Mobile Medical Sources: Medical Information Anytime and Anywhere

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October 16, 2006
John Luo, MD

Assistant Clinical Professor, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles

On the Internet, medical information is one of the most frequently searched terms by consumers.¹ Medical professionals have also turned to the Internet for access and delivery of information at various sources such as Pubmed.² In the 1990s, information on the Internet had been primarily text based; however, with increasing availability of high-speed Internet via DSL and cable modem as well as faster and more powerful computers at lower cost, information on the Internet has become more multi-media based with video and audio. In a parallel development, mobile phone technology has also progressed with faster networks and more capable and smaller devices that can even handle multimedia. Mobile devices such as personal digital assistants (PDAs), ultramobile personal computers, and handheld computers have also seen growth in terms of higher memory capacities and methods of connectivity. For the healthcare provider, these options are wonderful new tools to access information, but they also create a conundrum to decide which options are best. This article reviews the capabilities of these various devices and methods of information access to help healthcare practitioners decide what fits in their needs and budget today as well as in the near future.

Mobile Devices

In 1996, Palm Computing³ launched their first product, the Palm Pilot.⁴ Although Apple Computer⁵ had entered the handheld computer market years earlier in 1993 with the Apple Newton, the Palm Pilot was a major success due to its smaller size, faster learning curve to adoption, ease of text entry, and synchronization with the personal computer. Since then, the Palm operating system (OS) PDA market has seen various manufacturers such as Sony, IBM, and Handera come and go, leaving Palm as the sole vendor today. Much of this shift has been due to market share erosion secondary to the increasing numbers of manufacturers including Dell and Hewlett-Packard who developed devices on the Windows Mobile OS,⁶ which was initially called the Pocket PC OS. Windows Mobile devices became more popular as their initially higher costs were reduced and matched Palm devices and their memory capacities and capabilities began to surpass their Palm counterparts.

In the last several years, there has been a convergence of these devices with mobile phones. The Palm Treo is an extremely popular device that offers mobile phone service, limited Internet access, and compatibility with various Palm OS software. Devices such as the Blackberry⁷ have recently become popular due to their ability to provide e-mail access and serve as a mobile phone. Many cellular phone manufacturers are also beginning to provide e-mail access and web browsing capability in their phones along with higher quality cameras. In order to determine which of these devices is best for the mobile healthcare provider, it is important to understand the differences between their features.

Information Portability

The PDA, whether based on the Windows Mobile or Palm OS has been the device of choice for many mobile healthcare professionals in recent years. One of the primary reasons why, is the availability of medication database programs such as Epocrates⁸ and Lexi-Drugs.⁹ These programs offer a wide variety of information such as medication dosage, indication, side effects, contraindications, formulary availability, pregnancy category, route of metabolism, and cost. Most significantly, these programs will check for drug-drug and dietary interaction to help the healthcare practitioner make appropriate medication choices. There are many medical texts available for the PDA, such as the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, and the Psychopharmacology Guide both from the American Psychiatric Publishing, Inc.¹⁰ These titles and many others are available as a subscription from Skyscape,¹¹ a company well known for its technology to bring many electronic titles to the PDA platform. One of the challenges with smaller screens, such as those on PDAs, is how to reformat information to be legible as well as easily searchable. Skyscape is well designed with navigation links as well as the ability to have specific terms hyperlinked to other Skyscape titles on the PDA.

Unbound Medicine¹² is another provider of both titles as well as a technology platform for content creation and information delivery. MedHand International’s Dr. Companion¹³ provides a large number of mobile medical titles on secure digital cards. Their product differs from Skyscape and Unbound Medicine in that the medical content resides primarily on the card, which saves space in the main memory. Dr. Companion is currently available in Sweden and England but will be available soon in the United States.

A number of familiar sources, such as the Merck Manual¹⁴ and the Physicians Desk Reference (PDR)¹⁵, are available for free. The advantage to signing up for a Merck Medicus account is that, in addition to having the Mobile Merck Medicus installed on the PDA, the online account offers access to Harrison’s Online, MD Consult, DXplain—a diagnostic decision support program, Cecil Textbook of Medicine, Mosby’s Drug Consult, among many other textbooks offered by W.B. Saunders, a medical text publisher. The electronic PDR provides a PDA based International Classification of Diseases, Ninth Edition, program as well as serving as a portal for drug news and alerts and offering Stedman’s Medical Dictionary and patient education materials. The National Heart, Lung, and Blood Institute¹⁶ offers a number of PDA-based tools such as a body mass index calculator, Clinical Guidelines on Overweight and Obesity in Adults, and the Adult Treatment Panel III Cholesterol Management Guidelines. Epocrates offers a number of medical tools, including a depression assessment tool that works in conjunction with their main product, MedTools.¹⁷

Many of these PDA programs offer content updates via the Internet, either directly via WiFi of indirectly by synchronizing through an Internet-connected computer. After this synchronization, Epocrates issues “DocAlerts”—messages about Food and Drug Administration warnings or highlights of articles of interest. The viewer can choose to receive a more detailed e-mail message, which will be sent after the next synchronization. The Mobile Merck Medicus and PDR also offer a similar feature, with brief summaries of journal articles and medical news. Avantgo,¹⁸ a well-known mobile content provider, offers many medical “channels” of content such as Medscape Mobile and TheAnswerPage, which have peer-reviewed questions and answers in various specialties. The advantage of having Avantgo on a PDA is that many online travel planning systems can create an itinerary for download to your Avantgo account. In addition to Avantgo, Highwire Press¹⁹ and JournalToGo²⁰ also offer the table of contents of various journals for review.

Journal articles are often available in an online version as well as in the Adobe Portable Document Format (PDF).²¹ PDFs can be viewed on the PDA with the appropriate Adobe Reader for the device OS but the PDF must be converted for the PDA screen. The conversion software and PDF reader for both Palm and Windows Mobile OS are available at no cost on the Adobe Web site. In general, documents without columns are easily converted for reading on a handheld, but those with multiple columns and sidebar topics may be difficult to read.

If a Web site does not offer a method to download the information, the site content can be captured for offline viewing on the PDA. Any Web site or document that can be printed can be converted into a PDF via the Adobe Acrobat program. Alternatively, PDFcreator²² and PrimoPDF²³ are two programs that also create PDFs via virtual PDF printers, but are available at no cost. Although the PDF is almost a standard on the web, there are other products that are similar. Cerience Repligo,²⁴ iSilo,²⁵ and Plucker²⁶ are alternatives to the PDF. Repligo has the advantage of making content available on Blackberry, Nokia phones, Microsoft Smartphones, and Symbian-based phones. Isilo creates hyperlinks to other documents and captures several levels deeper on a Web site. There are a number of iSilo medical documents already converted and available on the Web at such sites such as Memoware.²⁷ Plucker offers the advantage of reading e-books such as those available at Netlibrary.com.²⁸

Direct Access

Many of today’s multi-media capable mobile phones and combination PDA-phone devices are capable of directly connecting to information on the Internet. In general, these devices use the Wireless Application Protocol to access this information, which makes delivery of content available over the generally slower connection speed. Unfortunately, the legibility and access to various Web sites depends upon the device memory, graphics processor, Web browser capability, and ability to utilize Java and other scripts. Mobileleap²⁹ and Sweezer³⁰ are Web site proxies which attempt to detect device type, reformat Web sites by compressing data, filter out unsupported content, and fit the pages onto the device screen. Although accessing information on the go is a tremendous benefit, it is important to keep in mind that depending on the service plan, the cellular provider may be charging extra per megabyte of data transfer.

A few sites actively support browsing by devices by keeping their graphics to a minimum as well as avoiding complex HTML code. The National Library of Medicine has created a Pubmed for handhelds³¹ and Medline Databases on Tap³² to provide access to handheld devices connecting remotely. Merck Medicus¹⁴ recognizes the handheld or mobile phone browser and adjusts content delivery accordingly. Unboundmedicine³³ offers its own interface to Medline, which offers both articles organized by clinical focus as well as article browsing by topic.

An alternative to using the small screen on a Blackberry or Treo is to use the handheld device as a modem. PDANet³⁴ allows the Palm Treo to serve as an intermediary for a notebook computer to access the Internet. A Blackberry can serve as a tethered modem without use of software,³⁵ but this is only supported by Code Division Multiple Access carriers, not Global System for Mobile (GSM) communication based. For Blackberry users who have GSM carriers, MobiShark³⁶ helps bridge this gap. Otherwise, notebook users who are not within reach of a wireless Internet “hotspot” will need to use a “PC card” to provide Internet data access via the cellular network.

Multimedia

In addition to the text-based information, there is a growing number of audio and video medical education files. The iPod³⁷ has become an increasingly popular device for both recreational and professional use. Audio files in the compressed format known as MP3 are available from MedicineNet,³⁸ McGrawHill,³⁹ and iTunes,⁴⁰ with shows geared towards the public as well as professionals. The National Institutes of Health⁴¹ offers videocasting of various topics to be viewed on both the computer and handheld video/audio devices.

Conclusion

There is a dizzying array of products and services to bring access and delivery of medical information, whether it is portable or on demand. The variety of mobile medical sources is tremendous and varied, which makes it difficult to find the one best option. Especially with the high turnover of mobile phones and handheld devices, and newer ones on the horizon, it can be anxiety provoking to decide to make a commitment to a device or connection service. However, once “plugged in” to information anytime and anywhere, it may be difficult to disconnect.

References

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