PDAs and Smartphones: Clinical Tools for Physicians

Posted by Craig
October 25, 2009

PDAToday’s cell phone technology has advanced to the point that a cell phone can do much more than just place calls. Along with the personal digital assistant (PDA), these devices can now play a major role in making clinical information portable and readily available.

Robert Jones, MD, is a family practice physician with a subspecialty in sports medicine practicing in Charlotte, North Carolina. He serves as the medical director for the student health center of a large public university, he’s the team doctor for the athletic department at that same university, and he’s on the faculty of a family practice residency program. Filling all these roles keeps Dr. Jones constantly on the move, and he relies on handheld technology to keep him connected and informed in several ways.

Smartphones and PDAs can be extremely helpful to physicians caring for patients. Whether in your office, a clinic, or the hospital, the ability to check drugs and dosages instantly at the point of care results in better patient care and can sometimes be lifesaving.

In testimony before the US Senate in 2000 regarding adverse drug events, the President of the Institute for Safe Medication Practices quoted a 1995 study by Leape and colleagues in JAMA that reported that over 40% of adverse drug events can be tied to a lack of critical patient information and drug information at the time of prescribing, dispensing, and administration of medications. Smartphones and PDAs can provide this information to physicians instantly at the point of care.

Smartphone or PDA?
Both smartphones and PDAs allow you to perform many functions that were once reserved for the desktop computer. Simply stated, a smartphone is a cell phone that has the ability to add additional third-party software. In addition to running medical software programs that can help you, smartphones can play videos, take pictures, and play music.

A BlackBerry is a particular brand of smartphone that is very popular. It made its mark providing outstanding corporate email support to business users, yet it is very popular with noncorporate users as well.

In contrast, a PDA is a mini-personal computer without cell phone capability. As a clinical tool, either a PDA or a smartphone will accomplish what you need and will help you throughout your workday. With either type of device, you can access clinical reference programs that give you instant information when you’re with a patient.

If you work a lot in the hospital and plan to access the Internet regularly, you may be better off with a smartphone. One advantage to having a smartphone is that you can access the Internet from wherever you have a good cellular signal. In contrast, a PDA requires a Wi-Fi connection to do this. Even if Wi-Fi is available, you may not be permitted to access the hospital’s Wi-Fi network with a personally owned device; that could prevent you from using the Web-based programs that you want to use. Or you may be able to convince the hospital’s IT department to provide you with a handheld device for this purpose, particularly if you spend a lot of time there.

At your own practice, setting up Wi-Fi access for your device is a fairly simple matter for your IT person to do. Make sure you employ security features such as data encryption and strong passwords to ensure the safety and security of your patient data. Here’s an additional tip for better security: have your IT technician configure your office network’s firewall to only allow wireless traffic to pass to and from your particular device, as opposed to any device that knows the password. Every computing device has a unique code called a “MAC address” assigned that is not changeable. By configuring your firewall to only allow traffic from a device with your MAC address, you add an extra layer of protection should your password ever get compromised. Even if a rogue user attempts to crack your system using your stolen password and their own PDA or laptop, the firewall will refuse access if the MAC address doesn’t match up.

How to Choose?
Several factors will influence the type of device you choose. The first is the operating system (OS) that runs the device. There are 4 major OSs: Palm, Windows Mobile, BlackBerry, and iPhone. While most major medical software is available for any of these platforms, there are a few that may only be available for some of them.

Most Windows Mobile devices available now are smartphones, although some Windows Mobile PDAs still exist. Both Windows Mobile smartphones and Windows Mobile PDAs use the same OS. There are still Palm PDAs in the marketplace, though this once-dominant brand is not nearly as prevalent as it used to be.

The Palm Pre, their newest smartphone, runs on a new OS that is Web-based. Additionally, if you have an older Palm app that you can’t bear to part with, you can buy an application (“Classic”) that allows the Pre to emulate an older Palm OS device and run your legacy app. At this time, the Pre does not have much medical software written for it, though this will likely change in time.

Sources for obtaining applications for your device may be limited as well. Applications for the iPhone are only available at Apple’s iTunes store, and all programs must be approved by Apple before becoming available. Programs for Windows Mobile smartphones, PDAs, and BlackBerries are available from a plethora of online sources. For all these devices, some applications are free and some have a cost. This may be a one-time charge or a recurring subscription fee.

Dr. Jones currently uses 2 handheld devices: a Hewlett-Packard PDA running the Windows Mobile operating system and a BlackBerry smartphone. While he acknowledges that some favor using one device for everything, this particular combination best suits his needs at present. His PDA was issued to him by the hospital system where he teaches family practice residents; it has been set up by their computer department so that he can directly access the hospital’s electronic medical record (EMR). Dr. Jones says, “This is a tremendous help for me because I can access patients’ lab results and chart data in real time.” He uses it a lot when performing inpatient rounding with the residents. His PDA is set up so that whenever he walks into the hospital, the device synchronizes with the hospital’s EMR, allowing him to pull up the latest data for his patients on demand. “Because of this, I no longer have to ask who a patient’s nurse is, find them, and then have them run a printout of, for example, last night’s labs. I can just pull it up on my PDA as soon as I’m in the hospital.” His device allows him to view data but not enter or change it. It is already set up with wireless security features like data encryption and password protection to protect his patients’ data, and the device can be wiped clean remotely if it ever gets lost or stolen.

In the past, accessing an EMR through a PDA or smartphone was not possible. However, more vendors are now making this type of access available. Allscripts, eClinicalworks, and Medent allow you to access their EMRs through a handheld device; you can review medical summaries, check appointments, and perform other patient-related tasks.

Dr. Jones’ other handheld device is a BlackBerry smartphone. He doesn’t use clinical applications on it because they are already loaded on his PDA, but he finds the BlackBerry invaluable for accessing his email and staying in touch via phone when he’s on the go. With all his different roles, Dr. Jones spends a lot of time in transit. With the BlackBerry, he can be reached by phone and can also receive emails from both his hospital and university email accounts no matter where he is. “I find this valuable because I can get my email in real time, which helps me to prioritize which issues need to be addressed first. Often, my email arrives on my BlackBerry before my PC!”

A couple of years ago, only a few medically themed applications were available for the BlackBerry; however, the number of available programs has grown steadily. Now there are a reasonable number of medical applications available for this platform.

While most BlackBerries are similar enough to each other that applications written for that OS work fine on any model BlackBerry, the new BlackBerry Storm uses a touch screen and therefore is a bit different. Some apps written for the BlackBerry may have problems running on the Storm. Be sure to check before you buy.

Andrew E. Craig, MSN, FNP-C

Computers, Doctors,

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Comments

I don’t think Filipino doctors don’t need this kind of gadgets yet. They are still used of using pocket notes.

Comment by Boloy on October 26, 2009 @ 3:33 pm
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