Mobile data could help medicine

Personal digital assistants (PDAs) and other mobile devices offer an ideal way for healthcare staff to access medical information when they are away from computer terminals. Despite this, the use of PDAs to access reference texts and drug information is still relatively low.

In the UK, for example, a few hospitals and NHS trusts are piloting the use of hand-held devices linked via wireless networks to the main hospital IT network. However, these initiatives are still limited in scale and the emphasis is often on management issues, such as work scheduling, or patient records. The use of PDAs to access external information at the point of care is very low.

More extensive research on the use of PDAs in healthcare has been undertaken in the USA. PDA penetration is higher there but use is still 'rudimentary' according to a recent study by De Groote and Doranski¹. They note that 'health sciences PDA literature shows that while PDAs are popular, the ways in which they are used lack depth'.

In the USA, the use of PDAs by medical staff increased by 47 per cent between 2001 and 2002 and has grown steadily since then. The Taking the Pulse study published in October 2004 by Manhattan Research² found that 40 per cent of all US physicians use a PDA, compared with 35 per cent in 2003.

The study found that the top activities performed on a PDA by all US physicians (in order) are personal and professional scheduling, accessing a drugs reference database, accessing online information, writing clinical notes and mobile email access.

The Manhattan Research study also revealed that about half of the non-PDA users express some level of interest in future PDA use. That said, PDA adoption by US physicians is expected to experience limited growth until after 2006 although the use of PDAs to access drugs information is likely to show the strongest growth. Many physicians, particularly older ones, are sceptical about the benefits that these technologies will bring, while Manhattan adds that funding for implementing and maintaining relevant programmes has been scarce. Growth in PDA use is being driven by young, 'tech-savvy' physicians entering the market, and legislation mandating technology adoption in the healthcare sector.

The idea that young health professionals will drive the market in the next few years is echoed by the Mobile Healthcare Alliance in the USA³. This organisation has anecdotal evidence suggesting that up to 75 per cent of new physicians come out of medical schools using or expecting to use PDA/smart phone applications.

In the UK, the use of PDAs to access external content in the healthcare sector is still extremely low and mainly limited to a few isolated examples and pilot studies. At the end of 2004, IRN Research interviewed 20 information managers in NHS trusts and hospitals regarding the use of external medical databases by users in their organisations⁴. Only three interviewees (15 per cent) were working in institutions where PDA access to some external databases was available and, in two instances, this PDA access was part of a pilot study. Another 15 interviewees (75 per cent) stated that PDA access to external content was not a current option. The main reasons given were lack of funds or no technical infrastructure to adequately support PDA use across the organisation. The prohibitive extra cost of licences from vendors to support this access was also given as a reason. A point mentioned by a number of interviewees was the general lack of awareness amongst medical staff of the opportunities for digital access to reference books and textbooks. Time constraints for users and limited library staff resources were mentioned as obstacles to increasing this awareness.

Tackling the challenges
Both the US and UK research identifies factors to improve the use of PDAs for accessing external content. The first of these factors is improving the technology. More NHS trusts and hospitals in the UK are investing in local wireless networks and allowing the connection of mobile devices to hospital IT systems. Improvements to the PDAs themselves, such as better screens, longer battery lives, improved memories, and better connectivity for updates will also help.

Funding is also a big issue. The UK's NHS, for instance, is increasing its spending on IT systems. There have also been examples of content vendors and others sponsoring the use of PDAs amongst medical students and workers to encourage greater use.

Tackling user resistance is another challenge. Many experienced staff are happy to use traditional print content while, for others, technological drawbacks have eroded their confidence in using mobile devices. Concerns over the security and confidentiality of patient records have also had a negative impact. On the other hand, the younger generation of medical staff is expected to accept these devices as a matter of course. The Manhattan Research study suggests that more use should be made of such 'champions' in the healthcare sector who can spread the word within institutions and amongst colleagues of the value of PDAs.

Improved awareness of PDA content and greater user support will also help uptake. The study from De Groote and Doranski noted that many medical professionals were unaware of the potential uses of PDAs to support their work and added that librarians and information managers should provide support and training relating to the use of mobile devices for medical content. 'There is little evidence that librarians have taken advantage of the opportunity to provide PDA instruction and support,' according to the study.

A further incentive will be more PDA-friendly content. More vendors are likely to offer content suitable for mobile devices, particularly in the pharmaceuticals and medical reference areas. An article by Z.A. Chaudry⁵ provides a useful guide to the medical software already available for PDAs.

The final factor in improving PDA use will be spreading the word about the potential for reduced costs and errors. There is growing evidence that access to medical information at the point of care can reduce costs, improve accuracy in diagnosis and treatment, reduce errors, and optimise workflow5. Wider distribution of these findings should encourage more interest from hospital managers, as well as medical staff.

Despite the encouraging moves in these directions, one health information professional interviewed in the IRN survey suggested that it would be at least another two years before mobile devices become a regular access route to medical information for health professionals. Funding issues will continue to limit their penetration but the renewed investment in many hospital IT systems, and national programmes such as the move to electronic patient records, can only help. The influence and expertise of information staff in the healthcare sector will be crucial if widespread adoption of mobile devices is to be achieved.
David Mort is director of IRN Research, a UK-based market research and information company specialising in the analysis of European information and content markets. He can be contacted at: dmort@irn-research.com.

Further reading
¹ The use of personal digital assistants in the health sciences: results of a survey. Sandra L. De Groote, Marceline Doranski, Journal of the Medical Library Association, July 2004, pp341-349.
² Taking the Pulse, Manhattan Research, October 2004, www.manhattanresearch.com.
³ Mobile Healthcare Alliance, USA, www.mohca.org.
⁴ IRN Client Research, 2004, www.irn-research.com.
⁵ Personal Digital Assistants in Medicine: Critical Data in the Palm of your Hand. Zafar A. Chaudry, UK Health Informatics Today, No. 45, Winter 2004, pp4-6.