PDAs for Doctors

Know your needs, pick a device to fit

Bewildered by the plethora of models, features, and options? We take the "hard" out of hardware for you.

By Neil Chesanow, Northeast Editor

Personal digital assistants scan cost from $149 to more than $1,000, and they're available in many types and brands. But all share certain features. Among them:

• An operating system (OS).

• A display or viewing screen.

• Ways to get information into the device.

• Battery operation.

• A modem or the ability to accept one.

• An infrared transmitter.

• Software that lets you perform basic tasks—like keeping your schedule, address book, to-do list, and memos.

If you want to use a PDA to generate scripts electronically, you can simplify comparison-shopping by checking our descriptions of five prescribing systems (see "Your ticket to fast, flawless prescribing"). All offer a free PDA (although in one case, quantities are limited), and four give you a choice of models. If, however, you don't want a prescribing system, your options are far more extensive. To pick a PDA appropriate to your needs, here's what you need to know.

The operating system

PDAs are classified by their operating systems and their size. An OS interacts between the PDA's internal circuitry and software to ensure, among other things, that the hardware and software communicate with each other properly. Several PDA operating systems are available, but two dominate the market.

The Palm OS. Currently found on more than 88 percent of PDAs, this OS is featured on offerings from four companies: Palm (which devised the OS), Handspring (led by the team that started Palm), TRG, and Sony. The Palm OS comes in several versions, but all reflect Palm's philosophy of what a PDA should be: a small, simple, elegant, machine—one that's relatively inexpensive and easy to learn, with low memory requirements and long battery life.

The Windows CE OS. The other major PDA OS, designed by Microsoft, is called Windows CE or simply WinCE. The latest version has been dubbed Windows for Pocket PC. (To avoid confusion, we refer to all versions of Microsoft's OS as WinCE.) Designed to offer as many functions of a Microsoft Windows desktop PC as possible, it's a far more ambitious OS than Palm's, but it's also newer—and, some would say, not as polished. Compared with the Palm OS, WinCE is more powerful, feature-rich, and graphical, but also more complex and harder to learn. PDAs that use it are generally more expensive, with more memory requirements and shorter battery life.

Comparing PDAs

All PDAs fall into one of two groups: palm-size (meaning they fit in the palm of your hand, not necessarily that they're made by Palm) and handheld. Most palm-size PDAs have either the Palm OS or WinCE. Those with the latest version of WinCE are known as pocket PCs. PDAs with the Palm OS weigh only a few ounces. They're slightly larger than a deck of playing cards and, in some cases, about half as thick. Pocket PCs are a bit larger and heavier. As previously noted, a PDA can keep your schedule, address book, to-do list, and memos, but one of its most important uses to you as a physician is its ability to run medical software. Some valuable software for doctors runs only on the Palm OS, some only on WinCE, and some comes in versions for each.

You can't run software written for the Palm OS on a PDA with WinCE, and vice versa. And the number of medical software programs currently available for the Palm OS dwarfs that offered for WinCE, but many of these are specialty-specific drug references and calculation tools. For major programs geared toward primary care physicians, though, the PDA software gap isn't as huge. Many useful programs are available in both Palm and WinCE versions, or soon will be.

Another type of PDA is the handheld personal computer, or HPC. HPCs are larger than palm-size PDAs, ranging from checkbook-size to nearly the size of this magazine. They're also a bit thicker than palm-size PDAs, and they can be a good deal heavier. As the name implies, you can hold an HPC in your hand. Even the smaller models, however, aren't likely to fit comfortably into any pocket other than those on men's trousers or a lab coat; some, weighing nearly three pounds, aren't really pocket devices. As with pocket PCs, most HPCs run a version of the WinCE OS.

Why consider a larger-than-palm-size device? Some doctors consider an HPC easier to use because it features a larger display and built-in keyboard. More on those in a moment.

In focus groups on PDAs conducted with doctors at the State University of New York's Upstate Medical University, the devices' portability emerged as the single most important consideration, especially among female physicians. Women doctors often complained that HPCs didn't fit into the pockets typically found in women's clothing. Or if they did fit, they were in constant danger of slipping out.

Getting information into a PDA

All palm-size PDAs come with a penlike stylus and have touch-sensitive displays. One way to enter information is by using the stylus to print letters or numbers in a little box on the PDA screen, which special software then converts into text. In PDAs with the Palm OS, these characters must be printed in a particular style for the software to work. Some doctors master the style easily; for others, it's a hassle to learn. A palm-size WinCE device lets you print normally, but there's a trade-off: Character recognition by the PDA software is a bit less accurate. This means you may have to reprint a character for the software to recognize it more often than you would with a PDA that uses the Palm OS.

As an alternative to printing, you can tap the stylus on a palm-size PDA to display an electronic image of a keyboard. You then tap the stylus on the characters or numbers you want to enter.

Most PDA software programs also include dropdown lists of tasks, called pick lists, or other ways to make quick choices. Tap the stylus on an item on screen, and the software automatically performs the task you've selected. This is how prescribing software enables you to generate scripts quickly.

Like their palm-size counterparts, HPCs include a stylus and a touch-sensitive display. You use them to make choices presented by whatever software is on screen, but not to enter information by printing. Instead, you use a built-in keyboard, which, in most cases, is quite small. Still, some doctors find this method of information entry to be faster, easier, and more accurate than printing with a stylus or tapping on a virtual keyboard.

If you don't want a larger HPC but like the idea using a full-size keyboard, you can purchase one designed to work with your palm-size device. Portability suffers, though. One keyboard model collapses, accordion-style, but it still doesn't fit into a typical pocket.

Displays

Another feature that sets HPCs apart from their palm-size counterparts is the size and detail of their displays. Handheld displays are usually about 6.5 inches diagonally, while palm-size displays are roughly 3 to 4 inches diagonally.

Only one PDA with the Palm OS—the Palm IIIc—boasts a color display; the rest are grayscale, with black type on a green background. All pocket PCs and HPCs offer color displays. While the color display on the Palm IIIc and pocket PCs is quite good, those on handheld devices are brighter and feature clearer, more detailed images.

How important is color? Some medical and other software programs use color coding to make information easier to locate. One medical database reviewed here, for example, a version of 5-Minute Clinical Consult 2000 (see "Colleagues rate the leading software"), has topic headings in blue, basic information in red, and more detailed information in black. The program also lets you open several little windows on screen at once, and each window is color-coded to indicate the sort of information it contains.

And color is a plus if you use a PDA to surf the Internet. However, those with Palm OS display Web pages in text only, without graphics. Or you may want to download images onto your PDA, view family photos, or play a round of solitaire. It's harder to distinguish hearts from spades when all the cards are black!

PDAs with color displays are generally more costly, though, and they're a much larger drain on batteries. PDAs with grayscale displays can run for a month or more on alkaline batteries. Battery life of Pocket PCs with color screens averages just six to 14 hours.

Memory

When you log on to the Internet from your desktop PC or your PDA, you'll discover plenty of enticing PDA software that you can download—in some cases, for free. The more you want, the more memory, or storage capacity, you'll need.

As the table on page 85 shows, PDAs with the Palm OS come with far less memory—measured in megabytes, or MB—than pocket PCs and HPCs with WinCE. The gap, however, isn't as dramatic as it may appear. Less goes further in PDAs with the Palm OS, because it uses memory more efficiently than WinCE devices. In general, though, more software programs are usable simultaneously on a WinCE machine than on one with the Palm OS. If, for instance, you want a drug reference program, a diagnostic and treatment reference program, and a patient information management program available at once, so you can quickly switch back and forth between them, WinCE devices are best equipped for such multitasking.

Choose a PDA that lets you add memory. This way, you can increase storage capacity as needed. Some doctors we spoke with who use unexpandable PDAs with the Palm OS were running out of memory and thinking about purchasing another PDA with more flexible storage capability.

Connectivity

No PDA automatically communicates with your desktop computer, printer, or office computer network, or with the Internet. You have to connect it. Depending on the model, various means of connectivity are available.

Cradles. A cradle that connects via a cable to a port in the back of your desktop computer is included with all palm-size PDAs. Put the PDA in the cradle, press a button on the cradle base, and automatically synchronize your schedule and other information on the PDA with backup copies on the desktop PC. (To do this, third-party software may be required.) If, for example, you changed an address listing since the last time you synchronized data, the most recently updated version—whether on the desktop or the PDA—will overwrite the other one during synchronization.

Infrared capability. All PDAs include special ports that can beam information via infrared light waves to other PDAs with a compatible OS as well as to desktop PCs and printers equipped to accept infrared signals. (You may need third-party software here, too. Also, if your equipment doesn't have this capacity built in, you may be able to add it.) Infrared capability enables you to transfer data from one device to another more conveniently without having to use a cable connection. The infrared beam won't go through walls, and you need to be within one meter of the device you're transmitting to, with a clear sight line between the devices.

Modems. To connect your PDA to the Internet, you need a modem. All HPCs are equipped with a built-in conventional modem. For palm-size PDAs, a modem is usually a separate expense, but all have a slot or some other receptacle to accept one. Insert the modem into the PDA, plug one end of a modem cable into the modem jack, and plug the other end into an ordinary phone jack. You can then connect to the Internet.

Wireless modems are also available. The Palm VIIx and the Symbol SPT 1700 are the only PDAs with one built in, but other models may accept one that you can purchase separately. Increasingly, the PDAs offered with prescribing systems include a wireless modem. As the name implies, this type of modem requires no cord connections. It communicates with other compatible devices via radio waves. Unlike infrared light waves, radio waves can penetrate walls and are less distance-sensitive—a major convenience. If your desktop PC or printer can accept radio transmissions, you can use your PDA with a wireless modem to beam a script to it from another location, such as your exam room or office.

Not only can a wireless modem communicate with a desktop PC in your office, it can connect to the Internet from remote locations via a special satellite network. To do this, you must be in a locale serviced by the network—usually a major city. If you're a Denver resident visiting New York, for example, you can use your PDA equipped with a wireless modem to access the Internet from your Manhattan hotel room, in order to send or receive e-mail or surf the Web. If you're visiting East Podunk, however, forget it. Wherever you are, the Internet connection is currently quite slow. You pay a monthly fee to subscribe to the network.

Other connectivity options. The PDA slot into which you can insert a modem can also accept a variety of other peripheral devices in the form of special matchbook-size cards (circuit boards). One of them is an Ethernet card. This lets you use your PDA to access information from a common type of computer network. The network is usually in a single, properly wired building or complex, such as a group practice facility or a hospital. You must connect the card via a cable to a special phone jack in a wall. Or you can access the network with a wireless Ethernet or LAN (local area network) card to avoid the hassle of having to connect a cable.

Three types of PDAs

Personal digital assistants at a glance

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ALL PDAs, EXCEPT AS INDICATED:

R. Eugene Bailey, MD, and Jennifer K. Schultz, MS Ed, helped with the preparation of this article.

Neil Chesanow. PDAs for Doctors: Know your needs, pick a device to fit it.

Medical Economics

2000;20:81.