It's 4:00 am and you're stuck in an ER rotation. Nothing major is happening so you decide to check on earlier admissions through the ER using your computer. The device immediately springs to life and you are warned that Mrs. Jones' labs have detected an abnormality. Quickly, you log on to Medline using the web browser and lookup the possible causes of hyperkalemia. The resulting information you copy and paste into Mrs. Jones' electronic chart residing on the ER's local intranet, again using your computer. You need a printout so you fax the information to a machine at the nursing station. The time is now 4:15 am - not bad at all considering the computer on which all this was done resides in your pocket.

PDA power
Enter the age of the handheld or palmtop computer, affectionately known as a Personal Digital Assistant (PDA). PDAs and their precursors have been around in one form or another for more than ten years. More recently, these small devices have evolved capabilities placing them in the "handheld computer" category. Why should physicians take a closer look at handheld computer technology? Two of the biggest reasons: Information management and decision support. However, the computerization of medical information will turn out to be a futile exercise unless doctors and allied health professionals have access to that information at the point-of-care, and in a format that is both useful and usable. Handheld computers are small, unobtrusive, and deal with information management on a personal basis. Simply put, the PDA takes information and puts it in the hands of those that generate that information, need instant access to it wherever the patient may be located.

The medical market

The market for medical applications for PDAs is set to explode. Millions of Palm OS devices have been sold, leading to Palm's establishment as a potential de-facto standard for healthcare professionals. There are many and varied reasons for this. The number of medical applications written for and by medical professionals for Palm OS is growing at an exponential rate. This makes sense. Application developers want to create programs for market leading devices and at this point in time Palm PDAs are it.

This will change soon with the revamping of Windows CE. I am sure that medical developers will give CE the attention it deserves given the rate at which CE devices are improving with a very rich feature set. Having said that, do not discount Psion's EPOC handhelds. I have recently discovered what all the talk was about after purchasing a Psion Series 5. It's an excellent machine worthy of the title "handheld computer" for its built-in applications alone.

I am not a physician. However, my experience, gained through research into this area and from many discussions with physicians, is that the most popular medical applications for PDAs will be these: medical record (patient tracking) systems, followed by formulary and prescription printing systems that link and cross-reference web-based pharmaceutical databases to provide contraindications, and that warn the prescribing physician of possible harmful drug interactions. Other popular applications (generally speaking) will include portable electronic reference materials, or guides, and evidence-based medicine tools, decision-support applications and, finally, billing systems.

The area with the biggest potential in my opinion is that of "repackaging" data so that information may be distributed to remote devices via the Internet or an intranet. For example, AvantGo has developed a server that supports the synchronization of remotely located PDAs to corporate databases using a HTML compliant browser for both Palm OS and Windows CE. In this example, the PDA becomes a "thin-client" on which one is able to access information normally distributed to users on a network. The implications for telemedicine are enormous. Physicians are no longer tied down by having to complete documentation back at their desk.

The bottom line.
My question to doctors or anyone asking me "Which PDA do I buy" is easy. Whether PDAs, or desktop or notebook PCs; whatever you do first examine the software. Evaluate your functional requirements and do some research into software that may do the job. After finding the appropriate software, buy whatever PDA the software will run on. I say again; look for the software first, then buy the PDA on which it operates. This will eliminate many of the problems inherent in buying a PDA. There is nothing worse than the feeling you get when discovering that the (very heavily) discounted PDA you bought at lunchtime is unable to run the applications you thought it would. With the rate of change happening in the PDA market, examine your options carefully.

Ralph La Tella is a lecturer at the School of Health Information Management, Faculty of Health Sciences, The University of Sydney, Australia. He teaches Database Systems and Introduction to Programming. His research interests are in the field of PDAs in medicine and mobile database design.