Always somewhat of a gadget hound, I bought a Palm Pilot, a personal digital assistant (PDA) that runs on the Palm operating system, back in medical school. I used it to take notes at the various grand rounds and conferences I attended, as well as to jot down the “pearls” from my various attending physicians during rounds. The technology was a bit clunky and not a very efficient way to input a large quantity of data. Then last year I bought a Compaq iPaq. I switched to Windows-based Pocket PC technology primarily because of the faster processors, bigger, brighter screens and much more memory capacity. I currently own a Hewlett-Packard Jornada 568 which, like all the new Pocket PCs from Casio, Toshiba, AudioVox, Compaq and NEC, features a 206MHz processor and 320 x 240 resolution screen (processor to be upgraded this summer in most models). My Jornada has a compact flash slot into which I popped in a 256MB card that I picked up off of the Internet for $70, leaving me with a 312MB machine.
My day starts with a quick synchronization of the Jornada with my home PC. Using Mazingo technology I get a download of some of my favorite essential reads off the Internet onto my PDA-AccuWeather, the New York Post and The Onion for my downtime. My e-mail also gets downloaded for me to review later in the day.
My morning in the hospital starts with a check-up on the stroke unit and any new patients admitted overnight. Occasionally a patient comes in with a disease I don’t remember the details about, such as meliodosis. I can take a quick look on my PDA using Skyscape’s 5MCC, the hand-held version of Griffith’s 5-Minute Clinical Consult. This handy application has details about the basics, diagnosis, treatment, medications, follow-up and miscellaneous data on a large number of diseases. When I go through patient charts, I check on drug-interactions and medications I don’t recognize on the newly released and free mobile PDR, the Physician’s Desk Reference for the Pocket PC published by Thomson Medical Economics. Sometimes I need more information on a drug and then look it up on DrDrugs, another Skyscape product with more complete monographs on each drug. One of our unit patients presents with mild weakness on the right side but with pre-existing dementia; I pull out my PDA and go through the mini mental status exam using free Pocket Stroke software, soon to be released by MedicalPocketPC. This enables me to quickly check off the patient’s responses and come up with a score indicating a significant level of dementia.
After rounds with the stroke team all morning, I head off to a noon lunch conference. There I meet one of our newly appointed faculty members. I would like his contact info, and he hasn’t had his business cards printed yet. He pulls out his Palm Vx and “beams” me his business card. Fortunately, with the new Pocket PC 2002 operating system, infrared beaming of contact info, databases and other files (though not applications) is built-in and seamless between Palms and Pocket PCs.
I then head off to my continuity clinic where once a week I see my own set of patients in an outpatient setting. Again, out comes the Jornada, this time with my Stowaway portable keyboard. I set up shop in no time and begin seeing my patients. I keep all my patient notes in my PDA. I have created a customized, secure database using HanDBase to track all my important patient information including demographics, diagnosis, examination and treatments. With the aid of the nearly full-sized keyboard, I’m able to quickly type in my findings. At the end of each visit, I run down the hall to the one laser printer in the department equipped with an infrared port. Using PrintPocketCE I beam my patient notes to the printer and provide these pages for inclusion in the patient charts. I’ve found that having access to my patients’ data in my PDA is useful when patients are admitted during off hours and clinic charts are unavailable.
Though it has been a long day already, I still have a half-hour waitt before grand rounds. I sink into an auditorium chair and begin answering my e-mail. Files from the inbox and outbox on my PDA synchronize automatically with Microsoft Outlook on my desktop computer at home for rapid transmission over the Internet. Answering several e-mail messages with short answers is easy with the natural handwriting recognition built into the Pocket PC operating system. For Palm users the Graffiti input system (upper case letters formed with a single stroke) and an on-screen keyboard are available and work with all software.
On my walk home I plug in headphones and listen to MP3s-digital audio files stored on my PDA-using the free Windows Media Player software bundled with my Pocket PC. With my medical software and patient data taking up less then 20MB of memory, I still have nearly 300MB available for music-equivalent to about five compact discs. On reaching my apartment I plant my Jornada into its cradle and let it, along with me, rest for the evening.
Nilay Shah, MD, is a senior resident in neurology at Mt. Sinai Medical Center in New York City. He is also a co-founder of MedicalPocketPC.com, a free Internet resource for healthcare professionals.