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Wed 13 Feb 2008 04:00 AM

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Up close and personal

Pocket-sized and popular, ‘physician' digital assistants have edged their way on to the healthcare market, offering the lure of on-the-spot information. Medical Times reviews the rise of handheld care.

Pocket-sized and popular, 'physician' digital assistants have edged their way on to the healthcare market, offering the lure of on-the-spot information. Medical Times reviews the rise of handheld care.

Once the realm of the business executive, personal digital assistants now look as at home on the ward as in the boardroom. From point-of-care support to e-prescribing, argues Khaled El Emam, an associate professor at the University of Ottawa and the Canada Research Chair in electronic health information, PDAs are helping physicians practice more efficiently.

El Emam develops electronic data management systems for clinical research and has watched a frosty market steadily thaw towards handheld systems. When PDAs first entered the market it was mainly for administrative tasks - for billing purposes, contacts list," El Emam observes.

For paper to disappear the whole cycle will have to be automated, which would take a long time. But that’s the direction we are going [in].

The next set of applications included what I would call reference tools, such as drug references, medical encyclopedias - but they are essentially read-only. More recently, though, there have been applications that will help us collect information about patients." El Emam argues that modern medicine bases itself on evidence, and handheld technology is in the best possible position (the physician's pocket) to collect immediate, accurate patient data.

According to market information, PDAs now enjoy adoption rates of around 60-80% in North America, although El Emam concedes that the figure is weighted more heavily towards administrative tasks.

If you look at the other types of use then the adoption rates will be smaller - also a lot of the data does not differentiate between personal and professional use." Nevertheless, the use of PDAs in healthcare has never been greater and industry insiders like El Emam predict the future is digital. "For paper to disappear the whole cycle will have to be automated, which would take a long time, but that's the direction we are going."

Handheld healing

Motorola Enterprise Mobility supplies rugged PDAs to the healthcare market. As well as the traditional handhelds, Motorola has recently launched the CA50, a voice over internet protocol (VoIP)-enabled wireless scanner. The product is a pared-down version of PDA technology and can be used as a portable communication and data tool for hospital staff. When even hospital orderlies have gone handheld, you know that healthcare is beginning to embrace mobile technology.

"A hospital is a very mobile environment - not a lot of people sit at their desks," reasons Tarek Hassaniyeh, channel manager for the Enterprise Middle East division. He believes that the plethora of healthcare projects currently under construction represent a golden opportunity for handhelds to get a grasp on the regional market. "There has been a lot of investment in healthcare systems here and they are really looking to mobilise their workforce"

While Motorola's Hassaniyeh agrees with El Emam that mobile technology is yet to fully establish itself, he believes we are approaching a digital dawn in healthcare. "I don't believe these technologies have become standard yet, but I think they will in the next two to three years.

Keeping up with the doses

Doctors are notoriously slow to embrace technology, and introducing a PDA into the workflow can be a labour-intensive exercise. The unit cost of the devices themselves is negligible when compared to most medical equipment, but PDA proficiency does not happen overnight. If you are determined to use handheld technology for admin, referencing and data entry, it will inevitably add valuable time to your procedures in the short term.

"If physicians have to bill according to the number of patients they see in a day then that becomes a pretty tricky selling point," says El Elam. The solution is to introduce PDAs from the start of medical training, and the more progressive medical universities now consider them an essential tool, claims El Elam.

If they have been using these tools since they were in med school, then their workflow has already been adapted and they can learn new things easily - change is always hard and it can be difficult to move with the times.

While techniques might be tried and tested, medical knowledge is swelling at a prodigious rate. If senior physicians wish to retain their authority, it is imperative they stay up to date - and a PDA provides one of the simplest ways to do so.

Keeping up with the amount of information that is out there is almost impossible," explains El Elam. "PDAs can be successfully used for looking up dosage information for drugs or for best available evidence for a certain sort of symptom, or condition.

Hand me downs

Information at your fingertips should not be a privilege reserved solely for doctors, argues Sylvia Suszka, editor of pdacortex.com, a website dedicated to resources for PDAs in healthcare, with an emphasis on nursing. "We saw that doctors were using them and we thought - what about nurses?

Nurses regularly have to consult reference material to and mistakes or outdated information can be lethal. "Nurses have been using PDAs for the referencing, because staying updated about the drugs can be very timely," she explains. "The big vendors update their systems every month or so and that makes a big difference.

Hospitals will usually have a collection of printed reference texts available for nursing staff but Suzka complains that they are usually four or five years out of date. Lengthy printing turnarounds mean that even the newest guides can be as much as 12 months behind their online counterparts. Suzka believes that PDAs with digital libraries would be the most cost-efficient way to keep nursing staff at the clinical cutting edge. Unfortunately, her employers do not agree.

Nurses in the US are left having to purchase our own handsets," she complains. "Our healthcare organisations are not willing to do that at the moment - they will for their doctors, but not for staff nurses."

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