Numerous surveys reveal the increasing use of personal digital assistants (PDAs) in medical practice. With this in mind, these authors offer pertinent pointers on how to choose a PDA that is best for you.

Let’s face it. The amount of information we need to collect, manage, analyze and integrate as healthcare providers is increasing rapidly. The International Medical Informatics Association (IMIA) suggests that we address the information overload by “using new information processing methodology and information technologies.” The IMIA also notes that applying information technology to health care and health care education can help enhance the quality of care we provide to our patients.^1,2

Using a personal digital assistant (PDA) is one way to stay on top of all the necessary information.³ Indeed, these portable, handheld computers are being used more and more by health care providers in all specialties. While standard PDA applications include calendar and date book functions, contact or address books, memos and task lists, one can use the PDA for a number of purposes and applications. Additional software can add more applications that are specific to the practice of medicine.

Beginning with the 1994 report of the Constellation Project, a project of the Decision Systems Group of the Brigham and Women's Hospital of Harvard University, over 100 publications have described demonstrations, case studies or experiments concerning the use of PDAs in health care provision and education.^4,5

A 2001 survey by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) found that 47 percent of internists used a PDA as part of their clinical practice and suggested that the percentage would increase to 67 percent by 2002.⁶ According to that 2001 survey, the most common use for PDAs was accessing drug information as well as normal lab values and other medical references.

The use of PDAs continues to grow in health care. Surveys in 2002 and 2004 indicated that two-thirds of medical residents surveyed used PDAs.^7,8 Similarly, a study of nurse practitioner students and faculty indicated two-thirds of this group used PDAs.9 Studies in 2005 found that between 87 to 91 percent of physicians use PDAs.^10,11

In another study, that focused on physicians in teaching hospitals, 87 percent of providers used a PDA during patient encounters. The majority stated that PDA use influenced their clinical decision-making.10 The most frequently noted outcomes of PDA use were increased efficiency and increased quality of care in standard and more unique health care environments.^12-18

Other common uses of PDAs across disciplines, practice settings and countries are as clinical logs and records as the devices allow health care providers to access medical reference materials and pharmacopeias, and use the devices as clinical calculators.^{7-10,16,19-39} Personal digital assistants are also utilized in clinical research in both U.S.-based hospitals and Third World field research.^40-42

Medical informatics is clearly a permanent part of contemporary health care. The advantages of using a PDA database for documentation of clinical services include immediate access to patient logging forms as well as easier and more efficient entry of data. The PDA also provides increased portability of and access to patient and clinical data. Using these devices also facilitates the ability to transfer information among collaborating clinicians. Those who use PDAs are able to maintain lists of current and past medications, patient demographics and relevant medical diagnoses and procedures.

How And Where Will You Use The PDA?
In order to determine which PDA is best for your specific practice or situation, you should consider what you will need it for and the environment in which you will be using the device. Clinicians or your facility’s systems administrator should consider issues such as the PDA operating system (OS), the desktop or server operating system, additional software needs and wants, and additional hardware functionality (i.e. Bluetooth, WiFi, Camera, etc.).

Key Questions For A Wise PDA Selection

The most common OS on standard PDAs is either Palm or Windows-based. Other operating systems include Linux, Symbian and BlackBerry. The enviornment in which you will be using the PDA is significant in determining the OS you choose. While the technology available in most clinical settings is compatible with most PDA operating systems, technical support personnel may have a preference based on compatibility with the specific software that is used in that setting.

One critical issue is PDA boot-up time. If you require “instant-on” operation with no boot-up time, the Palm OS has a clear advantage. However, if you only need to turn your PDA on in the morning and let it run all day, this may not be an issue.

Palm OS-based devices (mostly found on PDAs from Palm) provide the simpler approach. Out of the box, Palm devices will synchronize appointments and contacts with the Palm desktop. Many Palm OS devices include bundled software that can sync your data with Microsoft Outlook.

Microsoft's Windows Mobile OS is a significantly condensed version of the desktop Windows OS and is therefore more complex to use than the Palm OS. Keep in mind that Windows Mobile OS will generally require more memory than the Palm OS.

Studies in 2005 found that between 87 to 91 percent of physicians use PDAs.

Hewlett-Packard has historically offered the greatest variety of Windows Mobile devices but more competitors are emerging, particularly in the PDA/phone arena. You will need third party software to create and edit Microsoft Office-compatible documents on a Palm OS device. However, with most Windows Mobile devices, you get stripped down versions of Microsoft Office applications that allow you to create and edit documents as you would on your desktop.

When you synchronize your PDA with your PC, documents on each are updated accordingly regardless of the operating system. Note that if you need a full set of computer applications at the bedside or chair side, a laptop or tablet PC may be a better option than a PDA.

Stay On Top Of Memory Issues
Most PDAs come with internal random access memory (RAM) and built-in read only memory (ROM). Built-in ROM stores the OS and vital data such as contact information in your PDA. If the batteries run down and your device loses power, the data in ROM is not affected.

On the other hand, RAM requires power. If you lose power, you lose data stored on RAM. Most software runs in RAM and software applications can quickly use it up. The prices for RAM are continually dropping so it is worthwhile to look for a model with 64 mb or more of RAM.

External memory cards use ROM exclusively. External memory cards allow for storage of voice files, photos, videos or applications. For example, one can use a PDA to document physical exam findings if it has a camera function. These files can be stored on the external memory card. Only the most inexpensive devices do not come with a storage card slot. Currently, Secure Digital (SD) cards are the most popular media. Many older devices still use CompactFlash cards. If you plan to use external memory, consider adding a card reader to your desktop system.

What About Inputting Information?
Many third-party applications primarily use drop-down menus for input. A stylus, a hand-held pen-like device, is the primary input device. However there are still times when text input is required or desired. Both keyboards and/or handwriting recognition are available on PDAs. The handwriting recognition capabilities of Palm and Windows Mobile devices have improved over the years and all PDAs that support handwriting recognition come with a virtual, stylus responsive, software-based keyboard. Other models come with integrated, standard layout “thumb keyboards.” Most units with thumb keyboards still support the touch screen input methods.

SmartPhones, full-featured mobile phones with PDA-like functionality, do not support handwriting recognition even though they have touch screens. If you find that your needs require significant text input via keyboard, you may wish to consider third-party add-on keyboards or consider a laptop or tablet PC rather than a SmartPhone.

Other Key Considerations You Should Keep In Mind
Good, bright color screens are now the norm for PDAs. However, screen resolution can vary greatly. Windows Mobile displays typically offer 320 X 240 pixel resolution. Palm OS-powered PDAs offer up to 320 X 480 pixel resolution but less expensive models provide only 160 X 160 pixel resolution. While the lowest resolution may be fine for working with text-based applications, if you are viewing images, even the highest resolution may not be optimal.

Battery life can range from a few hours to 10 hours. Again, the requirements for rounding a hospital floor will be different from those similar to neurology or integrative medicine consults. The battery life depends largely on the size and brightness of the screen, the applications you run and if you are using Wi-Fi, which significantly drains battery life. Most PDAs include built-in batteries you recharge by connecting a combination syncing/recharging cable or by placing the PDA in a docking cradle.

Many current PDAs include built-in cameras similar to those found in camera phones. The PDA cameras are convenient for taking a quick snapshot of something or someone in moderately bright light. Resolution ranges from 640 X 480 pixels to a growing number of one- and even two-megapixel models. The need for a camera and image resolution will be based on the mode of use.

In regard to PDAs with built-in Wi-Fi, an integrated cell phone and/or Bluetooth, they can facilitate flexibility in getting more done with fewer wires. If you would like or need the added convenience of managing e-mail or consulting the Web while away from a desk, check the connectivity options closely. Entry-level PDAs typically do not provide e-mail or Web access without a computer connection whereas mid- and upper-range models often include Bluetooth, Wi-Fi or an integrated phone connection.

In Conclusion
Are you simply looking for a digital device to replace a pocket address book and calendar? Do you just need a device to note appointments, contact lists, tasks and memos, and synch with a desktop organizer? If so, basic PDAs may be fine. If wireless connectivity, integrated cameras and keyboards, and the ability to play music and video are important, then a higher-end PDA will probably be preferable. If you desire a combination device, such as a cell phone with PDA capability, consulting your cellular service carrier would be an appropriate starting point.

The growing demands in the health care arena make it necessary to work with technology that can, and has been proven to, enhance our quality of care. The most suitable PDA is the one that fits all your needs and provides access to the information you desire at any given time.