Last fall, this magazine called personal digital assistants "a driving force behind adoption of technology on the clinical side of medicine" when it reported the results of the fifth annual Modern Physician/PricewaterhouseCoopers survey of key healthcare information technology issues (November 2002, page 13).
At about the same time, Gartner, a research firm in Stamford, Conn., forecast that 350,000 physicians in the United States, about half of all practicing physicians, would have PDAs by the end of 2004 and that adoption likely would reach 500,000 doctors by December 2007.
Gartner also estimated in a November 2002 report that "most every medical student (i.e., more than 60,000) will be using a PDA by 2003, providing a new generation of experienced computer users to the medical profession."
Six months later, PDA manufacturers are waging a fierce battle for the hearts, minds and, indeed, palms of medical practitioners. Physicians are taking notice, in part because the compact, handheld computers finally have become powerful, convenient and affordable enough to be not just digital address books, but highly effective clinical tools.
"Today's palm-sized mobile devices already have computing power equal to desktop machines of only a few years ago . . . and they are getting more powerful every year," the Gartner report says.
"For the last two or three years, the processor speed has finally gotten to where it's fast enough for use as a business tool. It's a very snappy response," says Doug Dedo, marketing manager for mobile devices at Microsoft Corp., which makes the Windows CE operating system that powers the Pocket PC PDA platform.
Three years ago, Dedo says, a good PDA had perhaps eight megabytes of random-access memory. Today's high-end PDAs have 128 MB of memory, plus they can accept external memory cards--the same ones that store images from digital cameras--to boost memory to as high as 512 MB.
"That's an awful lot of medical data," Dedo says.
Currently, Milpitas, Calif.-based Palm and its Palm OS operating system hold about two-thirds to three-quarters of the PDA market among physicians, according to Gartner, but Redmond, Wash.-based Microsoft is working to chip away at the lead.
"The trend used to be 99% Palms, but now it's about 85% to 90%," says Alan Ying, M.D., CEO of MercuryMD, Durham, N.C. MercuryMD builds mobile connectivity tools to help physicians interface their PDAs with hospital information systems.
Karen Kelly, marketing manager of Palm, says that 80,000 medical applications have been developed for the Palm OS.
This includes handheld electronic versions of the American Association of Family Practitioners' Physician's Guides for various clinical initiatives, currently not available for the Pocket PC.
"The (PDA) software market is still in its infancy, so developers are still choosing one over the other," Kelly says.
Among the most popular applications is the ePocrates Rx Pro drug reference software, which has "phenomenal penetration in the marketplace," according to Kelly.
Until now, ePocrates has written software only for Palm OS, but the company says it will release a Pocket PC version of Rx Pro this spring "in response to thousands of requests." That should give the Palm alternative a boost.
"The one stumbling block for the Pocket PC is that the doctors I talk to all say, `I really rely on ePocrates for my reference material,"' Microsoft's Dedo concedes.
Conventional wisdom holds that Palm-powered devices offer significantly longer battery life and are easier to use, thus they are more popular among individual users than Pocket PC, while the Microsoft offerings are far more powerful and conducive to enterprise-wide deployment.
Individuals currently account for about 70% of all PDA sales, according to Gartner.
"When the hospitals purchase these devices, there is a heavier disposition toward the Pocket PC," perhaps about 50/50, Ying says. "The market has not taken to Palm's enterprise strategy."
But the distinction is blurring.
When the personal computer was in its infancy in the mid-1980s, people started using them for single purposes, such as word processing, according to Dedo.
"But the fact that the PC could support multiple tasks has made it so popular. We're seeing that reinvented in PDAs," Dedo says.
"The key thing here is that you have a rich platform. People are now using their PDAs for calendar and contacts, e-mail, but also enormous amounts of reference material," he says.
Dedo says PDA users will take to Windows CE because it provides "smarter connectivity" with office computers and a "familiar experience with familiar PC applications."
Palm OS is addressing the fact that Microsoft dominates the desktop operating system market by offering support for Microsoft Word, Excel and PowerPoint files, so Palm users can access the same information in or out of the office.