Medicine in the palm of your hand

The IT revolution is here to stay. Are you prepared to jump on the bandwagon?

You must have noticed them-personal digital assistants (PDA), palmtop computers, or hand­held computers, as they are alternatively known, are everywhere. In the past, devices such as psions, palms, and pocket personal computers (PPCs) were the expensive toys of business executives and computer buffs. They were bulky, slow, and a poor alternative to a filofax. The last few years have seen a revolution in technology. These devices are now more powerful than most PCs were five years ago, at a quarter of the price.

So why do you need one? After all there are computers on the ward and in the library, and as for gizmos, you probably still do not use most of the features of your mobile phone. Put simply, they have the potential to revolutionise your life and your medical practice.

The white paper Information for Health¹ and its update² describe the NHS's commitment to electronic health records (EHRs). Their advantages are immediately obvious to anyone who has tried to find and then interpret the hieroglyphics of their patient's last clerking. The Naval Medical Center, Portsmouth, United States, recently issued doctors with palm III handhelds to allow them to accurately maintain their patients' notes while on the go. The handhelds also contain reference materials, medical algorithms, and frequently used pager numbers. At handover time the latest patient information and outstanding tasks can be easily beamed (via the built in infrared port) to the staff on­call. This scenario could soon be reality in Britain as limited forms of electronic patient records (EPRs) are due to be implemented in all short stay hospitals by 2005.

It is not only professionally but also personally that you can become paper­free. Your cluttered diary, address book, and scribbled "to do" list will be consigned to the past. Everything on your handheld is backed up when you synchronise with your PC, so if you lose your handheld you do not lose your life with it.

An EPR must be accessible and up to date. Currently the solitary ward computer would act as a bottleneck for where and when you can edit it. One solution is to equip every room or office in the hospital with a computer. Alternatively, handhelds linked to a wireless network will allow members of the healthcare team to access and revise clinical information anytime, from anywhere.³ As a student or junior doctor you will be able to view a patient's notes, order investigations, get blood results, and surf the web while at the bedside, during a ward round, in the mess, or while waiting for the lift. A trial of this type of network is currently running in the acute medical admissions unit at the John Radcliffe Hospital in Oxford.⁴

A doctor apparently needs to know two million pieces of information to practise effectively; unfortunately, recalling more than two is often a struggle. For this reason in America handheld computers have become know as "peripheral brains." You can load your handheld computer with countless different programs, documents, and databases to create your own personally tailored mobile library. Currently several major American textbooks are available for download at a price, but most of the information out there is written by fellow doctors and freely distributed via the web. You can even install a program that loads up the abstracts from the latest issues of all the major journals to your handheld each time you synchronise.

Handhelds and their associated technology clearly have potential to make a big impact in helping the doctor with some of the process of practising medicine. There are still challenges to their everyday use, both technological and ethical (notably patient confidentiality), but probably the most difficult will be the implementation of change. In America, where most trials have been undertaken, the financial motivation is clearly measurable. A study in the department of surgery at Brigham and Women's Hospital, Boston, gave a remarkable 989% return on their investment. It is more likely that Britain will see more insidious change driven by individuals.

Matthew D Gardiner, sixth year medical student, University of Oxford
Email: matt.gardiner@oriel.ox.ac.uk

Nick de Pennington, sixth year medical student, University of Oxford
Email: nick.depennington@oriel.ox.ac.uk

Adekoyejo Odutola, sixth year medical student, University of Oxford
Email: adekoyejo.odutola@keb.ox.ac.uk

With the Oxford Medical Informatics Department we have formed an organisation called OxfordHandhelds to promote and aid the use of handhelds in medicine. If you want to find out more visit the sites listed below or get in touch with us.
www.oxfordhandhelds.co.uk
www.handheldmed.com
www.pdamd.com

studentBMJ 2001;09:261-304 August ISSN 0966-6494

1. 1 Department of Health. Information for health. London: Stationery Office,1998. www.doh.gov.uk/nhsexipu/strategy/
2. Department of Health. Building the information core: implementing the NHS plan. London: Stationery Office, 2001. www.doh.gov.uk/nhsexipu/strategy/update/index.htm
3. Cedars­Sinai uses palm VIIs to access clinical information. www.mobilecomputing.com/showarchives.cgi?59:4
4. Kay J. Handheld computers move on to the wards. GPNet 2001 May.