Data In Hand

Personal Digital Assistants (PDAs) are fast becoming mainstream in the medical setting. About 35 percent of practicing physicians were actively using a PDA last year, according to Manhattan Research -- up from 15 percent in 1999. And Harris Interactive predicts that half of all doctors will be using handheld devices by the end of this year or in 2005. Physicians in all specialties are buying them, first for personal use, and then adding PDA applications they can use to increase efficiency in their practices.

According to Scott Russell, MD, "The drug reference has become an integral part of my practice, allowing me to check drug doses, side effects, and prices without leaving the patient's side." Russell, an internist at the University of Tennessee, Memphis, previously used outdated medical textbooks, the Physicians' Desk Reference, and his own scribbled notes to answer questions and solve problems as they arose in the clinic. "Now I've got the power of all things in a machine that fits in my front pocket," he says. He reports that the residents he works with use PDAs heavily.

"While many doctors use them simply for basic personal information management, it's such an easy step to start using the PDA for simple things like drug references or medical calculations," notes Andy Spooner, MD, a faculty member of the University of Tennessee's Health Science Center College of Medicine. Spooner chairs the American Academy of Pediatrics Steering Committee on Clinical Information Technology and serves as Director of Telehealth and Informatics at the Le Bonheur Children's Medical Center in Memphis.

The most common medical uses are accessing drug and general medical reference information. "It only takes a couple of megabytes of memory to load in a basic textbook of what ever specialty you like," Spooner says. "They're better suited for people with some clinical experience who need a little reminder about a disease process or what a symptom can mean."

"I have become quite dependent on [my PDA] for quick look-ups of factual information," says Kristin Benson, MD, a pediatrician at the Southdale Pediatric Association in Edina, Minn. Benson uses her PDA mainly to store phone numbers of physicians she regularly refers patients to as well as drug reference information.

Support the business side

PDA prescribing is another area of growing use. "Prescribing on the PDA is not widespread, but we have used it in my clinic for about six months now," Spooner says. Using the PDA to connect with a payer's formulary, he can generate legible prescriptions and is able to retrieve them for refills at any time without having to pull the paper chart.

However, "the business end of medicine is really where PDAs earn their keep," notes Spooner. "Charge capture is a natural fit for PDAs. The data entry is pretty simple once the patient information is automatically loaded by our clinic computer system," he says. His practice's system also improves patient tracking and dictation.

Physicians can see on their PDAs which patients have yet to be seen and which have already arrived. Its pocket PC platform supports voice recording so they can use the same devices to record dictation about a patient and route that recording electronically to the transcription service. "No more keeping up with cassette tapes or tying up a phone for dictation," Spooner points out.

PDA programs that track patient information can be tedious, says Spooner, since they require manual data entry. "Most doctors are not really interested in tapping in a patient's lab values and so on," he says. "If your hospital or practice sets it up to synchronize information automatically to your PDA, that's a different story."

Amy Helwig, MD, medical director and family physician at the Quad Medical Clinic in Brookfield, Wis., finds her PDA useful for coordinating administrative work. "I have full access to Microsoft Word, Excel, Outlook for e-mail, contacts, calendar, and tasks, and this is .... what I find it most useful for," she says. Currently, she is testing an evidence-based reference guide for point-of-care recommendations and reviews on her PDA.

Not without problems

But PDAs do have some drawbacks, say users. They have small screens, for one, and limited user-interface features make it difficult to use them for tasks that require a lot of data entry. Benson says it is time consuming to open her device, turn it on, and let the application load. "There's also the need to "click" accurately while walking around," she says.

"You must be reasonably comfortable with a computer to understand how to use and update programs on your PDA," adds Russell. "Battery life becomes an issue when you're using it wirelessly to access your clinic information system."

Other complaints include fragility, poor backlighting, and inadequate connectivity options --  some areas and devices can't support wireless or cellular connectivity. Also, once a physician is already carrying a pager, cell phone, and clipboard, juggling a PDA as well can just seem like a nuisance. Of course, many new devices combine these tools into one handheld device.

Keep in mind, too, that HIPAA rules apply to patient information kept on a PDA, just as they apply to patient information kept on paper or in an electronic medical record. If you use your PDA only as a reference device, it's not a problem. But if it has details about patient appointments or prescriptions, take precautions. "The simple answer is to use passwords to protect that information, or use a system whereby the patient information is available only when the PDA is within the range of the wireless network you use in your clinic," Spooner suggests.

There are physicians who are reluctant to use a PDA because they feel paper works fine in most situations. Systems have been built for decades around paper processes, so introducing technology that replaces this can be disruptive.

"Unless everyone around you is using the same technology, and unless the technology is well supported by your workplace, it can be rough sledding," Spooner says. "A lot of doctors are just content with paper. And then there are those who find all technology tedious.... It's all about your set-point for tedium, not costs or technophobia or lack of knowledge," he says.

"Even those physicians 'frightened' by the technology can be converted if their key concerns can be addressed and a measurable improvement to a process or outcome can be realized," suggests Jon McIntosh, a medical practice management consultant in northern Colorado. "One physician may be frantic about ongoing missed charges whereas another is a procedure coder's nightmare. If a seasoned user can clearly show the relationship between PDA use and a better --  faster, easier, more profitable --  outcome and a better patient, cost and learning time become secondary to expected gains."

What about cost?

The price of the devices is not a real barrier, though more sophisticated models with built-in phones and wireless e-mail capabilities can be expensive. "My original PDAs were $99, and these are nice at the office because no one is worried about the rough use they get," Benson says. "The actual costs end up being higher due to the various software add-ons."

"You can get a decent PDA starting at $200," says Russell. He paid about $60 for a drug reference and another $60 for a medical textbook for his appliance. "As with any medical reference, you'll need to periodically pay for updates to keep the information up-to-date," he notes.

Helwig paid about $279 for her PDA, which includes some limited wireless Internet services.

On the expensive end of the spectrum is a device that comes complete with a phone, camera, e-mail, and text-messaging, as well as the usual organizer features; it costs $449.

Of course, the price matters less than the potential ROI thanks to improved productivity.

"Using a PDA, I've been able to see patients more quickly and answer their questions without leaving the room in search of a textbook or computer," Russell says. "My patients seem to appreciate that our clinic physicians embrace the technology, too."

Nina Silberstein can be reached at editor@physicianspractice.com.

This article originally appeared in the July/August 2004 issue of Physicians Practice.