The truth about handhelds
David MacAllister explores the facts behind the hype
Are you using a wireless application protocol (WAP) phone to book cinema tickets? How about the Internet to do most of your shopping? All right, what about CD ROMS for the majority of your medical learning and the Internet for the rest?
No? But when these technologies were introduced predictions were made that you would be doing just that. In fact, whenever a new technology emerges enthusiasts pop up with fanciful claims, just like the ones above.
Now, in medicine, the new technology that everyone is talking about is the handheld computer.
The handheld is the next big small thing--a phenomenon that has spread here from the United States. It began in business and journalism, but by 1999 a staggering 15% of US doctors owned handheld computers.1 With an even higher proportion of medical students owning handhelds, and given the fact that ownership is still growing, this is a remarkable feat for a device that is less than two decades old. Moreover, if US doctors were initially slow to pick up on handhelds, their British counterparts have not been.
Doctors seem to be the pioneers in Britain, and the "Psion organiser" was released in Britain in 1984.2 But that handheld was a workhorse; it grew out of a range of scientific calculators and data input devices. The new handhelds currently gripping medicine are an altogether different animal.
They are "cool"
The new keyboardless handheld, like the mobile phone before it, is cool. It has been a cultural phenomenon in the United States.3 Marketing for these handhelds has been more about building up a sophisticated brand image than telling us what they can do. Their adverts share much in common with the car adverts that are full of evocative images and dramatic music and don't let on that they are really just boxes for sitting in traffic jams.
Unsurprisingly, there are claims that handhelds will revolutionise medicine.4 Some commentators claim that electronic patient records are just around the corner, and that we can carry large reference texts around in these devices (less than 10 ounces, and 5 x 3 x 1 inch in size).
How doctors use handhelds
You may also have heard about some of the more sophisticated medical software available for handheld computers--for example, the processing and memory hungry patient tracker software and diagnostic databases.
However, this is not how doctors use handheld computers5 6 and is not why they have become popular. Electronic patient notes are felt by many to be cumbersome and inadequate. Medical programs that calculate drug doses are rarely used and electronic medical textbooks are seldom looked at. The modern handheld computer was born as an electronic alternative to the filofax, and that is how most doctors use it.
Much of the doctor's job is simply organisation. Often this involves carrying notepads, timetables, diaries, lists, lecture notes, and assorted scraps of paper and sticky labels. We wander the wards with white coats bulging.
What the handheld does is store information and allow you to organise all this information--deleting, replacing, and moving it around as you see fit.
Instead of having to fumble through a 100 leaf notepad for the page where you put that post it note with the pager number on it, you can call it up in a second with a handheld. It will even be legible and perhaps even cross referenced to related information--for example, page number for crash team along with the advanced life support system algorithm. With a handheld you can even share information with others who also have them, back information up on computer, and even download information from a desktop computer that you have typed or downloaded from the Internet.
What handhelds don't do
Unfortunately, however, all this information does not get on the handheld by wishful thinking. It does not recognise handwriting, only a kind of pigeon alphabet that you have to learn. This is fine for jotting down a quick note, but is neither fast nor accurate enough to enter longer information, such as a medical clerk in. Moreover, while the keyboards available on some versions are small enough to fit in your pocket, who wants to sit hunched over their lap with fingers poised over miniature keys every time you want to "note something down?"
Similarly, the average screen size is, by necessity, not much bigger than the front of a box of cigarettes. This is fine for a few notes or short bullet point guidelines. But surely no one wishes to peer at a tiny screen to read the equivalent of an entire set of case notes, let alone the Oxford Textbook of Medicine.
Moreover, the handheld will not organise itself. While organising is easier it still must be done. Take a look at the barriers to you being organised now; look at how you organise your files and folders on a desktop computer. If you find it hard to do this it is unlikely that a handheld will be of much more help to you.
A cautionary tale
In short, the handheld is a useful tool, but like any tool it depends on the skill of the user. And as to the extravagant claims made about revolutionising medicine, they may come true one day, when there is a better display device, but not soon. If you are considering buying one I suggest that you have a look at one of the many guides on the Internet, although they come from a mainly US perspective. An excellent guide can be found at http://edcenter.med.cornell.edu/Course/
Palm.html
Consider this. There is a market segment called "the early adopters." This comprises a predominantly male, young group which buys technology early. Technology is a sort of hobby. It is a boon to be in on the ground floor. But what will it benefit you to have bought early, as the technology rapidly drops in price and increases in quality, and all the while barely compatible systems rise and fall? Cast your minds back to the 1980s. A wonderful format, they said, far superior to VHS, they said. Who do you know now with a Betamax?
David MacAllister, third year medical student, Glasgow University
Email: email
studentBMJ 2001;09:261-304 August ISSN 0966-6494
- Shah M. Grassroots computing: palmtops in health care. JAMA 2001; 285:1768.
- History of psion. http://www.3-lib.ukonline.co.uk
- Kennedy D. Cult of the palm pilot. The Boston Phoenix
- Gardiner M, Pennington N. studentBMJ 2001;9:000. (August.)
- Potts M. The three and a half most useful applications for your palm. http://www.handheldmed.com
- Potts M. Could I have been an intern without one? http://www.handheldmed.com
