Personal Digital Assistants Considerations before you hot sync

by David Orenstein freelance writer

I last dedicated “Computing Care” to handheld computers (also known as personal digital assistants, electronic organizers, or glorified calculators) in February 2000. Since then, I have recused myself from revisiting them because a few months later my wife began working for a company that provides electronic prescription software for Palm PDAs. I’m never comfortable with even the appearance of a conflict.

But PDAs are too common in medicine to ignore. Surveys by independent pollsters and physician groups show that between 25 percent and 50 percent of physicians use PDAs in their practices. I feel obliged to account for the phenomenon and to alert you to some pitfalls as you consider participating.

Prescribing is just one use for Palm OS gadgets from Palm, Handspring, and Sony or “Pocket PC” Windows from HP/Compaq, Casio, and Toshiba. Doctors use PDAs as portable reference libraries (to look up medical terms and drug information), as electronic clipboards (to keep track of billing codes, procedures, and EMRs), as voice recorders (for dictation and notes), and even as diagnostic aids (input symptoms and out pops a suggestion). At their best, PDAs increase accuracy by eliminating illegible handwriting, and extend your human memory by putting crucial information in your pocket.

As usage has grown and applications have improved, the large vendors (Palm, Microsoft, and Handspring) have been touting case studies where large medical organizations have saved time and money by using PDAs. In one such study, featured on Palm’s Web site, North Shore-LIJ hospital in Queens, NY, saw a 10 percent increase in charges captured after switching scores of physicians from writing on index cards to entering charges in Palm handhelds. Palm claims that the more efficient billing system provided a fivefold return on the investment of developing the application and buying the instruments. I haven’t seen studies about the specific benefits for small office-based practitioners, but many such physicians swear by their PDAs as great time savers.

Despite the testimonials, handheld medical applications are not yet fully mature technologies. Before you buy a PDA or make one into a practice tool, consider:

Integration. Generally, PDA software can’t automatically share data with your desktop practice management software. Also, different PDA-only applications don’t integrate, ie, drug reference software with prescribing software.

Memory. PDAs don’t have much memory (never more than 64 megabytes), so it’s easy to fill them up with just a few programs. You may have to make hard choices about which applications to install. Although newer PDAs have slots for memory expansion cards, programs tend to run slowly on these cards.

Performance. Don’t expect a program written for a low-memory PDA to perform as well as a comparable program on a desktop computer. Also, don’t expect PDA reference applications to be as comprehensive as a printed book. Case in point: Dorland’s Medical Dictionary for the PDA has 33,000 entries; the full book version has more than 100,000. It’s a sensible trade-off, but a trade-off, nonetheless.

Cost. Many applications cost about as much as a low-end PDA ($150). If you’re considering using a PDA in your practice, budget the cost of the software you plan to run. Many software publishers make trial versions of their software available as downloads. Take the opportunity to test drive.

Many physicians have made a PDA as much a part of their uniform as a stethoscope, although they hardly are as obligatory. They are proving valuable, but are not yet essential.

David Orenstein is a technology and business writer in Silicon Valley. To learn more about a technology topic in Computing Care, e-mail him at davealli@attbi.com.