: I think that they will have a tremendous effect. Handheld computing is going to revolutionize the way that medicine is practiced. Computerized physician order entry is ultimately going to be a key factor in reducing errors in medicine, and I think these devices will serve as a major hardware interface. I think in most hospitals, it will eventually become the norm for physicians to enter orders using a PDA or Tablet PC; I think it will have to be the norm, I think it has to be, because of the perceived problems with errors in the system.

SM: I think to say that handheld computing will revolutionize medicine may be overly enthusiastic. However, if they can decrease paperwork for health care providers, in a setting where the paperwork is exponentially increasing, they would be extremely helpful.

SP: I believe PDAs are the wave of the future in the clinical practice of medicine, in the office setting as well as in hospital based practices. I think as managed care continues to affect the practice of medicine, you’re going to see information technology rolled out into clinical practice in order to increase efficiency in the delivery of care. In time, I think we’re going to find that clinicians will want more and more portability and mobility, and that’s where PDAs (and other handheld devices) will play a critical role over the course of the next five to 10 years.

SM: Right now the technology is advancing so fast that I believe doctors are hesitant to commit to PDAs on a wide and uniform scale. For example, if a department spends thousands of dollars on PDAs and trains all of their staff on using them, but then in two years the system is obsolete, and the PDAs they have don’t support the latest software, many will be discouraged from adopting them on a large scale.

GSN: I also believe that, 10 years from now, electronic medical records will be more accepted, and that handhelds will probably be the interface by which physicians interact with the database. Finally, I think having ready access to content is really going to change things; it certainly has for me. It’s easy to look things up at the point of need, which I think is the key. It used to be, if you wanted to look something up, you had to interrupt your routine; now, when you need a piece of information, you have it just in time.