Personal Digital Assistants in Healthcare

Personal Digital Assistants in Healthcare

Current Applications and Future Trends in the Use of Personal Digital Assistants in Healthcare

Today, healthcare practitioners enjoy a wide range of digital equipment that can help them provide more efficient healthcare services, including laptop computers, cellular telephones and personal digital assistants, or PDAs. These devices have been used in various ways by clinicians to improve their ability to deliver more timely and accurate diagnoses and treatments, and it is clear that the use of these devices will continue to increase in the future. The purpose of this study is to provide a current snapshot of how personal digital assistants are being used in various healthcare settings, including military and government tertiary facilities and the use of PDAs on the battlefield in times of war, but with a specific focus on how PDAs are being used in nongovernmental healthcare facilities today. To this end, a critical review of the relevant peer-reviewed and scholarly literature is provided below to describe the general history and evolvement of PDAs, a recapitulation of current literature and research studies, a discussion of how these devices are currently being used in the healthcare arena, and an estimation of future trends based on the foregoing descriptions. A summary of the research and relevant findings are presented in the conclusion.

Review and Discussion

A. History and evolvement of PDAs in the healthcare field.

Although personal digital assistants have been widely used for a number of years, their evolution has been faster than many observers might have expected and sophisticated refinements continue to routinely appear in the marketplace today. According to Wegis and Van Der Mars (2006), "Personal digital assistants are extremely small and lightweight, and with appropriate software they can easily and accurately store activity data. Depending on the make and model of the PDA, ranging in price from $150 to $500, various types of software may be used" (p. 27). In this regard, Stringer (2005) reports that PDAs provide a wide range of functions, with some of the most popular features being the ability to access wireless e-mail communication services, and to allow users to check their online mailboxes while they are away from the office. In addition, PDAs provide users with convenience by being sufficiently small to be able to be held in one hand while being lightweight enough to carry in a pocket, backpack or briefcase; these devices can store data, share files with computers, display graphs and images, and rapidly exchange information (Rajala, 2003).

Furthermore, the use of wireless networks that support these devices are also becoming increasingly common, as they allow users to dial in and operate an IT network from a remote location. For instance, Stringer notes that, "Although it first emerged 11 years ago, Bluetooth technology has only really become popular in the past couple of years but, as with PDAs, it's rapidly gathering pace" (2005, p. 33). In their study, "Carry Your Office in the Palm of Your Hand; a Pocket-Size Device Is Your Computer When You're on the Road," Cieslak and Van Winkle (2003) report that, "With today's technology, not only can you take your 'office' with you when you travel, but you also can stash it conveniently in your pocket or purse. Welcome to the world of PDAs -- personal digital assistants. These handheld devices can perform many of your computer tasks and some even do double duty as cell phones" (p. 52). Today, a majority of healthcare providers in all settings - including both government and nongovernment healthcare facilities - use some type of computer-based technology to improve their delivery of healthcare services, and a majority of these clinicians use PDAs as described further in the studies reviewed below.

B. Current literature and research studies.

Around 1994, the introduction of cellular modems that allowed users to connect with laptop computers, cellular phones, and personal digital assistants to the Internet or to local area networks without the use of wall outlets because possible; however, technical problems remained during these early efforts, particularly relating to the lack of wireless communications standards which have since been largely resolved through wireless applications such as Bluetooth (Lauerman, 2002). Over a decade ago, one observer enthused about the potential for PDAs thusly: "The computing capabilities of PDAs have come a long way. Once simply superior business organizers, PDAs now support DOS-like operating systems that are compatible with many types of software packages, including handwriting recognition software" (Corbett, 1996, p. 34).

According to this prophetic author, "No matter what operating system a PDA uses, it probably supports an ever-widening range of scaled-down software.... As communications devices, PDAs are still finding their niche in the telecommunications market. As more telecommunications companies offer greater wireless communication access, and as prices far, PDAs could become as essential to people on the road as the telephone" (Corbett, 1996, p. 34). In their book, The Mental Health Professional and the New Technologies: A Handbook for Practice Today, Maheu, Puller, Wilhelm and their associates (2005) report that, "Indeed, unprecedented and inexpensive technologies are already reshaping society, health care, and mental health practice. Laptop computers, mobile phones, personal digital assistants, and portable stereos are permeating everyday experience and steadily building the foundation of a technology-mediated life. Technology will continue to be disseminated throughout the developed world and will become routine, invisible, and indispensable tools for all professions" (p. 3). In fact, as Wegis and Van Der Mars (2006) point out, even Excel spreadsheets can be developed and manipulated using PDAs, thereby improving assessment and accountability for a wide range of applications, including educational institutions.

Not surprisingly, the use of PDAs in professions that are focused on keeping careful track of details and remaining in touch is becoming commonplace. For instance, according to recent surveys of certified public accountants practicing in various settings, PDAs lead in the list of "must-have" technologies today as shown in Table 1 and Figure 1 below.

Table 1.

List of "must-have" technologies.

Technology

Percentage of Respondents

Personal digital assistants

WiFi

Ultralight laptop

Smartphone

GPS device iPod

Source: Telberg, 2005, p. 6.

Figure 1. List of "must-have" technologies.

Source: Based on tabular data in Telberg, 2005 at p. 6.

C. Application of the area in the healthcare arena.

Because effective communications are important in the delivery of quality healthcare services, it is not surprising that many clinicians have been drawn to PDAs. In the process, these devices have been targeted for new applications in the healthcare arena today. For example, in their study of injured adult patients who presented to a Level I trauma center in a university hospital's emergency department between August 1999 and February 2002, Blow and his colleagues (2006) used personal digital assistants to screen eligible patients for their study of how tailored text messages could be used to as an intervention for at-risk heavy episodic drinkers. The research staff in this study connected the screening PDAs to a desktop computer station in the hospital's emergency department. According to these authors, "A computer program automatically determined eligibility for the randomized controlled trial and randomly assigned participants to one of four intervention conditions. This was the first study to examine the potential benefits of tailored vs. generic written messages for at-risk alcohol use" (Blow et al., 2006, p. 568). The study by Blow et al. determined that generic and tailored ED-based interventions, with and without healthcare advice concerning the risks involved in episodic drinking, could help reduce quantity/frequency and some consequences of alcohol use, and did not require a post-ED visit booster session in order to be effective (Blow et al., 2006).

In what is perhaps the first-ever study of its kind, Segelken (2006) reports that PDAs have been used to gauge job satisfaction levels among healthcare providers. The pilot study involves volunteer clinicians carrying PDAs and answering a few questions each day (e.g., where they are, what they are doing, and with whom) when an alarm on the PDA sounds each hour. According to Segelken, "At the end of the workers' shifts, they pass along the PDAs to their replacements. Once a day, associates collect the PDAs to download the recorded data and hand the volunteers fresh PDAs for another day of data gathering. (The pilot study will start in Cornell's Gannett Health Services clinic before expanding to other facilities, such as Ithaca's Cayuga Medical Center)" (2006, p. 6).

These researchers emphasize that existing PDA and data-analysis technology are sufficiently powerful to accomplish these tasks; however, some minor logistical issues remain to be resolved: "For example, trouser-clad volunteers can wear the PDAs on their belts, but some nurse's uniforms have no belts. And a PDA dangling from a lanyard around the neck could interfere with medical procedures" (Segelken, 2006, p. 6). Other constraints have been resolved through reprogramming. If a participant in the study is too busy to respond when the alarm is sounded each hour, the signal is capable of being reset for a 10-minute extension; following more attempts, the PDA will wait for the next hourly reporting interval before going off again (Segelken, 2006). In sum, this author suggests that, "When combined with results from other kinds of studies, such as written surveys and direct observations, the PDA study could demonstrate how health care teams interact to do their jobs, how the physical spaces might be changed to improve the quality of medical care, and how to give team members a place to learn and to feel satisfaction in the jobs they do" (Segelken, 2006, p. 7).

While it is vitally important to assess job satisfaction in any workplace setting, it is also important to provide clinicians with the tools they will need to accomplish their mission in the first place and the U.S. military has sat up and taken notice of the potential offered by PDAs for this purpose. According to a recent report, "The Paperless Battlefield" (August 30, 2007), "Laptops and PDAs are increasingly common gear for combat troops, and that eliminates a lot of paper. Moreover, U.S. military equipment and weapons are increasingly filled with microprocessors, and displays for the users. Most reports are now prepared on a laptop, and transmitted electronically. This includes some reports that are prepared under fire" (p. 2). In the past, Army medics completed required medical forms after they had treated a casualty, and attached that form to the soldier upon evacuation; in some cases, though, the casualty form was lost, or made difficult to read by the nature of battlefield conditions (i.e., getting blood on the forms).

The editors of the Strategy Page point out that the exigencies of battlefield conditions made these constraints understandable, but did little to help resolve these fundamental issues: "At the field hospital, the doctors may have had problems with the medic's handwriting. Not much you could do, as everyone knew that the poor guy was probably writing in bad light, with a battle going on around him" (The paperless battlefield, 2007, p. 3). The introduction of PDAs has helped facilitate the administration of casualties across the board: "Over the last few years, the army has introduced computerized patient records, that can now be created using a PDA. Some 5,000 of these PDAs have been sent to Iraq and Afghanistan. Combat medics keep info on the people their units on these HP Ipaq devices. If someone is wounded, the medic quickly records the treatment on the PDA, and transmits it to the field hospital. There, the record keeps getting updated as the patient goes through treatment. The electronic record of treatments become part of the soldiers permanent medical records" (The paperless battlefield, 2007, p. 4).

In terms of job satisfaction, PDAs have provided military healthcare providers with one of the tools they have needed for some time, and represent an ongoing initiative by the Department of Defense to streamline the delivery of military healthcare services, particularly in combat situations: "The medics prefer the PDA to the old forms, as does all the other medical personnel that had to deal with the paper documents in the past. All this is part of the Department of Defense's effort to create a battlefield Internet. It's arriving, a piece at a time" (The paperless battlefield, 2007, p. 4).

D. Visions for the future.

The day is coming where ubiquitous computing eliminates the need for even tiny hand-held digital devices. Moore's Law continues to hold true, and computer processing speeds are doubling about every 18 months. When it comes to using these new digital communications technologies in healthcare settings, it is clear that their efficacy is directly tied to the perceived desirability of these devices to the individual healthcare practitioner. According to Greisler and Jackson (2000), "Medicine is an ever more complicated family of information which physicians and now physician extenders are permitted to join provided they have aspirations to care for patients and to learn new ways of learning" (p. 260). As Wegis and Van Der Mars (2006) emphasize, though, "Needless to say, learning how to use a PDA requires some time and effort, yet the authors believe that it likely will pay important dividends in the long run" (p. 27). Indeed, some "old school" healthcare practitioners may be reluctant to invest the time needed to learn how to use PDAs or other digital technology, but they do so at their professional peril: "No longer able to absorb mountains of expensive and dated textbooks or heaps of slick weighty journals," Greisler and Jackson (2000) advise, "today's physicians rely on a combination of heuristics and a quick look at journal web-based references. The power to carry entire digital texts on PDAs (personal digital assistants) and exchange clinical pearls via infrared ports will supplant the hallway banter of former learning" (p. 260). Moreover, as more and more people use these devices, new applications continue to be discovered and the end is not in sight. According to Proctor and Vu (2005), "The growing development and use of ubiquitous computing through personal digital assistants (PDAs), cell phones, and other on-board devices has led to Web access in a variety of new settings, which poses new challenges to fitting the tasks, environments, and technology to peoples' capabilities and limitations" (p. 52).

While computers and other digitally-based devices are becoming smaller and more powerful, there is the opposite trend taking place towards larger digitally based access systems as well according to some observers. For instance, in this regard, Jacko and Sears (2003) suggest that, "It is easy to predict that computers both smaller and larger than today's desktop workstations will be widespread. This will be a force driving the design and adoption of future interface mechanisms. Small computers such as laptops, palmtops, personal digital assistants, and wearable computers are often intended to blend more closely into the user's other daily activities" (p. 148). These types of digital devices will require smaller input-output mechanisms and will likely feature less obtrusive interfaces because they are going to be used in various settings where the user is simultaneously engaged in other tasks such as talking to people (Jacko & Sears, 2003). "At the same time," these authors note, "computers will be getting larger. As display technology improves, as more of the tasks one does become computer-based, and as people working in groups use computers for collaborative work, an office-sized computer can be envisioned, with a display as large as a desk or wall (and resolution approaching that of a paper desk). Such a computer leaves considerable freedom for user interaction" (Jacko & Sears, 2003, p. 148).

Already today, new communications frameworks are emerging that are based on the concurrent adoption of the following concepts:

Integration of different wireless and wired telecommunication technologies to offer services through both fixed terminals in public places and mobile personal terminals [e.g., mobile phones, personal digital assistants (PDAs), laptops];