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April 4, 2001

Grassroots Computing: Palmtops in Health Care

Author Affiliations

Not Available

Not Available

JAMA. 2001;285(13):1768. doi:10.1001/jama.285.13.1768-JMS0404-6-1

Palmtop computers first arrived on the market nearly 10 years ago. However, it was not until the last few years that they started to be widely used. A combination of technological advances, improved form, and diverse applications has led to a 169% increase in sales from 1999 to 2000.1 Originally designed as personal organizers—a replacement for bulky and inefficient day-planners—these pocket-sized devices are quite versatile and can support a wide variety of functions. From medical references, to prescription writing, to electronic medical records, palmtop computers may be key to the ever-elusive adoption of health care information technology by physicians.

In the past, most information technology in health care was imposed on physicians by the institution in which they practiced. This often led to an "us vs them" mentality that has severely hampered physician adoption of new technology. In contrast, palmtop computers have been brought into health care by physicians looking to improve their productivity. This grassroots movement towards a new technology is unprecedented in health care.

When personal computers (PCs) were first made available to the general public, they were shunned by large enterprises, including health care institutions. The enterprises were already entrenched in mainframe-based computing, and personal computers were not seen as suited for the workplace. However, as PCs became more and more popular with individual users, large enterprises had to adapt; networking technology was created to connect individuals' computers and to allow them to access server applications. Despite these developments, PCs were never as widely adopted in health care as they were in other industries. Since physicians do not often practice at their desks, large, immobile desktop PCs did not fit into the physician workflow.

The adoption of palmtop computing in health care is in many ways analogous to the adoption of PCs in other industries in the 1980s. In contrast to the PC revolution, nearly 15% of physicians are already using palmtop computers.2 While most of these individuals are still using their devices for simple organizational tasks, many are beginning to investigate how to use the devices to improve their professional productivity. Small group practices and departments within large health care institutions have even started purchasing devices for all of their members.3

There are many reasons palmtop computers have had a larger grassroots movement driving them into health care than other technologies. The first is mobility. For physicians used to wearing white coats filled with reference books, index cards, and hundreds of scraps of paper as their ad hoc mobile filing system, the promise of 1 pocket-sized device that could simplify and organize all of their clinical responsibilities is invaluable. The second is cost. Most palmtop devices, equipped with all necessary software, cost well under $500. This puts them within the price range for the traditional early adopters of technology—young physicians and physicians-in-training—and has further facilitated the rapid growth of the palmtop movement. Third is the large breadth of applications available. Individuals can download current reference information that is automatically updated to their devices at no additional cost. Furthermore, there are hundreds of niche applications that can be used to solve specific clinical problems.

However, the biggest hurdle for adoption of palmtop devices by individuals and enterprises alike is the ability to connect them directly to clinical information systems. As was the case with PCs, the technology that most significantly impacted their adoption and functionality was networking—the ability to connect to local intranet and global Internet resources. For mobile, disconnected devices, the analogous technology to networking is synchronization—updating new information from the palmtop to the existing information system, and sending new information from the existing information system to the palmtop. Palmtop computers will only reach their true potential when they can connect to any and all clinical information systems the physician uses. For example, while in the clinic, the palmtop must connect to the physician's practice management system to check patient information and record visits. While at the hospital, the device must connect to the hospital's information systems to obtain lab results or enter orders. Institutions and companies are now addressing the technical challenge of connecting to these disparate systems.

Palmtop computing promises to help finally realize the benefits that health care information technology has been promising for years. Physicians will be able to perform all of their information management responsibilities from individual palmtop devices that are with them at all times. From prescribing medications and checking formulary restrictions, to ordering labs and viewing test results, physicians will soon be able to interact with both personal and professional information and improve their productivity, their income, and ultimately, their patients' care.

Financial Disclosure: Dr Shah owns stock in PatientKeeper Inc, a company that develops palmtop medical applications.
Not Available, PDA Sales Soar in 2000. Available at http://cnnfn.cnn.com/2001/01/26/technology/handheld/index.htm. Accessed January 27, 2001.
Fisher  JWang  R The cure is in hand.  WR Hambrecht & Co. San Francisco, Calif October 192000;Report available at http://www.wrhambrecht.com/research/coverage/ehealth/ir/ir20001019.pdf. Accessed February 8, 2001
Wake Forest School of Medicine Academic Computing Department, Not Available Available at http://www.wfubmc.edu/academic_computing/ACAbout.htm. Accessed February 8, 2001.