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At ASCO's Annual Meeting in May 2005, Clifford Hudis, MD, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center, along with Bernie Khoo, ASCO's Director of Internet Technology, distributed personal digital assistants (PDAs) to participants in a program entitled “Practical Tips For Oncologists: Advanced PDA Applications.” Each attendee could try a PDA loaded with software programs for oncologists.
Hudis emphasized three concepts: (1) PDAs offer oncologists myriad applications; (2) physicians must take precautions to protect patient data entered into PDAs; and (3) users who access medical information online must remember that it's only as good as its source.
Practitioners at large institutions often have ready point-of-care access to desktop computers and diverse software. For solo practitioners or physicians in smaller practices, that may not be true, and a PDA can be a valuable additional point-of-care tool. PDAs can allow an adept user to use every working minute efficiently.
For example, using a program called Documents To Go (www.dataviz.com), Hudis can access PowerPoint presentations on his handheld. “Sitting in a meeting shortly before my own presentation, I can crib for it, reviewing my slides on my Treo.” He's used this program to speedily edit documents. “I've pulled up an abstract, revised it and sent it off,” all from his handheld, he says. Expansion cards can give a PDA vast storage capacity.
Another example: Hudis can tap Google to access the Internet instantly. “Once a colleague and I were introducing a guest speaker. We had no idea where he was from,” Hudis says. “With my Treo, during the preceding speaker, I found him online and we could make a respectful introduction naming his institution and title.”
Those who have purchased a PDA subscription can view the above-mentioned presentation (ASCO members and nonmembers can subscribe). The PDA subscription program gives subscribers access to downloads, discounts, and resources. To learn more visit www.asco.org/ac/1,1003,_12-002999-00_18-0040353,00.asp. To view Hudis' presentation, subscribe at www.asco.org/ac/1%2C1003%2C_12-002848%2C00.asp.
Hudis is on his 10th PDA. He's left one in an airplane and driven over another. “There are significant HIPAA issues involved when we put patient information into these. Losing your PDA can be a bit of a breach,” he said.
Solutions have emerged, including a program called PDA Defense (www.pdadefense.com). This program requires that a user to regularly synchronize the data in his PDA with his own desktop computer (perhaps once weekly). If such synchronization fails to occur, the PDA detonates a “little bomb” that destroys all data, Hudis explained.
When users do regularly synchronize PDA contents with a desktop computer, digital information is, Hudis said, “much safer than paper. If I lose the Treo, I'm only out the equipment. It's the information that matters. That data gets backed up regularly.”
Physicians employ typical PDA applications (address book, etc.) and they stand to benefit from a continually expanding array of applications tailored to medicine (see Table 1). Using his Treo 600 to illustrate this point, Hudis introduced several deservedly popular applications. When it comes to clinical resources, numerous programs exist that oncologists can use to refresh their thinking and determine the best course of treatment. For instance, a breast cancer doctor can use AdjuvantOnline for the PDA (www.adjuvantonline.com) to evaluate the relative value of various treatment options depending on important patient variables such as age and tumor grade.
Peter Ravdin, MD, PhD, clinical associate professor at the University of Texas Health Science Center at San Antonio, and colleagues regularly update this program. On the fly, this application can allow a doctor to show a patient the reduction in risk of relapse or death that they can expect with various regimens. “This tool,” said Hudis, “has been validated and proven remarkably accurate for groups of patients.”
Another useful program, NarcConvert lets doctors determine equivalencies between various narcotics. Other programs can allow one to accurately stage a range of cancers and to calculate the risks of developing various diseases based on patient-specific data. Some applications even contain details of treatment regimens for specific diseases and settings. NarcConvert is available to download from the ASCO PDA subscription program at www.asco.org/ac/1%2C1003%2C_12-002848%2C00.asp.
Bluefish Rx (www.bluefishrx.com) has become popular because it allows wirelessly connected PDAs to serve as prescription pads. With security ensured by the requirement that the user's signature match a registered signature, it allows a physician to securely write and wirelessly transmit a prescription to any pharmacy from anywhere.
PDAs can also be effective management tools. Hudis showed how the full agenda for a complicated meeting could be entered into a PDA. At ASCO, users could download the meeting program from beaming stations in the lobby and then tap sessions of their choice to have those sessions instantly added to their calendars (with location information). An ASCO member can download the entire ASCO directory into his PDA and with one tap add all of another member's contact info to his phone book; using a Treo or Bluetooth-connected PDA and phone, another tap will call that member.
Hudis suggested that many doctors are more likely to adopt a limited PDA such as a Blackberry rather than tackling a complex and potentially more powerful Palm-based device. “Most people focus on e-mail and scheduling. People everywhere are holding Blackberries under tables at meetings,” he said. “A minority are like me. I've never programmed anything, but gadgets don't scare me. Puzzling this thing out pays off. I can work in places and at times that I'd otherwise accomplish nothing.”