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    Handheld computing in pediatric practice: Is it for you?

    Handhelds, or personal digital assistants (PDAs), have evolved a great deal since their beginnings as a monochromatic screen with miniscule memory. Here is a look at how you, your practice, and your patients can benefit when you use a PDA.

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    Bryan R. Fine, MD, assisted in the preparation of the manuscript of this article.

    DR. STOCKWELL is an attending physician, pediatric critical care medicine at Children's National Medical Center, and assistant professor of pediatrics and critical care at The George Washington University School of Medicine, Washington, D.C. He is editor-in-chief of Pediatrics on Hand ( http://www.pediatricsonhand.com/), an information-only Web site for pediatric users of handheld devices, but otherwise has nothing to disclose in regard to affiliations with, or financial interests in, any product or program mentioned in this article.

    In the mid-1990s, handhelds were a fairly new technology, with few medical applications; only the most dedicated clinicians persevered to master and use one. Today, the use of handhelds and smartphones (a technology that combines a handheld and a cell phone) is consistently increasing in general as well as in medicine. According to the 2005 report of the Liaison Committee on Medical Education, 28% of US medical schools require that students use a handheld.1 Although physicians were reluctant to accept this technology in the early part of this decade,2 recent surveys have shown that more than 50% of physicians use a handheld or smartphone in their practice.3,4 (See the glossary of handheld terminology).

    What has changed? What is the utility of having PDA technology in your pocket? This article discusses relevant ways to benefit from using a PDA—namely, making your job easier, improving efficiency in the office, improving patients' experience of care, and keeping patients safer. It will also discuss the limitations of a handheld and offer recommendations for appropriate compliance with HIPAA regulations. I'll conclude with a look at what's possible for the future.

    Making the job easier

    Drug reference is far and away the most common medical application found on a clinician's handheld.5 Having the ability to reference medications instantly is a powerful tool. In a drug reference such as ePocrates (http:// http://www.epocrates.com/), dosage and forms of administration can be referenced and interactions with multiple medications can be checked; many drug reference programs have an integrated calculator for weight-based dosing. In addition, ePocrates recently added safety and monitoring sections that reflect black-box warnings issued by the US Food and Drug Administration.


    Table 1 A sampling of commercial medical references for the pediatric handheld
    The second most common medical applications are diagnostic and therapeutic references, followed by medical calculators. Several well known pediatric references, such as The Harriet Lane Handbook and the 5-Minute Pediatric Consult, are available on handhelds. Increasingly, publishers have improved the convenience and utility of these programs.

    Many novel pediatric references are available on handhelds to simplify and speed up appointments with patients. Numerous programs allow for checking guidelines (BiliTool, Kidometer, PediSuite and Breastfeed 1.1), calculating complicated medical equations (MedCalc & PediSuite), plotting growth charts (Growth Charts) and providing catch-up schedules for missed immunizations (Shots 2006) (see Tables 1 and 2). Checking age-based normal ranges is made easier by PDA programs as well (Kidometer & PediSuite).

    Few clinicians use a handheld for electronic prescribing or patient record-keeping. This may change, however, as the electronic medical record (EMR) is increasingly integrated into pediatric practice.


    Table 2 Helpful (and free!) medical references for the pediatric handheld
    Handhelds have had a positive impact on medical education, too. They have been shown to be an effective tool for nursing, medical student, and resident education.6-11 Having educational programs available on a handheld allows for point-of-care teaching and connects didactic learning to the patient in the examining room or hospital bed.

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