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on devicesCase 1
Joanna is a third-year medical student getting ready to start her clinical clerkship. She has seen other clerks and residents using their handheld computers to look up drug dosages and medical reference information on the wards. She feels that a handheld computer would be a useful aide for her clinical training. She envisions using a handheld primarily as an information resource, but she worries that she is limited by a narrow budget. Which handhelds would best meet Joanna's needs?
Case 2
Dr. Edwards is a family physician with a busy practice in Northern Ontario. Although he uses a personal computer in his office for word processing and email messaging, he does not regard himself as technologically savvy and is skeptical about using a new electronic gadget in his practice. After hearing from colleagues at a conference about how they use their handheld computers to log their billing claims, he is interested in finding out if a handheld could improve his billing efficiency. What benefits could a handheld computer bring to him? What models would best suit his needs through being functional, yet small and elegant?
Although handheld computers have yet to take their place alongside the stethoscope and the reflex hammer as essential tools in the practising doctor's armamentarium, they are becoming increasingly popular in medical practice. According to a recent survey of 834 US physicians, about 26% of physicians now use handhelds and an estimated 50% will use the devices by 2005.1 Physicians are using handheld computers in their practices today for a variety of routine tasks: from accessing medical textbooks and making medical calculations using laboratory test results to tracking patient data and billing for patient encounters. Recent data suggest that handheld computers may not only enable clinicians to practise more efficiently,2 they may even reduce medical errors and improve patient outcomes. For instance, in a recent Canadian study, the introduction of handheld computers in an intensive care unit (ICU) in a teaching hospital led to improved communication of patient information among ICU staff.3 Research presented at a meeting of the American Society of Anesthesiologists suggests that handhelds can facilitate screening for drug interactions and can be used to improve postsurgical pain control through recording each patient's pain ratings and response to analgesics.4
Recognizing that familiarity with information technology will be as important to the future physician as knowledge of the pathophysiology and treatment of common diseases, many medical schools in the United States, including Wake Forest University, NC, and Stanford University, Calif., are providing their undergraduate students with handheld computers.5,6 Medical students are using handheld computers to keep track of clinical encounters and facilitate evidence-based decision-making.7,8,9 At the postgraduate level, a recent survey of family practice residency programs in the United States indicated that handhelds were used by 67% of residency programs that responded to the survey.10 Medical training programs are integrating handheld computers in their curricula to meet the changing information needs of their trainees.11 Given the growing volume of medical information, and the increasing expectation for practitioners to adhere to standards of evidence-based care, physicians and trainees increasingly require ready access to medical information at the bedside. The appeal of the handheld computer is that it can function as a compact, portable medical information resource that can be accessed at the point of care. Moreover, it can be easily updated to incorporate emerging research and evolving clinical practice guidelines.
Although the handheld computer offers the promise of bringing evidence-based medicine to the bedside in everyday practice, most physicians today either do not own a handheld computer or use their handheld computers solely as a day planner for keeping track of important appointments and contact information. There are a number of reasons why many practitioners are reticent about using handheld computers: data entry through the “Graffiti” character recognition pad on a handheld, although fairly easy to learn, can be tedious for entering large quantities of data; handhelds have small screens that are less than ideal for reading long volumes of text and for displaying graphics; when compared with personal computers (PCs), handhelds have limited memory and slower processing speeds and, finally, many physicians have raised questions about the security of storing confidential patient information on handhelds.12
In spite of these concerns, many practitioners are interested in purchasing their first handheld computer or upgrading their current handheld model. For non-computer-savvy physicians, the handheld industry's excess of technical jargon and its rapidly expanding array of available gadgets can be dizzying. The aim of this article is to introduce novice handheld users to the range of hardware options that are available and the important features that should be considered when purchasing a handheld for medical use. A second article will describe software applications relevant to medical practice.
