Back to Front PageVOLUME 6, NUMBER 4

Finding the Answer in the Palm of Your Hand
The Use of Portable Devices in Clinical Medical Education

By Jennifer Proctor

An electronic device that weighs no more than a few ounces is helping students and residents access critical information on diagnosis and treatment at the touch of a button.

Advocates of personal digital assistants (PDAs) say they could become as common in doctors’ pockets as stethoscopes. They argue that PDAs make patient care more efficient and effective, allowing doctors to quickly access multiple sources of information at their patients’ bedsides.

"PDAs are lightweight, fast, searchable, high-capacity resources that can alert physicians about such things as harmful drug interactions," says Michael Zaroukian, M.D., Ph.D., internal medicine residency program director at Michigan State University. Dr. Zaroukian pushed in 1995 for PDAs to be provided to internal medicine residents and hasn’t looked back since.

PDAs can be screen- or keyboard-based, and models range from the basic to the highly sophisticated. Basic models allow users to store and retrieve simple information such as names and phone numbers, create lists, and take notes. More sophisticated models can support word processing, electronic book reading, e-mail, and Internet access.

These hand-held computers can provide residents with access to myriad resources, including databases, clinical calculators, and guidelines, Dr. Zaroukian says. "With the innumerable facts — estimated to be more than a million — they are expected to learn in medical school, doctors can’t remember everything," he stresses.

Dr. Zaroukian says that by putting specific information at physicians’ fingertips when they need it, PDAs are both a source of convenience, because they eliminate the need to leave a patient to consult a print source or specialist, and a safeguard against medical mistakes.

Other experts agree that PDAs and similar emerging technologies can play a role in reducing medical errors. "It is unacceptable for physicians to practice medicine off of the top of their heads," says Joseph Scherger, M.D., associate dean for clinical affairs at the University of California, Irvine, College of Medicine and a member of the Institute of Medicine Committee on the Quality of Health Care in America. Speaking at a recent AAMC Council of Academic Societies meeting, Dr. Scherger stressed the need to "create systems to override errors," emphasizing the role of emerging technologies in meeting that need.

Conclusive studies on whether PDAs improve patient safety are scarce. However, recent research funded by the Agency for Healthcare Research and Quality shows that computerized systems can reduce medication errors and prevent 28 percent to 95 percent of adverse drug events. Dr. Zaroukian says that in his experience the patients of physicians who use PDAs benefit from better decisions about appropriate drug dosing and knowledge of side effects.

The New York Medical College gives PDAs to all third-year students in its family medicine clerkship for use throughout the four-week curriculum. "It’s critical that these students be prepared for the way health care will be practiced in the future," says Laurie Sullivan, an educational and behavior specialist at the school.

During the family medicine clerkship, students use their PDAs to document each patient contact and record diagnoses, medications, and procedures. At the conclusion of the clerkship, the information is uploaded to a central database for analysis.

However, Sullivan reports that student response to the introduction of PDAs in the clerkship has been overwhelmingly positive. In fact, she says, students originally encouraged the school to provide the devices and have been quick to demonstrate the efficacy of PDAs to the family medicine community preceptors with whom they work.

At the University of Washington’s Roosevelt Clinic, doctors are experimenting with new uses for these portable information tools. Most of the residents consult formularies, applications, and do calculations on PDAs, says Jeffrey Wright, M.D., medical director of the Pediatric Care Center at Roosevelt. Doctors also use higher-capacity portable devices to write out electronic prescriptions, lab orders, and more.

In addition, the Roosevelt Clinic puts electronic tools in the hands of its patients, who fill out electronic questionnaires in the waiting room. The information is instantly stored and available to the care team. Dr. Wright says that when the Internet becomes more secure, patients will be able to fill out questionnaires online before appointments, helping to reduce waiting room times, paperwork, and the necessity for data entry.

Some worry that this increased use of technology, especially at the point of care, will reduce the human contact element of doctor-patient interactions. Although he acknowledges that the use of technology can at times be intrusive, Dr. Wright stresses that "high tech should also mean high touch."

Dr. Zaroukian adds, "Burying one’s face in a paper chart, thumbing through mind-numbing pages of labs, scribbling progress notes, or leaving the room to consult resources — all of which happen now — are less effective. If a doctor can obtain accurate and reliable information needed to make a decision quickly and immediately applicable to the patient, everyone benefits."

Nevertheless, Dr. Wright cautions that careful thought should be required before the latest technology is applied to medicine. "There are still a lot of unanswered questions. More research is needed so we can assure ourselves and our patients that technology is helping, not hurting."

 

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18 May 2001