Personal Digital Assistant
(PDA): A new Tool for
Health Care Professionals in
Palestine
By
Abdel Hakim Bishawi
Library Manager
Harvard Medical School Dubai Center
Dubai Health Care City
United Arab Emirates
E-mail: hbishawi@yahoo.com
http://www.hmsdc.hms.harvard.edu/
Objectives
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To define what is PDA and name the
advantages of this new tool.
To name factors to consider which
should be taken before purchasing a
PDA.
To compare between Palm OS and
Pocket PC.
To list the websites and resources which
enable users to download Medical
applications.
Continued… Objectives
• To be aware of the uses of PDA in Medical
Education, Respiratory care, Radiology, &
drug information applications.
• To be aware of the Pediatricians’ use of and
attitudes about PDAs and new free software for
cancer information.
• To define the role of the Medical Librarian
in the use and support of PDAs.
• To keep PDA users current and updated in
technology news.
What is a PDA?
• An abbreviation for Personal Digital
Assistant, a handheld device combining
computing, telephony/fax, and networking
capabilities.
• PDAs are handheld computers that
originally were designed as personal
organizers.
• They serve as an extension for PCs &
Laptops.
Statistics
• Number of Physicians who use handheld
computers increased from 15 percent in
1999 to 26 percent in 2001 and concluded
that 50 percent of all physicians will use a
handheld by 2005.
LaRochelle, B. (2002) Health Management
Technology 23(10):67-68
PDA Awareness
• In Spring 2000, 100 primary care
physicians in the Rochester Independent
Practice Association (IPA) / NY each
received a PDA. (Dr.Drew Werner).
• Most people in our 3,000-doctor at IPA
probably wouldn’t have gone & bought
one of these gadgets on their own.
Glorified calculators. (Chesanow, 2000).
Medical Schools
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University of Calgary, Canada.
Wake Forest.
University of Southern Florida.
University of Southern Dakota.
Harvard.
East Carolina University.
University of North Carolina-Chapel Hill.
PDAs Features
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Have and Operating System.
Use handwriting recognition, or keyboards.
Software to perform basic tasks.
Have a display or viewing screen.
Have devices (i.e. cradle, wireless modems)
Are battery operated.
Can connect to a PC’s serial port (USP)
Can be Synchronized with a desktop.
Can be locked for security issues i.e. Only Me
and PDA Defense.
PDA Brands
• Palm OS vs. Pocket PC
• Palm OS: Palm, Handspring Visor, Sony,
Handera, Zire and Tungsten.
• Pocket PC OS: iPAC, Dell, HP Jornada,
Casio, Toshiba, Compaq, Everex, & Acer.
Cingular Treo 650 GSM
Tungsten C
PamOne Tungsten T5
Zire 72
Stretch Display
PocketPC
iPAQ h5555 Pocket PC
HP iPaq H5550
Two Operating Systems
1- Palm OS
2- Pocket PC Windows CE
• The difference = Windows & Macintosh.
• Palm OS: defacto standard for Medical.
• Windows CE: miniaturized version of
Microsoft Windows on PCs except
95/98/2000/NT software. Allows efficient
file transfer into many programs (Business
Community).
Buying a PDA
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What operating System runs the PDA?
Memory: expansion cards.
Color: Pocket PC are color.
Does it use household or rechargeable
batteries?
What accessories are available & cost?
Speed: Palm OS are very fast.
Applications & programs.
Voice recorder,MP3 player, digital camera.
Which PDA is Right for Me?
Operating System & Device Features
Respiratory Care 2004, May 49(5):497-
Feature
Palm
Pocket PC
• Screen size
Smaller, but getting better
Larger
• Screen resolution
Generally - 320 by 320
pixels"
Generally - 320 by 240
pixels
• 16-bit color support
Yes
Yes
• Size / weight
Smaller, lighter
Bigger, heavier
• Battery Life
(rechargeable lithium)
Days
Generally 8-14 hours
• Wireless connectivity
Yes, on new high-end
models
Yes
• Price
Larger range of prices
No low to mid priced
models
• Works with PCs
Yes
Yes
• Works with Macs
Yes
No
Hardware
Software
Memory
Up to 64mb (most 16mb);
expansion cards for
additional memory
Up to 128mb, (operating
system requires more
memory to run); expansion
card for additional memo
Processor speed
Slower, but operating system
requires less to function well
multi-tasking not available
Faster, but required to run
the operating system and
allows multi-tasking
Navigation
Proprietary , simple/intuitive
Much like a Microsoft PC
desktop
Graffiti, onscreen key board
Character recognizer, block
recognizer, transcriber,
onscreen keyboard
Handwriting recognition
Contact management,
calendaring and to-do lists
Integrate with outlook
Medical software applications
Other software applications
Quicker navigation to get to
the information needed
Requires software addition
(included)
Large selection, leader
Larger selection
More clicks to get to the
information needed
Out-of-the-box integration
Smaller selection but growing
Smaller selection but growing
Pocket Word, Pocket
Excel, Pocket
PowerPoint
Windows applications
“Documents to Go”
software converter
HTML Browser
Free & for cost software Pocket Internet
available
Explorer
Offline browsing
Third-party software
available (AvantGo &
others)
Pocket Internet
Explorer
Instant messenger
client
Third-party software
available
MSN Messenger
E-book reader
Palm Reader & other
free third-party
software
Microsoft Reader
http://computing.kelkoo.co.uk/b/
a/ps_9148613/114501.html
http://www.tigerdirect.com/application
s/Category/category_tlc.asp?CatId=19
Hp and Pocket PC
• HP presented their HIS solution,
mentioned the use of Pocket PC’s by
doctors, nurses, and administrators would
be a part of the contract to issue certain
staff with PDA’s.
How PDAs work-The Basics?
• Syncing from PC to PDA: through a
“cradle” to exchange programs & data.
• Data Input.
• Beaming: Sending a program, document,
or file from one PDA to another using
infrared transmission. PDA to a printer.
• Basic functions: Date Book Address Book,
To Do List, Memo or note pad, Mail.
Beaming a Business Card
http://www.library.uthscsa.edu/con
sultation/guides/tutorials/businessc
ards.cfm
• The University of Texas Health
Science Center at San Antonio
has created a flash tutorial on
PDAs.
UIC Library of the Health
Sciences Peoria
• http://www.uic.edu/depts/lib/lhsp/resourc
es/pda/core.shtml
• ePocrates Tutorial, Johns Hopkins
Antibiotic Guide (ABX Guide)
Bluetooth
Expansion
WEB Browsing
WEB Browsing
Physicians can:
• Read the complete medical records of
patients.
• Check Lab reports.
• Diagnose illnesses.
• Write prescriptions.
• Communicate with Nursing staff.
General Uses of PDA for HCP
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Store reference material
Function as specialized calculators
Aid in the billing process
Control hospital inventory
Track & collect patient data
Perform organizational tasks & scheduling
Access the Internet
Provide patient education material
Read medical journals
Transmit electronic prescriptions
Voice recording.
South. M J. 2003; 96(10):996-9
http://mytreo.net/news/archi
ves/000379.php
• Two of the hottest tech trends today are camera
phones and blogging. SplashData has combined
them both with its new SplashBlog. Now, you
can publish photos instantly to an online "photoblog" from a camera-equipped smartphone. The
initial version is for Palm OS devices only, such
as the Treo 650, but versions for other platforms
(Windows Mobile Pocket PC, Windows Mobile
Smartphone, Symbian Series 60 and Symbian
UIQ) will be released in upcoming months.
ICD-9 – Clear Coder
• Physicians can enter their own codes at
the point of care, improving coding
accuracy and reimbursement rates.
• Charge capture capabilities vary widely
among software programs. Some
programs check for billing errors.
• Some coding software automatically audits
physicians’ coding for errors, reducing the
amount of undercoding or overcoding that
occurs & increasing revenue.
Medical Education
• To track patient encounters and
procedures done during medical school
rotations and residency training.
Specific uses of PDA in Med Edu.
• Document pt. encounters & procedure.
• Retrieve medical information (practice
guidelines, edu. biomed resources.)
• Check residents’ call schedules & pt. data.
• Prompt teachers’ self-assessment about
their own performance.
• Record students’ evaluation.
• Store reference material.
Medical education?
• Voice recorder: dictation & digital recording.
• Video/Audio Player: Basic echocardiograms
can be stored for bedside comparison. Heart
& lung sound patterns, electronic
stethoscope support digital recording.
• Anatomy dissection videos stored on local
servers for students to review prior to
entering the wet lab.
• Image viewer: disease figures or diagrams,
histology & pathology slides
• Infrared beaming: PPt. articles
sharing.
• Wi-Fi wireless networking: feedback
after lectures, formative assessments
or testing, image based practicals,
questions during lectures through wifi enabled PDAs.
• Miscellaneous: PPt., CME’s, can be
beamed or downloaded,
Nurses and PDA
• Inpatient staff Nurse : Nursing pt. keeper,
drug, nursing diagnosis references.
• ICU & ER: drug, emergency, procedural
references,
lab,
blood
gas,
and
weight/drug/drip calculations.
• Pre-op: Rx drug, OTC & Herbal/Alternative
medicine references.
• OB Nurse: Pregnancy calculator.
• A home care, float Nurse: store valuable
information about the organization & units
Nursing applications
• HHM Nursing Care Plans: Total pt. needs.
• RN Diseases (A Nursing Therapeutics
Manual): Complete information on 241
disorders. Nursing students.
• RN Emerg: EKG strips, MI data, ACLS,
bradycardia, Chest pain, & CHF/Chock.
• Fast Facts for Adult Care: Critically ill pt.
• PEPID: Nsg. Assessment, pain management,
Toxicology, Drug interactions, diseases,
abbreviations, General Nsg., & Calculators.
http://www.collectivemed.com
http://pdacortex.pdaorder.com
Staying Current: Nursing PDAs Listserv
http://www.rnpalm.com/nursing_pda
s_listserv.htm
More than Basics…
Productivity Resources:
* Documents to Go / Ms Office applications
Allows you to use MS files on handheld.
http://www.dataviz.com/products/documentsto
go/index.html
* Margi Presenter to Go: Digital projector.
http://www.margi.com/products/prod_ptg.htm
Continued More than …..
Document Readers
• Acrobat.
• E-book Readers:
Palm OS: Palm reader,
palm reader pro,
Mobipocket.
Pocket PC: MS Reader.
Continued More than…
Current Awareness
• Avant Go: to pull information from the
Web & turn your Palm OS.
• http://www.avantgo.com
Customizing your PDA
• Software add-ons
http://www.handango.com
Health Sciences Resources
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Reference Books
Drug handbooks
Medical calculators
Clinical decision rules & Guidelines.
Current awareness / TOC services
Health Sciences Resources
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Patient Tracking
Prescribing
For your patients
Portal sites
Databases
Examples
• Textbooks: BMJ BS, Boabab e-Dentistry,
e-medicine, NephroToGo, Skyscape.
• Drug Books: PDR, Nurses Drug Guide,
ePocrates, Mosby Drugs, Dr Drugs.
• Calculators: Dose Calc, MedMath, Enteral
Calc, Med Formulas, PalmStat, Statcoder.
• Guidelines: Am C Card, CA Tools, EBM,
Antibiotic Guide, Diagnosaurus free.
Examples
• Current Awareness: 911, AvantGo, NEJM,
BMJ, JournalToGo, BioMed Central, Mazigo
• Patient Tracking: ACE Dental, Patient
Tracker, Ward Watch, Patient Keeper.
• Prescribing: ePhysician, iScribe, PocScript.
• For Your Patients: 4TMedical, BabyLog,
BloodPressMgr, BalanceLog, HealthEmpo.
• Databases: Ovid. MD Consultant,
PubMed, Access Medicine.
PubMed on Tap
• An application for PDAs with the Palm OS
& a wireless connection to the Internet.
• To discover & implement design principles
that will facilitate practitioners’ access to
medical information. It supports retrieval
of MEDLINE citations from a PDA.
• http://archive.nlm.nih.gov/proj/pmot/pmo
t.php
• http://www.nlm.nih.gov/pubs/techbull/ja0
3/ja03_pda.html
New Statistics
• 80 % use PDA to maintain an add. book.
• Forrester Research & AMA–1300 Doctors:
• Less than 10 % to order medication,
access pt. records, & lab results.
• 16 % whose practices have EMR, use PDA
to record pt. data.
• 16 % use PDA for electronic prescribing
• Healthcare IT News Mar 23, 2005
• Spyglass Consulting Group issued that
Physicians were generally unsatisfied with
mobile devices Physicians are often
frustrated with the number of screens
they have to click through to chart pt info.
• 57 % are regularly using PDAs. (five times
than the average population to use them.
• Female Physicians, older Doctors,
Surgeons, & who practicing in small
offices are less likely to use PDAs.
Another bright spot
• 60% are using PDAs for e-prescribing.
• 66% regularly check medication
information.
• 28 % are accessing clinical database
information.
New Statistics
• “Handheld
Technology for
Radiology on the Brink of Big
Expansion”
• RSNA News - April 2005
• http://www.rsna.org/publications/rsnanew
s/apr05/hhtech.html
• Survey Demographics:
Of 1,658 randomly selected active and
training RSNA members within North
America, 528 (32.4 percent) completed
the survey.
• 417 Men (79.0%)
• 104 Women (19.7%)
• 181 Academic Practice (34.3%)
• 319 Private Practice (60.4%)
• 91 Trainees (17.2%)
• 413 Attending or Board-certified
Radiologists (78.2%)
Use of PDAs
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238 (45.1%) on a daily basis
Address book and calendar (98.3%)
Drug references (31.2%)
Radiology applications (24.6%)
General medical references (21.7%)
E -mail/internet access (13.6%)
290 (54.9%) did not use a PDA
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Never really found a need for one (83.3%)
Poor screen readability (19.7%)
Too awkward to use (16.7%)
Not enough applications (13.3%)
Not enough radiology software available
(12.9%)
Pediatricians’ use of & attitudes about PDAs
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35% currently use a PDA at work.
40% use a PDA for personal use.
9.6% had used a PDA.
89.7% use Palm OS.
8.9% use Pocket PC.
80% for drug reference.
67% personal scheduling.
61% medical calculations.
38% computerized texts.
8% prescription or billing. Ped. 05, Apr.12:238-
Radigraphics 2003, 23(4): 1035-
• (a) Screen shot of
a sagittal MR image of the knee on a 4-bit (16
levels) gray-scale PDA display.
(Courtesy of C. F. Beaulieu, MD, PhD, Stanford
University, Stanford, Calif.)
• (b) Screen shot of a midline sagittal T1weighted image of the brain displayed on a
higher resolution PDA.
Photograph shows an electronic image display appliance that is being
substituted for a radiology view box. The appliance is mounted in a
hospital corridor, & the user controls the display from a wireless PDA,
which contains list of relevant patients. It’s connected to the hospital
imaging network. The user can review an imaging study by selecting
it on the PDA.
Portal Sites
• Duke Un. Med. Cent. Lib: Links to PDA.
http://www.mclibrary.duke.edu/respub/guides/p
da/index.html
Arizona Health Sciences Libraries: PDAs for Health
Care providers.
http://educ.ahsl.arizona.edu/pda/index.htm
Univ. of Pittsburgh: PDA applications
http://www.hsls.pitt.edu/guides/pda/topics
Healthy PalmPilot:
http://www.healthypalmpilot.com/
Where to find Medical
applications?
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www.handango.com
www.handheldmedical.com
www.healthypalmpilot.com
www.handmedical.com
www.medicalpocketpc.com
www.doctorsgadgets.com/links/
www.handheldsfordoctors.com
www.pda.bmjbooks.com
Freeware
• http://www.freewarepalm.com/ Palm OSonly. Click on “Medical” in the “Category” list
on the left hand side of the page.
• pdaMD http://www.pdamd.com/ type
“freeware” under “Search our Product catalog.
• VersionTracker: Palm OS Software
http://www.versiontracker.com/palmos/index.
shtml – nothing for Pocket PC.
• PDA Cortex http://pdacortex.com/ articles,
reviews, and links.
Freeware
• PDA Center
http://www.collectivemed.com/tshtml/Fre
e_Software/
• Medical Eponyms: Rovsing’s Signs.
• Shots 2004: Child Immunization schedule.
• BreastCa: The Gail & Claus models.
• EBM Calculator: Stat. for RCT, diagnostic.
http://www.cancer.org/docroot/COM/content/div
_TX/COM_5_1x_The_C-Tools_20.asp?SiteArea=
www.medicalpocketpc.com
Drug Handbooks
• ePocrates Rx: up-to-date medical
information. It reaches more than one in
four U.S. doctors. Free.
www.epocrates.com/index.jsp
epocrates Rx Pro: 3000 drug, not free.
Dr. Drugs
• PDR.
• LexiDrug.
The Ann of Pharma 2005
May. 29
• There are many excellent PDA drug
information applications that provide fast
and accurate drug information and other
features that assist the health care
provider.
Evaluation of Clinical Drug
References
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User friendly
Comprehensiveness: Drug Interactions.
Accuracy.
Time interval of updates
Free-hand written available.
Memory requirements
Cost
Medical calculators
• MedCalc: designed
for rapid calculation
of common equations
used in Medicine.
• http://medcalc.media.net
Clinical Decision Rules
• MedRules: an application
featuring useful clinical
prediction rules taken from
the medical literature.
• http://pbrain.hypermart.net/
medrules.html
Current Awareness & TOC
• Journal to Go: delivers medical literature,
abstracts, & news to your handheld
device.
• http://www.journaltogo.com
• AvantGo: Websites, news, maps, images.
• http://www.avantgo.com
OVID@hand
• Order searches, review & retrieve journal articles.
• Have instant access about drugs, drug interactionsall with the convenience of handheld delivery.
• http://www.unboundmedicine.com/partners/ov/Ovi
dDemo/a2z-01.htm
• Journals@ovid: allows you to keep abreast, TOC,
abstracts.
http://www.unboundmedicine.com/partners/ov/OvidD
emo/journals-01.htm
Licensing models for PDA
content
• Free with existing licensed product:
PDA content is free with a subscription to
an existing licensed product. MDConsult
and UpToDate.
• User Add-on with purchase:
Allows Library clients to purchase PDA
content if the Library has a subscription to
the online version. Harrison’s on Hand.
Continued Licensing…
• Set number of downloads:
allows software to be loaded on a set
number of PDAs for a particular
institution. OVID@Hand and PDXMD.
• Institutional Site Licenses:
e-journals and online databases. It allows,
for a fixed annual fee, as many downloads
as required for a particular site. PEPID and
InfoRetriver.
Continued Licensing…
• Electronic loaning with due dates:
Content is borrowed from the Library ie
downloaded for a set period of time to a
PC, Laptop or PDA. It’s then returned ie
removed from the device via expiry date.
Overdrive (www.overdrive.com).
PDAs
• Are an essential instruments for health
care professionals.
• Provide a portable, integrated platform for
point-of-care clinical reference, patient
management & data communication.
• Are user-friendly devices, save time,
enhance quality, effectiveness, & accuracy
of clinical practice.
The Role of the Library
• As facilitators of easy access & free-flow
of information as a service, Librarians
need to play a key role in developing PDA
awareness, content searching services &
evaluation, instruction, security issues, &
technical support for their users.
In Palestine
• How many doctors, Nurses, Pharmacists,
and Dentists use PDA?
• Hospitals in Palestine?
• MOH?
• Others
Evaluating PDA Services
• Web survey, Interviews, focus groups.
• Librarians can assist in the delivery of
relevant information to their users, such as
suggesting appropriate electronic reference
texts, useful websites, & cutting edge
software applications i.e. Ovid@hand
Training & consultation
• Librarians need practical, hands on
knowledge of a variety of PDA software
applications currently available.
• Technical Support
• Downloading databases or catalogue
results.
• AvantGo channel for Library information.
Why do Librarians need
PDAs?
• Lurking items: Librarians can scan a bar code into
the handheld & then update the circulation status
in OPAC through syncing.
• can keep track of the books that patrons have
checked out.
• http://www.palmblvd.com/software/pc/Li
brary-Assistant-Version-1-0-2001-10-31palm-pc.html
• Set up a sync station in your Library
Librarians…
• Provided handheld computers, associated
peripheral equipment, general & specialized
software & applications, training, technical
support, e-content, various discussion
methods (websites, blogs, & email discussion
group)
to
enable
the
Healthcare
Professionals to use & evaluate the use of
PDAs in real-life, real work situations.
University of Alberta Libraries
• PDA Infrared Beaming Station: to beam
results of databases searches.
• Library News via AvantGo.
• U of A Listserv: for sharing ideas.
• Books on expansion cards
• MDC Mobile
• Resources: Textbooks, Patient tracking,
Prescribing,
PICOmaker
• A free Palm OS-based application that lets
users create and store queries in the PICO
(Population, Intervention, Comparison,
and Outcome) format for later reference.
This application is intended to assist
students and clinicians with EB practice.
http://www.library.ualberta.ca/pdazone/pi
co/
Keeping Current
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Read articles.
Learn from an expert
Join a Listserv
Surf the Web sites for ideas
CE Sessions
Purchase a PDA
Download some software
Subscribe to Newsletters
Conclusion
• PDAs will soon take full advantage of
wireless communication technology.
• Integrate EMR, EBM, medical references,
guideline
implementation
&
allow
coordination of clinical communications.
• Using PDAs improve the quality &
continuity of patient care.
• PDAs to be essential as stethoscope??
Announcement
•The PDA Interest Group
in Palestine is coming…
A question?
How can decision makers
initiate and support PDA
services to benefit health
care professionals in
Palestine?
Q&A
Thanks