Personal digital assistants are hot. So hot that major computer and electronics manufacturers like Sony, Hewlett-Packard, Compaq and Casio now are offering their own versions alongside the many Palm and Handspring Visor models already available. The king of operating systems, Microsoft Corp., has developed a PDA-compatible version of Windows.
And physicians are buying.
Some 60% of respondents to the technology survey report that physicians in their organizations now use PDAs. That is more than double the 26% who said they used handheld devices of any kind in the 2000 survey.
Granted, more than half said they use their PDAs for personal matters such as address books or calendars. But a sizeable chunk of physicians now look up pharmaceutical information, screen for potential drug interactions, check formularies, perform clinical calculations and even write prescriptions on handheld computers.
"Our main use for PDAs is to communicate between the department and the house staff," says Daniel Hier, M.D., chief of neurology at the University of Illinois at Chicago. Hier is the physician adviser to the information technology services department at the school's 600-physician medical center. UIC medical faculty and residents can coordinate their call schedules by synching their PDAs to a particular Web site.
Because UIC's outpatient facilities are 100% paperless (Hier says the inpatient side is about 80% there), UIC physicians soon will be able to create and review electronic medical records via PDA.
"In the next year or two, we're going to synchronize with the EMR," Hier says. "It would potentially allow for (handheld) billing and results reporting."
Academic medical centers may be ahead of the curve, though. Other medical groups and hospitals aren't quite as sold on the capabilities and merits of PDAs.
The 42 physicians at St. Cloud (Minn.) Medical Group, a multispecialty group practice, can record and look up laboratory results, call schedules and office notes on their PDAs, "but (the information is) not real easy to get at," says Patrick Zook, M.D. And that's not the only complaint about PDAs, says Zook, a family practitioner and St. Cloud partner.
"The wireless thing is not so solved in my mind," he says. Zook says he is concerned about security issues and the possibility of theft.
"Personally, I'd prefer to use a desktop (computer) if possible," he says.
The largest primary care group in Ohio, University Primary Care Practices, an affiliate of University Hospitals Health System in Cleveland, favors full-function computers, not PDAs. While some of the group's 200 physicians have used PDAs for coding and prescription writing, one of the organization's practices is testing wireless transmission of data to laptop computers from the health system's centrally located EMR server.
"We're actually using wireless to reduce the cost of connectivity," says Michael Nochomovitz, M.D., president and CMO of University Primary Care Practices. "Instead of running a T1 line from our main center to all the satellite practices, the docs link up to their local hospital by wireless (communications)."
Nochomovitz says laptop computers may be a better option because primary care physicians generally deal with a greater number of ailments than specialists and thus are more dependent on quick access to medical reference tools.
The survey results do seem to indicate that acceptance of PDAs often depends on specialty.
"We have a unique set of problems that we face in an emergency setting, so we are concerned about the durability of PDAs and handhelds," says Philip Chase, M.D., western regional chief information manager in Pleasanton, Calif., for Team Health, a hospital-based PPM in Knoxville, Tenn.
"Personally, I think they're good for drug reference" because that sort of information comes in an "easily encapsulated form," Chase says. But for looking up patient charts in ER and inpatient-type settings, "there's just not enough real estate on the screen for the kinds of things our doctors would need to do. We're interested in higher resolution and more real estate."
David Patterson, M.D., a Fishers, Ind., allergist in solo practice, writes prescriptions on his handheld linked to the application service provider-based EMR system he accesses via his laptop.
Patients love the electronic scripts for their accuracy and legibility, he says.
