Elsevier

The Lancet

Volume 366, Issue 9492, 1–7 October 2005, Pages 1210-1222
The Lancet

Review
Personal digital assistants in health care: experienced clinicians in the palm of your hand?

https://doi.org/10.1016/S0140-6736(05)67484-3Get rights and content

Summary

Physicians and other health-care professionals are rapidly adopting personal digital assistants (PDA). Palm pilots and other hand-held computers are also increasingly popular among medical students. PDAs can be used for medical student education and physician training, daily clinical practice, and research. PDAs and their increasing integration with information technology in hospitals could change the way health care is delivered in the future. But despite the increasing use of PDAs, evidence from well-designed research studies is still needed to show how much these devices can improve the quality of care, save patients' lives, and ultimately reduce health-care expenses. In this Review of PDA use in health care, the operating systems, basic functionality, security and safety, limitations, and future implications of PDAs are examined. A personal perspective and an introduction to medical PDA applications, software, guidelines, and programmes for health-care professionals is also provided.

Section snippets

Platforms and operating systems

In the past, hand-held computing was restricted to sophisticated programmable calculators with or without a data storage option. By comparison, most PDAs currently run on the mobile operating systems of either Palm OS (PalmSource Inc, Sunnyvale, CA, USA) or Microsoft Windows (Microsoft Corp, Redmond, WA, USA) that, in addition to their intrinsic functionality, allow customisation by the installation of third-party software applications. Furthermore, some Palm OS or Windows mobile-based PDAs

Basic functionality

PDAs are shirt-pocket-sized devices with a touch-sensitive screen, a dedicated input area or keyboard, customisable application buttons, and a multiway (button or mini joystick) navigator to browse information on the screen. Depending on the brand and model, some devices feature an expansion slot for memory cards or accessories, a built-in camera, headphone jacks, speaker, microphone, ports for infrared, Bluetooth, or Wi-Fi (Wireless Fidelity), and even built-in GPS (global positioning system)

Applications for health-care professionals

Physicians, nurses, dieticians, medical students and trainees, and other health-care professionals must review an ever-increasing amount of constantly changing information about their patients several times a day and correlate the data with the most recent diagnostic and therapeutic recommendations and management options to make sound decisions. Traditionally, health-care professionals consulted meticulously collected personal notebooks and article cut-outs, white-coat-pocket manuals,

How and where to find medical software for hand-held computers

Several thousands of medical software applications and documents are available for health-care professionals to use. Medical software can be grouped into major categories: standard medical textbooks and manuals adapted for PDAs, PDA-designed medical references, medical dictionaries, drug reference and interaction check programmes, medical calculators, medical prediction rule applets (a Java software component), document readers, medical image viewers, software for medical evidence retrieval,

A personal perspective

As an internist and gastroenterologist, I face the same challenges that all academic physicians do: attending on the wards, clinics, critical care units, and emergency rooms; doing consultations for other specialties; dealing with numerous conferences, administrative work, lecturing, and bedside teaching; being an investigator in clinical trials; mentoring doctoral students; and running a basic science research laboratory, which often hardly fit into those 24 hours, unless one is very

PDA safety and security

Information recording and interchange always raise the question of security and privacy. Overall, PDA security hazards are probably similar to other computers used in hospitals and elsewhere. Catastrophic data loss can only be prevented with regular backups. PDA viruses have been reported for the mobile operating system from Microsoft Windows and also, to a lesser degree, for the Palm operating system. Major security firms are addressing this problem with the development of commercial antivirus

Challenges of current PDA technology and future outlook

Evidence of PDA use and dominance in medical education, clinical practice, and research is still evolving. Most studies available so far have not been randomised, controlled, or are multicentric in design. The fact that physicians can carry an entire shelf of medical reference textbooks on a hand-held computer's memory card does not automatically mean that physicians know their contents or can apply their knowledge appropriately in clinical practice. The increasing incidence of the so-called

Search strategy and selection criteria

I first searched in MEDLINE with the MeSH term “computers, handheld”. The National Library of Medicine (NLM) summarises the following entry terms under this MeSH: “computer, handheld”, “handheld computer”, “handheld computers”, “computers, palmtop”, “computer, palmtop”, “palmtop computer”, “palmtop computers”, “computers, palm-top”, “computer, palm-top”, “computers, palm top”, “palm-top computer”, “palm-top computers”, “personal digital assistant”, “digital assistant, personal”, “PDA

References (114)

  • MA Astrahan

    HDR quality assurance methods for personal digital assistants

    Med Dosim

    (2004)
  • ES Chen et al.

    PalmCIS: a wireless handheld application for satisfying clinician information needs

    J Am Med Inform Assoc

    (2004)
  • A Krause et al.

    Mobile decision support for transplantation patient data

    Int J Med Inform

    (2004)
  • J Gaertner et al.

    Electronic pain diary: a randomized crossover study

    J Pain Symptom Manage

    (2004)
  • DD Esakof

    Use of a personal digital assistant for viewing echocardiograms

    J Am Soc Echocardiogr

    (2004)
  • RN Jamison et al.

    Comparative study of electronic vs paper VAS ratings: a randomized, crossover trial using healthy volunteers

    Pain

    (2002)
  • PDAs and tablet PCs make the rounds with doctors and nurses

    Postgrad Med

    (2004)
  • S Martin

    More than half of MDs under age 35 now using PDAs

    CMAJ

    (2003)
  • RH Miller et al.

    Physician use of IT: results from the Deloitte Research Survey

    J Healthc Inf Manag

    (2004)
  • PalmSource website

  • palmOne website

  • Windows mobile-based pocket PCs

  • D Topps et al.

    Introducing personal digital assistants to family physician teachers

    Fam Med

    (2003)
  • RJ Kurth et al.

    Use of personal digital assistants to enhance educational evaluation in a primary care clerkship

    Med Teach

    (2002)
  • JS Lee et al.

    Validation of electronic student encounter logs in an emergency medicine clerkship

    Proc AMIA Symp

    (2002)
  • BL Seago et al.

    Using a decade of data on medical student computer literacy for strategic planning

    J Med Libr Assoc

    (2002)
  • GD Denton et al.

    Core problems reported by students in a palm OS and Internet-based problem entry system predicts performance on the third-year internal medicine clerkship

    AMIA Annu Symp Proc

    (2003)
  • S Bakken et al.

    Informatics competencies pre-and post-implementation of a Palm-based student clinical log and informatics for evidence-based practice curriculum

    AMIA Annu Symp Proc

    (2003)
  • JM Johnston et al.

    Evaluation of a handheld clinical decision support tool for evidence-based learning and practice in medical undergraduates

    Med Educ

    (2004)
  • J Sutton et al.

    Handheld computer use in a family medicine clerkship

    Acad Med

    (2004)
  • GM Leung et al.

    Randomised controlled trial of clinical decision support tools to improve learning of evidence based medicine in medical students

    BMJ

    (2003)
  • A Gandsas et al.

    Live broadcast of laparoscopic surgery to handheld computers

    Surg Endosc

    (2004)
  • A Gandsas et al.

    The personal digital assistant (PDA) as a tool for telementoring endoscopic procedures

    Stud Health Technol Inform

    (2004)
  • SB Bird et al.

    Emergency medicine resident patient care documentation using a hand-held computerized device

    Acad Emerg Med

    (2001)
  • S Fischer et al.

    Surgical procedure logging with use of a hand-held computer

    Can J Surg

    (2002)
  • S Joy et al.

    Personal digital assistant use in Florida obstetrics and gynecology residency programs

    South Med J

    (2004)
  • AE MacNeily et al.

    Implementation of a PDA based program to quantify urology resident in-training experience

    Can J Urol

    (2003)
  • C Vincent et al.

    Documenting procedures and deliveries during family practice residency: a survey of graduates' experiences, preferences, and recommendations

    Fam Med

    (2003)
  • R Brilla et al.

    Introducing new technology: handheld computers and drug databases. A comparison between two residency programs

    J Med Syst

    (2004)
  • TD Sequist et al.

    On Track: a database for evaluating the outpatient clinical experience of internal medicine residency training

    AMIA Annu Symp Proc

    (2003)
  • JJ McGowan et al.

    Implementing wireless evaluation in a hospital-based OSCE center

    AMIA Annu Symp Proc

    (2003)
  • AE Carroll et al.

    Pediatricians' use of and attitudes about personal digital assistants

    Pediatrics

    (2004)
  • SJ Enders et al.

    Drug-information software for Palm operating system personal digital assistants: breadth, clinical dependability, and ease of use

    Pharmacotherapy

    (2002)
  • KA Clauson et al.

    Evaluation of drug information databases for personal digital assistants

    Am J Health Syst Pharm

    (2004)
  • BC Grasso et al.

    Reducing errors in discharge medication lists by using personal digital assistants

    Psychiatr Serv

    (2002)
  • R Barrons

    Evaluation of personal digital assistant software for drug interactions

    Am J Health Syst Pharm

    (2004)
  • SM Miller et al.

    Personal digital assistant infectious diseases applications for health care professionals

    Clin Infect Dis

    (2003)
  • Bar code label requirements for human drug products and biological products

  • BD.id patient identification system

  • Horizon Admin-Rx and Robot-Rx

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