Power in Your Hands

Why You Should Be Using a PDA

By Mary Medland
Mary Medland is a writer for Physicians Practice

They're rapidly becoming the tool physicians use when checking their schedules, taking notes, seeking drug or disease information and managing patient records. Personal digital assistants, or PDAs, are handheld devices that are as powerful as desktop computers and may have the potential to change the face of medicine.

According to the American College of Physicians-American Society of Internal Medicine Web site, "Personal digital assistants are quickly becoming an important working tool for the physician. The value of these devices is in their ability to furnish physicians with the right knowledge at the point of care."

Although physicians are increasingly turning to PDAs, it is estimated that about 75 percent of doctors use them; some have just begun to learn about the potential of the PDA.

At the University of Maryland Baltimore, M.J. Tooey, deputy director of the Health Sciences and Human Services Library, recently sponsored a PDA fair. More than 20 vendors were on hand to demonstrate how their products worked and to teach attendees how to use the devices. Presentation topics included "HIPAA's Implications for Handheld Technology," and "PDAs at the Bedside: An Overview of Clinical Applications."

"News about the fair spread through word of mouth and people were pouring in all day," Tooey said of the 400 who attended. "People are still trying to get a sense of what they can do with these devices."

Whether you're using a PDA or considering one, there is still much to learn about this technology that can offer big rewards.

Better patient care
Don't let their small size fool you. PDAs are powerful. Physicians are now using PDAs to find information on more than 1,600 drugs, investigate drug interactions, research diseases, write and transmit prescriptions, download medical textbooks, access the Internet, educate patients, ensure proper billing and more.

For example, Andre Chen, M.D., a family practice physician with the Austin Diagnostic Clinic in Austin, Texas, has relied on a PDA for eight years. "I use it to do all of my own ICD-9 diagnosis coding, to optimize my evaluation and management coding based on CMS guidelines and calculate cardiac risk and the need for cholesterol medication based on the new Adult Treatment Protocol III," he said.

One widespread use of PDAs is patient education. Full-color images can be accessed with a PDA and used to help explain conditions and treatments to patients. "Click on an icon and you can beam an education leaflet to a printer, which the patient can take with him," said Bill Felkey, associate professor of pharmacy at Alabama's Auburn University, who also trains physicians about how to incorporate this technology into their everyday practice. "Patients often fail in their treatment regimens because they don’t know what to do, don't know how to do it or they are not motivated to adhere to that regimen. PDAs can help with all three of these areas," said Felkey.

PDAs can also reduce errors. As Felkey noted, there are a staggering 6,000-plus medical articles published every week — making it virtually impossible for a doctor to stay current with new research. PDAs allow doctors considering a new intervention to input a particular patient's regimen of drugs, along with information about alcohol, tobacco or herbal remedy use. In a matter of seconds, warning flags may be raised. PDAs also allow physicians to access information about rare diseases they would likely not be familiar with, as well as the classification and coding necessary for billing. Textbooks, databases, notes and information from the Internet can all be downloaded and organized with a PDA, too.

Laura Pimentel, M.D., the chair of the department of emergency medicine at Baltimore's Mercy Medical Center, purchased her first PDA in 1999 and has upgraded three times. "It's very helpful and quick and has listed a wide menu of drugs," she noted. "When I'm seeing patients in the emergency room, I want to make sure that I’m not going to prescribe something that will negatively interact with other drugs. If you are unfamiliar with a drug, you can look it up, check dosages and contraindications, and assess drug interactions and cost information."

An article in the May/June 2002 issue of the Journal of the American Medical Informatics Association noted that physicians said PDAs "save time during information retrieval, are easily incorporated into their usual workflow and improve drug-related decision-making. They also believe that it reduces the rate of preventable adverse drug events."

Dennis Mihale, M.D., medical director of PatientKeeper, which provides a mobile computing solution for health care providers, further emphasized the patient safety benefits of PDAs. With all the information a doctor needs — drug interactions, contraindications, lab results and vital signs, PDAs are doing perhaps 80 percent of the double- and triple-checking for safety. "When doctors use technology, medicine is much better," he said.

A boon for nurses
Although the benefits of PDAs for physicians and patients are myriad, Mihale firmly believes that nurses may benefit most. "The key that everyone is missing is how much greater a nurse's productivity is when a PDA is used," Mihale said.

For example, nurses spend more than half their time in non-nursing activities, such as locating charts and coping with other paperwork. If physicians were required to use PDAs, they would have all the information they need in their hands and would not be required to interrupt nurses. "Everything is right there for them," Mihale said, "which means physicians will be interrupting nurses much less frequently."

Mihale estimated that if physicians did as much work as possible on PDAs, nurses would have at least two more hours a day to spend actually practicing nursing.

The future of PDAs
Mihale expects that PDAs will be universally used in U.S. health care within two to four years. This will happen, he said, as health care administrators realize doctors are already using PDAs and that there is a significant financial return on investment, and when physicians see that they can use the technology to give better care without changing the way they practice medicine.

It's already beginning to happen. At the new Montefiori Hospital in the Bronx, the hospital CEO created a virtual hospital, "There are no paper pads and no manila folders," said Mihale.

Fine for a new facility, but how about older hospitals? Not a problem, said Mihale. He recommends the process of paper withdrawal begin when a patient is admitted to the emergency room. "At that point, don't create a binder, simply key in the information," he said. Mihale then suggested that one department at a time make the conversion until the entire hospital is paper-free.

David Liebovitz, M.D., a specialist in internal medicine at Northwestern Memorial Hospital in Chicago, envisions a future of portable, high-speed and continually connected devices that would use a cohesive set of applications capable of running on a variety of operating systems. For doctors, who might be moving throughout a hospital or busy practice, staying continuously connected to the most current information is crucial. "Otherwise you might inadvertently rely upon outdated patient information," Liebovitz explained. "I also expect that there will be excellent protections for patient privacy."

According to Liebovitz, the PDA will continue to grow in its potential. He strongly believes that every physician can benefit from using a PDA. "In general, the younger members of the medical profession have already embraced the use of handheld devices," he said. "They are increasingly being incorporated into the flow of real work and their evolution will continue."

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