Prescriptions that are more legible, thus decreasing potential transcription errors at the pharmacy, can be written with PDAs. These prescriptions are printed directly on specialized paper in standard printers or via specialized printers. Another advantage of handheld prescription writing is that the software can check for availability of the medication on the health plan formulary.
Psychiatrists rely upon reference texts such as DSM-IV-TR or Kaplan and Saddock's Comprehensive Textbook of Psychiatry. Only a few reference texts for psychiatry are now available in electronic form for review on the PDA; see <www.handheldmed.com>, <www.pdamed.com>. Many people have taken electronic versions and ported the codes and criteria into a variety of formats. Good resources for Palm OS DSM-IV software are at PocketPsych <www.pocketpsych.com/Resources/dowloads.htm> and Memoware <www.memoware.com>.
Patient tracking can be done on the PDA using the To-Do feature or specific software. Although many programs exist, even for mental health purposes, organization of patient care information is a matter of preference. Some programs have integrated features such as charge capture and coding.
Use of the PDA must take into account security measures due to its portability, especially in light of sensitive mental health information. The Health Information Portability and Accountability Act (HIPAA) of 1996 was developed to improve the efficiency and effectiveness of electronic information. It mandates that all providers who conduct electronic billing directly or via clearinghouses implement security in these transactions to maintain the privacy of an individual's medical record. Information in electronic form on the PDA is quite vulnerable to theft. Although HIPAA does not specify the security mechanism to be used, the best mechanism for security on the PDA is to use encryption software (Brown, 2002).
As briefly outlined here, the PDA has many capabilities that make it an attractive information tool in the practice of medicine. Hardware peripherals, such as the ActiveECG <www.activecenter.com> for monitoring electrocardiograms, add amazing but real capabilities to these powerful devices. Most of the software mentioned is focused on the individual PDA user. As PDAs have gained popularity, an emerging trend has been for manufacturers and software developers to focus on enterprise level capability. Companies such as Oracle and Sybase have developed PDA clients to allow access in real time to main databases. With time, there will be more integration and seamless exchange of information across various computing platforms and health systems.
The PDAs are not replacements for desktop and notebook computers but should be considered in terms of how they extend desktop computing capabilities. Mobility is a clear strength, keeping in mind the drawback of limited memory and small screen size. There needs to be seamless and effortless integration of information flow with desktop and mainframe computers as part of the pervasive computing presence. Technology should adapt to fit physicians' work needs instead of physicians adapting to new technology. In this manner, the future will be in the palm of our hands (Briggs, 2002).