Handheld Computers and Personal Data Assistants in Clinical Anesthesia:

An Overview of the Issues and a Look at the Future

D. John Doyle MD PhD FRCPCDepartment of General AnesthesiologyCleveland Clinic FoundationCleveland, Ohio, USA

WCA 2004, Paris, France

This talk may be downloaded at

www.PDAWCA2004.homestead.com

http://www.cmaj.ca/cgi/content/full/167/7/775

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http://www.mdtool.com/palmguide.html

Fossil Wristwatch

The WRIST PDA with Palm OS from Fossil features an illuminated touch screen with a stylus integrated into the band for Graffiti input, 2MB internal memory, Rocker switch user interface, infrared port to support beaming between all Palm Powered devices, rechargeable battery, and loaded applications including: Address Book, Date Book, Memo Pad, Calculator and To Do List. http://www.palminfocenter.com/view_story.asp?ID=4615

http://www.cmaj.ca/cgi/content/full/167/7/775

The Senseboard® Virtual Keyboard is designed to capture the motion of the fingers and hands, enabling keyboard functionality without the constraints associated with a traditional keyboard and mouse.

Touch typists are able to type anywhere and wirelessly transfer information to their portable device utilizing a Bluetooth connection. No longer do PDA or other portable device users need to struggle with undersized or inefficient text input devices and they don’t need a flat surface anymore

http://www.senseboard.com/

http://www.cmaj.ca/cgi/content/full/167/7/775

http://www.cmaj.ca/cgi/content/full/167/7/775

The PDA version is not compatible with Palm OS 5 despite the statement "for Palm OS 3.5 and higher". The publishers comment was an unhelpful statement confirming this incompatibility.http://www.medicine-book.com /Essence_of_Anesthesia_Practice_PDA_Package_Book_and_CDROM_0721697682.html

http://www.medicalpocketpc.com/

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Archimedes, a free medical calculator by Skyscape.

"With formulas ranging from Aa Gradient to Weights, our proprietary calculator provides you with 70 preprogrammed formulas that include specialties such as Cardiology, Pharmacology, Hematology, FEN, Pediatrics, Pulmonary and Renal. From a built-in calculator assisting with value field input, to control of decimal point placement in formula results, Archimedes allows you to determine the input and output details for every formula. Also included is a help button giving you access to complete formula information."

http://eponyms.net/eponyms.htm

Lack of information on treatments and disease is a pressing health care problem in Africa. To address this problem, SATELLIFE (http://www.healthnet.org/index.php) turned to PDAs to enable physicians and other professionals to have access to up-to-date information. SATELLIFE is conducting the project in three African countries: Ghana, Kenya and Uganda.

Medical students at Moi University Medical School in Kenya learn about PDA technology.

http://pda.healthnet.org/gallery.html

Anesthesia StatTracker

Anesthesia StatTracker is an application for your Palm OS based handheld device that simplifies the collection of anesthetic case data. All anesthesia providers will find StatTracker useful for recording cases while in the OR, ICU or pain clinic. Anesthesia StatTracker includes a conduit for your Mac OS based computer that automatically produces a tab delimited text file of all your cases that can be viewed on and printed from your desktop. This file is produced automatically every time you hit the HotSync button. StatTracker will be useful to resident anesthesiologists since it tracks case data in the format required by the American Council for Graduate Medical Education (ACGME) for end of academic year reporting.

http://de.mobile.yahoo.com/010301/3/jah.html

Pagers will allow doctors to receive critical updates concerning their patients. Two-way pagers will allow doctors to offer orders in response. Pager / PDA / Web browser devices will allow doctors to figure out what to order.

URGENT ALERTJones, Alfred. MRN 123-003-234Serum Potassium 6.6 mEq/LTest Repeated. Nonhemolized sample.

Doctors and RN's may use a wireless VideoPDA to download a patient's Electronic Medical Record (EMR) and update the EMR with current data including a video "progress report" on the patient.

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http://www.cmaj.ca/cgi/content-nw/full/168/6/727/T227

http://www.cmaj.ca/cgi/content/full/168/6/727/T327

http://www.cmaj.ca/cgi/content/full/168/6/727#T227

Volume 350(10) 4 March 2004 p 1059

The Intern's Palmomental ReflexTo the Editor: The contemporary palmomental reflex can no longer be viewed as primitive. Usually elicited by a probing question from a staff physician, it is a reflexive action observed in medical students and house officers. The reflex involves a quick movement to expose a personal digital assistant (Palm Pilot) or similar device, followed by repetitive stabs with the stylus on the device screen. The "palmo" component of the reflex seems to be necessary to start the "mental" component required to answer the question. The reflex has replaced the "um" and "ah" of indecision or thought and has almost eliminated the "I don't know" response.

G.L. Crelinsten, M.D. McGill University; Montreal, QC H3H 1V4, Canada gcrelinsten@qc.aibn.com

Gandsas A. Montgomery K. McIntire K. Altrudi R. Wireless vital sign telemetry to hand held computers. Studies in Health Technology & Informatics. 81:153-7, 2001

ABSTRACT Most physicians and other health care providers share/access patient information via hard copy chart records, telephone conversations, or through hospital computer networks. These modalities are cumbersome when physicians are away from the hospital and ground wiring infrastructure is not readily available. In a prior study, we used wireless in-flight telephony and the Internet to transmit vital signs from an airborne Boeing 757 to three remote locations on the ground. However, because all recipient stations relied on an institutional network to receive the information, it was not possible to transfer data to a given location beyond the hospital campus. We now propose an innovative system capable of transmitting telemetry information from any location in the globe to a single portable computer using Wireless Application Protocol (WAP) technology for the Internet. Medical data including blood pressure, pulse, respiratory rate, end tidal CO2, oxygen saturation and EKG tracings were transferred from a G2 (digital cellular) phone linked to a hand held computer to a remote hand held device and were viewed in real time using customized software. Cellular Digital Packet Protocols (CDPD) enabled data transfer speeds up to 19,200 bps. Advances including the Internet and wireless computer technology may revolutionize the way medical information is shared, making it possible for physicians and health allies to directly access patient data from anywhere at any time.

VanDenKerkhof EG. Goldstein DH. Lane J. Rimmer MJ. Van Dijk JP. Using a personal digital assistant enhances gathering of patient data on an acute pain management service: a pilot study. Canadian Journal of Anesthesia. 50(4):368-75, 2003

PURPOSE: Handheld computer technology provides a unique opportunity for health care professionals to access real time or near real time patient information and evidence-based resources at the point-of-care. The purpose of this study was to assess one physician's experience using acute pain assessment software on a personal digital assistant (PDA) to assess patients on an acute pain management service (APMS). METHODS: Using a historical control and a "time and motion" study design, comparisons were made on acute pain assessment time and comprehensiveness when patient assessments are documented on a PDA vs the current paper-based method. RESULTS: The study physician (a PDA-user) reported feeling comfortable with the assessment software after five patient assessments. PDA assessments were more likely to contain documentation regarding pain and side effects (e.g., nausea, pruritus, hypotension) than the paper assessments. The median time of the "assessment only" component of the patient encounter was 53 sec longer using the PDA compared to paper (P < 0.00), however, the median "total encounter" (chart review, assessment, documentation) time was 74 sec shorter using the PDA vs paper (P < 0.00). DISCUSSION: The findings of this preliminary study suggest that the PDA is a reliable tool that meets the data management requirements within an APMS setting. This study found that patient assessments documented using acute pain software developed for use on a PDA were as efficient and content-rich as paper assessments. The PDA may even enhance the efficiency of the patient assessment process through the provision of more comprehensive digital data for research, clinical, and administrative needs.

Leung GM. Johnston JM. Tin KY. Wong IO. Ho LM. Lam WW. Lam TH. Randomised controlled trial of clinical decision support tools to improve learning of evidence based medicine in medical students. BMJ. 327(7423):1090, 2003

OBJECTIVE: To assess the educational effectiveness on learning evidence based medicine of a handheld computer clinical decision support tool compared with a pocket card containing guidelines and a control. DESIGN: Randomised controlled trial. SETTING: University of Hong Kong, 2001. PARTICIPANTS: 169 fourth year medical students. MAIN OUTCOME MEASURES: Factor and individual item scores from a validated questionnaire on five key self reported measures: personal application and current use of evidence based medicine; future use of evidence based medicine; use of evidence during and after clerking patients; frequency of discussing the role of evidence during teaching rounds; and self perceived confidence in clinical decision making. RESULTS: The handheld computer improved participants' educational experience with evidence based medicine the most, with significant improvements in all outcome scores. More modest improvements were found with the pocket card, whereas the control group showed no appreciable changes in any of the key outcomes. No significant deterioration was observed in the improvements even after withdrawal of the handheld computer during an eight week washout period, suggesting at least short term sustainability of effects. CONCLUSIONS: Rapid and convenient access to valid and relevant evidence on a portable computing device can improve learning in evidence based medicine, increase current and future use of evidence, and boost students' confidence in clinical decision making.

The Future

• Continuing integration of functions

• Increasing flash memory size

• Video capability more common

• Wireless capability more common

• PDAs integrated into residency teaching

The End