In order to keep up with the increasing base of medical knowledge, PAs must practice lifelong learning. Consider that the National Library of Medicine (NLM) added more than 670,000 new medical articles published in 20071 and the FDA approved 127 new drugs between 2000 and 2006.2 In addition, the Institute of Medicine (IOM) estimates that at least 1.5 million preventable adverse drug reactions occur in the United States each year. According to the IOM, prescription drugs, herbal treatments, and OTC medications are changing so rapidly that clinicians cannot keep up; they need accessible electronic information.3 To keep their certification, PAs must pass the National Commission on Certification of Physician Assistants (NCCPA) Recertification Examination every 6 years. Educational options include reading journals, textbooks, and review books; attending continuing medical education programs; consulting with colleagues; and doing individual medical information research.
PAs need access to information that is convenient, current, authoritative, and evidence-based. Printed textbooks usually require a year of processing, and their contents may be out dated by the time they are published. Colleagues may be behind in their medical knowledge base depending on how they keep up. The Internet provides electronic text that is continually updated, but not every patient care setting will have access. CME programs are costly to attend and take time away from practice. The ideal information tool should contain quick, portable, updated, authoritative content available in any clinical setting. Personal digital assistants (PDAs) are convenient reference tools that help clinicians keep up with new treatments, practice lifelong learning, reduce medical errors, and prepare for recertification examinations.4
Cell phones are now a part of daily life and reside on your belt clip or in your pocket for instant access. Cell phone/PDA combination devices, or smartphones, offer wireless Internet connectivity and increased digital storage capacity to allow users to carry the equivalent of 30 medical textbooks in their pocket. Some PDA products contain information that has been deemed by medical professionals to be based on the best evidence and make clinical recommendations at the bedside. With these products immediately accessible by PDA, PAs can do fast lookups in the time it takes to review the chart before seeing the patient, as the patient undresses for the physical examination, after the examination while the patient dresses, and when formulating the medical record notes and plan.
EQUIPMENT
Continuous lookups are possible only if the PDA resources are convenient and fast. A PDA in the pocket or on the belt offers this convenience, encouraging frequent lookups, updated practice habits, and continuous lifelong learning. The best PDA choice is the one you are willing to carry on your person wherever you go. Having a cell phone/PDA combination encourages use and increases the likelihood that it will be carried throughout the day. The cell phone offers Internet data connectivity anywhere there is cell service, a great advantage over requiring Wi-Fi accessibility. The ideal PDA device will operate as a cell phone and connect to Wi-Fi networks when they are available.
Several cell phone/PDA operating systems exist, including those for the Palm, Windows Mobile, RIM Blackberry, and Apple iPhone. The operating systems with the most medical applications were available through Palm and Windows Mobile, but Palm is moving to a new platform, leaving Windows Mobile as the best choice.5,6 Find the cell phone provider that best meets your needs; then review that provider's Windows Mobile smartphones to make your choice.
DAILY QUESTIONS
Evaluation of patients should generate clinical questions continually. What is the differential diagnosis for this chief complaint? What are the best diagnostic tests? What is the best therapy? Are there any possible adverse drug interactions with the medications or herbal supplements the patient is already taking? You may see an unfamiliar disease on the patient's problem list. What are the implications for the current complaint, how will it affect treatment of the disease, and vice versa? What ICD-9 diagnosis code should you put on the billing document? How much will the prescription cost the patient? Is the medication covered by the patient's insurance plan, or will he or she be charged full price because the drug is not on the formulary? The cell phone/PDA is the most convenient and fastest way to obtain the needed answers at the point of care. Ideally, the PDA program should be quick, easy to use, easy to keep updated, and reasonably priced. The content should be authoritative and current, and it should offer the most information for the broadest number of patients and diseases.
The three types of PDA references to consider using are integrated software, electronic textbooks, and Internet databases. Integrated software is a multifunction suite of applications within a single program that offers diagnostic and therapeutic information. There are several PDA electronic textbook editions of the major medical best-sellers. If you buy all your textbooks from the same company, there is some limited interlinking. Internet databases offer access to the NLM, online textbooks, and clinical guidelines. These require Internet access via a cell phone service or a Wi-Fi environment.