Increasingly, physicians are relying on handheld personal digital assistants (PDAs) such as Palm Pilots to search the latest medical literature, calculate and cross-reference medication doses, and review and revise medical records. According to a recent poll by Harris Interactive, 26% of physicians surveyed in the U.S. said they use PDAs daily; by 2005, that number is expected to reach 50%. PDAs, which are small, portable computerlike devices that fit in the palm of the hand or in a pocket, can greatly simplify patient visits and help improve patient safety and minimize risk. Instead of using a keyboard, users enter information with a stylus (penlike device), or by downloading information from the Internet, personal computers or computer networks.

PDA use in medical practice
There are many uses for handheld devices in the medical setting, including the following:

Reducing medication errors—Prescription errors are one of the main causes of malpractice claims against physicians. Not surprisingly, one of the most popular uses for PDAs is to access drug references.

Having a patient’s medical record and/or a drug database on a handheld can reduce the number of steps needed to determine which medication is safe for a patient, how it will interact with other medications and any possible allergies to a medication.

Further, some pharmacies allow physicians to submit prescriptions directly from a PDA through a wireless network, thus reducing the chance for error in interpreting medication or dose. One study by Brigham and Women’s Hospital in Boston found that physicians who used a portable drug database avoided one to two medication- related adverse events per week.

Accessing clinical guidelines and journal articles—Physicians also can use their handhelds to make treatment decisions based on the latest clinical guidelines from sources such as the National Guideline Clearinghouse and the Centers for Disease Control and Prevention. In addition, various medical journals make their articles available for downloading to PDAs.

Calculating medical equations— Medical calculators for the handheld allow physicians to compute common equations used in internal medicine. Using such medical calculators can increase both speed and precision, as physicians need not rely as heavily on memory and mental arithmetic.

Tracking patient information—PDAs can give physicians mobile access to information in patient records, including the following: patient demographics (age, race, religion, insurance information, medication and treatment preferences, and medical record number), lab and test results, evaluations, consultations, surgical reports, and admitting, medication and treatment histories.

Medical record software can enable physicians to quickly find important information needed to make treatment decisions without having to track down and search through a patient’s chart or folder. New information can be added while the doctor is with the patient; then, it can be passed on to other healthcare providers either electronically or by printing out the information.

PDAs and patient confidentiality
Physicians should have a policy in place to govern how information is to be transferred to and from a PDA. The privacy standards of the Health Insurance Portability and Accountability Act (HIPAA) apply to handhelds as much as to other devices, such as fax machines.

The most popular medical record software programs for handheld devices come equipped with encryption technology to protect data during transfer. But some studies have questioned the security of such encryption. Software manufacturers expect to have the encryption issue resolved by the time HIPAA’s privacy standards takes effect in April 2003. In the meantime, PDA users should take every step possible to protect confidential patient medical information, just as they would with any paper record.

PDAs and security
It’s not uncommon for PDA users to lose their handhelds at some point. That can place patient information at risk if a user stores medical records on the device but has not set up password protection to secure the information.

All physicians need to be aware of this issue and take steps to protect their data. There should be a clear-cut policy governing who may access the information on PDAs.

PDAs in court
Physician notes created and stored on a PDA may be discoverable in a lawsuit. There is a difference, however, between work product and a medical record. Notes entered on a PDA can be considered work product, similar to notes dictated on to cassette tape; thus, they may be revised or even deleted before they become a permanent part of a patient’s medical record. Physicians should discuss this issue with their legal counsel and draft an appropriate policy.

Conclusion
Used properly, PDAs can be beneficial to physicians and patients alike, streamlining processes, helping to reduce errors and improving patient safety. However, physicians should take steps to protect the confidentiality of patient information and prohibit unauthorized use. Policies need to be implemented that govern who may use PDAs, how they are to be used, and who has access to the information stored on them.