Managed Care

Hand-Held Devices Take Hold

Joyce Ochs, MBA

It appears that physicians are joining other professionals who find the ubiquitous PDA (personal digital assistant) to be indispensable. Data from Manhattan Research, a health care and life sciences marketing information and services company, illustrate that about 35 percent of practicing physicians are actively using a Palm, another device that uses the Palm operating system, or a Windows Pocket PC.

Mark Bard, president of Manhattan Research, says that adoption of new technology is slow at first. "It may take two to three years to reach 20 percent to 40 percent market penetration." However, after the early-adoption phase, the change from 40 percent to 80 percent penetration is "relatively fast."

Critical threshold

According to his company's data, physicians' use of PDAs is reaching a critical threshold, and the early adoption phase is nearing its end. The next year or so should see a widespread use of PDAs along with more applications targeted at clinicians, and a drop in prices.

Like most people, physicians use PDAs for personal scheduling, and about two-thirds use it for professional scheduling. Physicians who use PDAs for practice-related tasks can be divided into two groups, says Bard.

The first group, which includes 60 percent to 80 percent of doctors with PDAs, uses what he terms "static content access," where they look up information. An example is a drug reference or a health plan's formulary. Between 10 percent and 20 percent use PDAs for transactions or interactive communications, such as prescribing, viewing electronic medical records, or using the Internet.

Some of the barriers that deter physicians from integrating PDAs into their practice as communication devices are:

Lack of infrastructure — For a physician to use a PDA for electronic prescribing, electronic medical records, or electronic lab orders, pharmacies must be able to receive electronic prescriptions, medical records must be electronic, and laboratories must be able to receive test orders and send results electronically. This is rarely the case today, and until this infrastructure is in place, these nifty applications will gather dust.

Lack of office networks — Wireless access beyond the hand-held device requires networks. Many physicians cannot see how the benefits of a PDA justify the cost of building an office network.

Lack of connectivity standards — While there is a standardized vocabulary for medical care in regard to administrative connectivity (e.g., medical record coding), there is none for clinical connectivity. Until one develops, physicians may be hesitant to use clinical applications.

Device shortcomings — In general, battery life is not long enough for wireless PDAs with Internet access. For steady use, battery life must be at least 10 to 12 hours, or three times what it is today. Also, PDA screens are not ideal for medical imaging. Finally, many physicians would like to have a keyboard for entering information, yet they want the PDA to fit in their hands.

Price — The high-end PDAs with Internet access and connectivity cost more than many physicians are willing to pay, especially if medical care applications are limited. However, prices should drop as PDA adoption by physicians reaches a critical mass.

As this market has grown, it has become clear that health plans and pharmacy benefit managers have an economic stake in PDA use by physicians. The savings brought by increased formulary compliance are motivating them to invest in e-prescribing projects, help build the necessary infrastructure, and underwrite or defray the cost of PDAs for clinicians.

A smart phone instead of a PDA?

Just as PDAs are starting to take hold among physicians, along comes the smart phone, which could make the physician's PDA obsolete. A smart phone is a cell phone and a PDA combined into one device. It has computer memory and a screen and has wireless access to the Internet.

Medix Resources, a supplier of Internet-based transaction software for physicians and health care organizations, has formed an alliance with the company that makes the Blackberry Wireless Handheld to use its wireless technology. Medix software runs on PDAs, and its alliance with Research in Motion (RIM) and PocketScript (which is being acquired by Medix) will put secure electronic prescribing capabilities on RIM's Blackberry device.

However, Darryl Cohen, president and CEO of Medix, is really excited about its smart phone, which is being launched this month. In addition to providing a reference guide and showing accurate formulary, the Medix Smart Phone will enable a physician to send electronic prescriptions to a pharmacy and send lab orders and receive test results in real time. Since the Medix Smart Phone includes voice recognition, a user can initiate transactions orally.

According to Cohen, the Medix smart phone would not only replace a physician's regular cell phone, but it would eliminate the need for a PDA and a pager. It can be used to dictate medical notes for transcription. Furthermore, some phones have a walkie-talkie feature with a nationwide range, so physicians can reach each other easily .

No network concerns

With the Blackberry wireless technology, smart phone users will not have to worry about networks. Their phones will work wherever their mobile phone company provides coverage. Cohen expects that physicians will choose a smart phone from a wireless company that provides service in their local geographic area.

"The order of magnitude for installation of the Medix systems goes from 100 to 0, compared to a networked system," says Cohen. Medix will send a local technical representative to help new users extract data from their practice management system and send it to the Medix computer servers.

This is a one-time operation. Then the Medix software applications will be transmitted to the physician's smart phone. "There is little training involved," adds Cohen. "We have tutorials and will probably have the local rep demonstrate all the features."

Medix is working with four large pharmacy benefit managers to distribute smart phones. Their targets are the high-volume prescribers. "We are working on incentives that allow health plans to distribute our product at little or no cost to the physicians," says Cohen. However, physicians will be responsible for the ongoing monthly fees, which will replace their current cell phone charges.

The wireless revolution is under way. I am not willing to guess which one — PDA or smart phone — will prevail. In fact, it might not be either. Whatever it is, we do know it won't have a cord.

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