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REVIEW ARTICLES
NUMBER 2 YEAR 2003
Review on Medical Use of PDA's
1 University of Medicine and Pharmacy, Timisoara, Romania

Correspondence to:
Ovidiu Ciobanu
Aurelianus 5A, Timisoara, Romania
Tel +40-745311364
E-mail: ovidiu@doctor.com
ABSTRACT
The purpose of this article is to give you a description of Personal Digital Assistants (PDA's) or handhelds and how they can be used to meet the needs of professionals, medical staff, eventually extending to biomedical scientists, health care enterprises, patients and their families and the public at large.
High quality, integrated clinical information is at the crossroad of clinical research, evidence-based health care and the clinical application research. Consequently, a coherent clinical information framework is required. The inability to deal effectively at the point-of-care with clinical information is a key limitation to using informatics to support safe, evidence-based healthcare and to gather the information needed to deliver clinical governance.
As medical professionals we understand that the majority of us are more focused on the practice of medicine than the ins and outs of handheld and wireless computer technology. Hence, this article has been written especially for novice users of handheld computers in the clinical setting. Here you will find instructions to get you started getting the most out of a handheld device, maximizing your productivity and improving healthcare delivery.
Motto: It's not the technology that's the barrier, it's the human factor.

What is a Personal Digital Assistant (PDA)

A personal digital assistant (PDA) is a hand-held computer that allows you to store, access, and organize information. Most PDA's work on either a Windows-based (PocketPC), a PalmOS (Palm) or a Linux operating system. Figure 1.
PDA's can be screen-based or keyboard-based, or both.
Basic PDA's allow you to store and retrieve addresses and phone numbers, maintain a calendar, and create to-do lists and notes.
More sophisticated PDA's can run word processing, spreadsheet, money manager, games and electronic book reading programs and also provides email and Internet access.
Some PDA's come with all of the programs included. For others, you have to acquire or purchase extra software to run these programs.
Some PDA's play stereo quality music and record voice memos, while some others can with additional hardware. 1
Very important, most PDA's can exchange information with a desktop or laptop computer, another PDA or a cellular phone.
The PDA's can be used alone or they can be used in networked environments like a wireless-LAN (Personal Area Network), wireless-PAN (Personal Area Network) or in a cellular (GSM or WCDMA) network, providing constant access to patient data from anywhere in clinic or in the field.

Classification of Medical Software for PDA's

- Calculators
Forget having to remember complicated formulas, just enter the values and out come the results.
By leveraging off existing calculator applications, there are add-ons that contain many different types of calculations ranging from A-a gradient to dosing calculations
- Charge Capture
Capture charges at bedside and easily transfer them to the billing system
- Drug Databases
Allows medical professionals to review drug information regarding indications, starting dosages, contraindications, drug interactions, adverse drug reactions, metabolism, excretion, mechanism of action, and pricing information
Prevent dangerous drug interactions by keeping up with the latest information.
Keep information on the latest prescription medicines at your fingertips. Figure 2, Figure 3.
- Patient Tracking
Review data, create notes and have the medical data available in a matter of seconds (Demographics, Tests, Labs, To-Do lists, Medications, Vital signs, Notes) 2
Automate and simplify many daily routines and free time to better provide for patients. Figure 4, Figure 5, Figure 6.
- Personal Healthcare
Keeps track of personal medical informationManages daily nutrition, exercise, and health
- Reference
Help medical practitioners make informed decisions at the point of care. Instant access to critical medical information. Get medical news, therapeutic updates, and medical journal information. Figure 7.
- Specialty
Dedicated software customized for every specialty. Figure 8, Figure 9.
Figure 1 - Different models of PDA's.
Figure 2 - Fujitsu siemens LOOX with 2003 Lippincot's Drug Guide.

Figure 3 - Drug Therapy Screen Capture from PocketPC PDA.
Figure 4 - Sharp Linux based PDA with cytological database.

Figure 5 - TI concept Pocket PC Patient Image Database.
Figure 6 - Ipaq 5500 with Patient Tracking Program.

Figure 7 - Surgery articles on Web and on Palm 505.
Figure 8 - Sony Clie NX73 with 3D CT scan analysis.

Figure 9 - TungstenC with a Panoramic RX image.
 
- Other
Clinical prediction tools, educational, dictation tools, clinical trials, telemedicine
Advantages of using a PDA over a desktop or notebook computer
- very compact and portable
- the size and weight is very small compared to a notebook; can be carried in a lab coat or in a pocket
- provides clinicians with a multitude of mobile, timesaving features by taking patient information with them when travel between office, the hospital, or patients' nursing home, so called nomadic computing
- access patients' data directly from the PDA
- add, delete, edit, view and manage patient information on the fly
- pull-down menus allow creating exam notes by simply tapping menu bars and selecting pre-configured procedures and results
- flexibility and ease of use
- extended full day battery life and memory
- decreased lag between the time of a patient visit until the charges are entered into the system
- using special document reading programs, users have immediate access to a vast library of news, medical texts and references. A vital, at-your-fingertips resource
- the is no need to remember complicated medical calculation formulas,
- scalability from large, multi-location outpatient environments to small outpatient clinics and offices.
- no need for workstations in each exam room!
- clinicians immediately become more productive, accurate, and efficient with the power to access clinical patient information on their handheld devices.
- provides clinicians, IT departments, and the hospital with a variety of clinical, productivity, and financial benefits.
- assist with billing tasks by allowing capturing data at doctor's convenience, even in the operating room.
- supporting collaborative and team-based diagnosis is a much easier step with the use of Wireless connected PDA. 3
- cut costs for medical data collection and reporting
- make more informed decisions at the point of care
- drop down lists and other shortcuts speed data entry
- return on investment measured in terms of eliminating paper forms and their resulting storing and filing expenses
- PDAs range from less than $100 to over $600, cheaper than a notebook
- powerful tools for educating patients in the examination room

Limitations of the technology

Because it's a new technology the learning curve is dependent on time and talent motivation. Physicians in training have little time to invest in truly mastering the intricacies of the handhelds unless of course they have a career or personal interest coupled with their future medical paths.
It's a fact that doctors are reluctant to integrate new technology into their practices
Not everyone is as comfortable with computer technology and those less experienced are easily dissuaded from future use due to the inconsistent stability and complexity of the different platforms The device can somewhat easily accidentally break or be lost or even get stolen.
The amount of information held on the PDA is limited by the memory available internal and on cards (fortunately the last ones can be easily upgraded or changed)
The amount of information available at a glance it's limited by screen display resolution, though now, by using High Resolution displays it's sufficient (480x320 for a SONY Clie NX-80, NX-73, NZ-90).
Data entry needs a training curve. Fortunately the majority of actual PDA's can even convert natural handwriting to typed text. In some cases, you can teach the software how you typically write letters for better conversion. 4

Conclusion

Why should you buy a PDA to help you with your medical career?
Because of the enormous amount of information needed by medical professionals during patient care and the increasing demand for that information to be available at the point-of-care, PDA popularity has been significantly building in the medical market. Not only have several companies released PDA products catering to the needs of medical professionals, but these offerings are becoming more and more useful as doctors integrate PDA's into their practice.
Primarily three uses for PDA's have emerged as their main functions in the medical environment: patient tracking, reference, and calculation. 5
The use of handheld computers in the medical environment has positive implications in terms of resident and student education, patient outcomes, and physician satisfaction.
The use of PDA's leads to significant reductions in medical errors and reduced medical costs because doctors can make more informed decisions faster.
REFERENCES

1. The new black bag: PDAs, health care and library services ; Jean P Shipman; Andrew C Morton Journal: Reference Services Review ,2001 Volume: 29 Number: 3 Page: 229 -- 238 Emerald
2. Personal Digital Assistant Use: Practical Advice for the Advanced Practice Nurse, Andrew E. Craig, MSN, FNP, Topics in Advanced Practice Nursing eJournal 2(4), 2002. © 2002 Medscape
3. Palm Computing In Clinical Medical Education 2003: An Update", Chris Helopoulos, American Academy of Physician Assistants (AAPA) National Conference - New Orleans, May 23rd through 27th. 2003, May 23rd 2003
4. Get a Grip on Patient Safety: Outcomes in the Palm of Your Hand, Goss L, Carrico R, J Infus Nurs. 2002;25:274-279
5. Using Personal Digital Assistants to Access Drug Information, McCreadie SR, Stevenson JG, Sweet BV, Kramer M, Am J Health Syst Pharm. 2002;59:1340-1343



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