Personal Digital Assistant (PDA): A new

Tool for Health Care Professionals in Palestine

ByAbdel Hakim Bishawi

Library Manager Harvard Medical School Dubai Center

Dubai Health Care CityUnited Arab Emirates

E-mail: hbishawi@yahoo.comhttp://www.hmsdc.hms.harvard.edu/

Objectives• 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 • 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 • 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 Systems1- 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• 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-

Pocket PC Palm FeatureHardware

Larger Smaller, but getting better • Screen size

Generally - 320 by 240 pixels

Generally - 320 by 320 pixels" • Screen resolution

Yes Yes • 16-bit color supportBigger, heavier Smaller, lighter • Size / weight

Generally 8-14 hours Days • Battery Life (rechargeable lithium)

Yes Yes, on new high-end models • Wireless connectivity

No low to mid priced models Larger range of prices • Price

Yes Yes • Works with PCsNo Yes • Works with Macs

SoftwareUp to 128mb, (operating system requires more memory to run); expansion card for additional memo

Up to 64mb (most 16mb); expansion cards for additional memory

Memory

Faster, but required to run the operating system and allows multi-tasking

Slower, but operating system requires less to function well multi-tasking not available

Processor speed

Much like a Microsoft PC desktop

Proprietary , simple/intuitive Navigation

Character recognizer, block recognizer, transcriber, onscreen keyboard

Graffiti, onscreen key board Handwriting recognition

More clicks to get to the information needed

Quicker navigation to get to the information needed

Contact management, calendaring and to-do lists

Out-of-the-box integration Requires software addition (included) Integrate with outlook

Smaller selection but growing

Large selection, leader Medical software applications

Smaller selection but growing

Larger selection Other software applications

Pocket Word, Pocket Excel, Pocket PowerPoint

“Documents to Go” software converter

Windows applications

Pocket Internet Explorer

Free & for cost software available HTML Browser

Pocket Internet Explorer

Third-party software available (AvantGo & others)

Offline browsing

MSN Messenger Third-party software available

Instant messenger client

Microsoft Reader Palm Reader & other free third-party software

E-book reader

http://computing.kelkoo.co.uk/b/a/

ps_9148613/114501.html

http://www.tigerdirect.com/applications/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/consultation/guides/tutorials/

businesscards.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/resources/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

• 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/archives/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 "photo-blog" 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 wi-fi 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_pdas_listserv.htm

More than Basics…Productivity Resources:* Documents to Go / Ms Office

applicationsAllows you to use MS files on handheld. http://www.dataviz.com/products/documentstogo/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.comCustomizing your PDA• Software add-ons http://www.handango.com

Health Sciences Resources

• Reference Books• Drug handbooks• Medical calculators• Clinical decision rules & Guidelines. • Current awareness / TOC services

Health Sciences Resources

• 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/pmot.php

• http://www.nlm.nih.gov/pubs/techbull/ja03/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/

rsnanews/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

• 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

• 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

• 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 T1- weighted 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/pda/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?

• 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 OS-

only. 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/Free_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.jspepocrates 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

• 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.med-ia.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

interactions-all with the convenience of handheld delivery.

• http://www.unboundmedicine.com/partners/ov/OvidDemo/a2z-01.htm

• Journals@ovid: allows you to keep abreast, TOC, abstracts.

http://www.unboundmedicine.com/partners/ov/OvidDemo/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/Library-Assistant-Version-1-0-2001-10-31-palm-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/pico/

Keeping Current• 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