Doctors are buying personal digital assistants,
although not necessarily for clinical purposes. But new technology and
a federal push to e-health could change that.
By Tyler Chin, AMNews staff. Jan. 17, 2005.
Richard Raborn, MD, a solo internist in Boynton Beach,
Fla., is like a lot of physicians when it comes to his personal digital
assistant. Since shelling out $400 for a Treo 600 from palmOne in
spring 2004, Dr. Raborn has used the handheld device primarily as a
communication rather than an office productivity tool.
"It's more of a phone and little bit of a reference tool to look up
[physicians' and patients'] names, addresses, faxes and phone numbers,"
Dr. Raborn said.
He wants to use it for more clinical tasks eventually, but "I
haven't had enough time to really do what I want to do with it," Dr.
Raborn said, explaining that converting his practice into a concierge
practice consumed most of his attention and energy in 2004.
When handheld devices hit the market, many experts predicted that
physicians, even those who weren't early adopters of computers and
health technology, would quickly find use for a device that seemed to
fit right into their busy lives, their need to have access to
information and their constant mobility.
And those predictions were correct. About 40% of practicing
physicians owned a personal digital assistant in 2004, up from 19% in
2001 and more than four times greater than the overall percentage rate
of consumer adoption, said Mark Bard, president of Manhattan Research
LLC, a market research company in New York.
But the other end of those predictions hasn't held up -- that
physicians would find PDAs useful as a clinical tool. Although
physician adoption of PDAs in the past four years soared for various
reasons, the devices have yet to come close to being used for their
fullest potential in medicine.
|
40% of practicing physicians owned a PDA in 2004.
|
Cost and lack of connectivity of PDAs with electronic medical
records and physician practice management software systems are major
deterrents keeping doctors from using the devices professionally. But
there are others. PDAs are touted as useful for e-prescribing, but most
pharmacies can't accept electronic prescriptions yet. The devices have
a small screen and short battery life. In some cases, a lack of
training and awareness of how PDAs can benefit physicians
professionally, and a perception among some physicians that PDAs offer
limited functionality, also pose barriers, industry observers say.
At this point, most doctors who own PDAs use them for personal
rather than professional purposes. And when they use PDAs
professionally, they typically use the devices to access drug and
medical references, scheduling applications, and, to a much smaller
extent, billing and prescribing systems.
Even those who use PDAs still gravitate to the good old-fashioned
paper and pen, if that way appears to work more quickly than an
electronic device.
"It's a combination of a cultural issue and technology [limitation],
said Scott Tiazkun, program manager of U.S. health care information
technology at IDC, a market research company in Framingham, Mass. Paper
and pen are "the way [physicians] have done business in the past, and
the technology is not compelling enough for them to change their way of
doing business."
Going mobile
But some new developments are under way that could drive physicians
to use and take advantage of what PDAs have to offer. For example, PDAs
are evolving into a new class of mobile computing devices known as
smart phones. Those devices combine cell phone functionality with the
personal organizer functions -- address book, date book and to-do lists
-- offered by other PDAs.
"You're kind of seeing saturation in the market for what was
historically defined as a PDA," Bard said. Smart phones will continue
to evolve into new mobile computing devices that will become more
computer-like, easier to use and still fit in your hand or pocket, he
said.
|
Most pharmacies could not accept electronic prescriptions in 2004.
|
"These next-generation mobile devices will open up the field of
mobile health to a new generation of physicians, including the ones who
held out based on the limited value -- in their opinion -- delivered by
current offerings," Bard said.
D. Bart Sills, MD, a family physician at a three-doctor family
practice in Fort Smith, Ark., agrees that the new devices and their
enhanced functionality will appeal to physicians who don't use PDAs in
the office now.
He has noticed substantial improvement in the devices since 1999.
"Since I first started using a Palm, the thing that has become amazing
is the amount of memory that's become available," Dr. Sills said. For
example, there are plug-in cards that make it easier to access a
greater amount of information. So he uses a drug database and a medical
reference on his PDA, as well as using the device for writing
prescriptions. "I hardly even use any [hard copy] reference now because
I have so many references available on my Palm."
Dr. Sills also keeps notes whenever patients contact him when he is
on call, accumulating more than 1,000 call notes to date. "Quite
honestly, I think most physicians would say that's needless work, but
if it saves me one lawsuit or keeps me from losing a lawsuit, I think
it will be worth it," Dr. Sills said.
Although physicians say PDAs have a lot of room for improvement, the
devices still can provide immediate help if doctors take the time to
learn how to use them and what handheld medical applications are out
there, Dr. Sills said.
"When you buy a Palm off the shelf, it has very few things loaded
into there except for the address book function, date book function and
a few other things," Dr. Sills said.
"It's maybe not as intuitive as it should be. ... I have evolved the
set of tools that I use over the last five years. It was not something
that someone walked up to me and said, 'This is what you need to have.
You need to have this, this, this and this.' I read a lot, I research a
lot, I get a lot of things off the Internet, my listservs and things
like that. So what I'm doing maybe is more than a lot of doctors are
willing to do -- investing in time."
Doing more with more
While Dr. Sills is a PDA power user, Dr. Raborn is at the opposite
end of the spectrum and knows he could be doing a lot more with his
Treo 600 smart phone.
But now that he has trimmed his practice from 3,000 patients to 400
patients through the conversion to a concierge practice, he intends to
take advantage of his smart phone.
For example, Dr. Raborn plans to store comprehensive patient
physicals and consultant reports in PDF form on a memory card that he
can insert into and access on the Treo, he said.
He also plans to download a medical drug reference onto his device
because he had used one for years before upgrading from a PDA to a
smart phone. "I do miss all the pharmaceutical help I got" on previous
PDAs, he said.
Furthermore, he plans to write prescriptions electronically, because
he believes that will take less time than calling a pharmacy or writing
multiple prescriptions for a patient by hand, Dr. Raborn said.
That attitude is on the rise, helping boost usage of PDAs in
physician offices, some say. "What I've seen in the last few years has
been an increasing number [of physicians] using it," Dr. Sills said. "I
really think every doctor I talk to, if they don't have [a PDA], is
thinking about getting one."
Another factor that also will boost PDAs is that medical schools
nationwide are increasingly requiring their use. As medical students
and residents go into private practice, PDAs will be more widely used
in physician offices, said Scott M. Strayer, MD, a family physician,
assistant professor of family medicine and health evaluation sciences
at the University of Virginia. He also is owner of PocketMed, a
Charlottesville, Va., company that sells a handheld-based charge
capture software to physicians.
Linking the PDA
As several health care organizations publish their research on
handheld devices in coming months, doctors will become more educated
about their usefulness, Dr. Strayer said.
For example, the Robert Wood Johnson Foundation is funding
Prescription for Health, a multimillion-dollar research initiative. The
health care philanthropy has funded 17 projects designed to improve
counseling on unhealthy patient behaviors. Several of those projects
involve PDA use.
"We still have a lot to learn as to how best to use those things in
practice, but I think once that occurs and there's more outcomes-based
data, then there could be an even larger swell [of physician
adoption]," Dr. Strayer said.
The federal government's and industry's current focus on making
electronic medical records more affordable and helping physicians
implement them also will lift PDA adoption, experts say. Most EMRs
aren't integrated with practice management systems, and data in those
systems can't be accessed via PDAs, making physicians reluctant to use
either EMRs or handheld devices in the office, Dr. Strayer said.
"As the pressure builds for efficiency, safety and EMRs, that is in
turn going to drive a lot of the PDA adoption," Dr. Strayer believes,
especially as the government, insurers and others in the industry offer
financial incentives to entice doctors to implement clinical
information technology. "I think over the next 10 years, all these
forces will come together, and the funding will be there."
Back to top.
ADDITIONAL INFORMATION:
Mobile computing
Over the past four years, the percentage of practicing physicians
who have and use personal digital assistants has grown significantly,
though it appeared to have stalled in 2004.
| Adoption rate |
|---|
| 2001 |
19% |
| 2002 |
30% |
| 2003 |
40% |
| 2004 |
40% |
Source: Manhattan Research LLC
Back to top.
Leveraging PDAs
Although many doctors use a personal digital assistant, most
physicians are using PDAs for personal rather than professional use.
Here are some of the applications or tasks that a PDA can help you
perform in the office:
- Charge capture and coding
- Clinical note-taking
- E-mail
- Electronic prescribing
- Medical calculators
- Medical reference
- Patient record access
- Patient scheduling
- Pharmaceutical reference
- Telephone numbers and addresses of patients, consultants and pharmacies
- Test ordering and lab results
