AAOS Bulletin - June, 2005

Are you ready for a smartphone?

Even PDA “holdouts” might be tempted by this popular new mobile computing device

By Carolyn Rogers

Quick: When you hear the acronym “PDA,” what phrase comes to mind first?

A: Public display of affection

B: Personal digital assistant

If you answered “A”—the lower- tech option—you’re not alone—for now. Although most doctors readily embrace new surgical technologies, many still hesitate when it comes to applying informational technology to the clinical setting.

As a group, however, U.S. doctors are nearly five times more likely than the general U.S. consumer to have a PDA or handheld computer such as a tablet PC, according to a recent American Medical Association/Forrester Research survey.

Fifty-seven percent of U.S. physicians now regularly use a PDA or handheld, according to the survey of 1,331 physicians conducted between August and December 2004.

How are they using them? Administrative and scheduling activities, primarily. Eighty percent of the PDA-using physicians use the devices to track appointments; 87 percent store contact information, and 65 percent check drug references.

When it comes to clinical tasks, however, the numbers aren’t as impressive. Just 7 percent of physician PDA owners use the device to send prescriptions electronically; 6 percent use them to access patient records; and 5 percent to view lab results.

Of the physicians whose practices have an electronic medical records system in place, only a third use their PDAs to chart directly into the application. However, 60 percent of physicians whose practices have implemented an electronic prescription system use their PDAs to enter their orders.

Smartphones: “The next hot item”

Although the percentage of physicians using PDAs has grown significantly over the past four years, that growth appears to have stalled in 2004, according to Manhattan Research LLC.

“I think that the market for PDAs—as they they’ve traditionally been defined—has reached a saturation point,” says Jay D. Mabrey, MD, chief of the department of orthopaedics at Baylor University Medical Center in Dallas, and past chair of the AAOS Electronic Media Education Committee. “Smartphones are the next hot item—a lot of people are moving to them.”

What’s a smartphone?

Smartphones are a new class of mobile computing devices that combine cell phone functionality with the personal organizer functions offered by PDAs. In addition, all of the information can be synchronized with the user’s personal computer.

Individual phones vary, but most smartphones allow you to:

• Make and receive phone calls

• Initiate, receive and respond to e-mail

• Schedule meetings

• Browse the Web

• Maintain contact information

• Access up-to-date reports

• Organize appointments

• Access patient records

• Prescribe electronically

• Order tests and receive lab results

• View Microsoft Office documents

• Send instant and text messages

Trade in your PDA, pager, cell phone

“There are three basic types of smartphones—Windows CE, Palm and BlackBerry,” Dr. Mabrey says. “They’re all reasonably equivalent, and all can access the Internet. However, the most important feature of a handheld is access to e-mail.”

Dr. Mabrey carries a BlackBerry 7100.

“It looks like a PDA, but it’s also my phone,” he says. “It does everything my PDA did, but it also syncs automatically with my Outlook calendar, my contacts and all of my e-mail, so I don’t have to carry a pager anymore. All incoming requests, even from my message service, are sent via e-mail, so I’m not answering the phone all the time. I can just look at the screen.”

When Dr. Mabrey used a PDA, the feature he accessed most was the drug index, he says. “But now that every nurses’ station has Web access, when I have a question about a drug I just type in the name on GoogleTM and I’ve got 50,000 sites that tell me about the drug, all ranked in order of importance.”

Smartphone users also have the option to access the Web directly, or even download a medical drug reference onto the device, if preferred.

Most smartphones are slightly smaller than regular PDAs.

“My BlackBerry weighs just over 4 oz., and it has a 1-1/2" x 1-3/4" full-color, high resolution LCD screen,” Dr. Mabrey says. “Almost everything works using a thumb wheel—you just move it up and down. The keyboard integrates a traditional phone keypad and a QWERTY-style keyboard with intuitive software that ‘learns’ as you type.”

E-mail/calendar synchronization

“I love the fact that my smartphone calendar syncs up automatically with the calendar on my administrative assistant’s desk,” he says. “She can change things around and add new appointments. Then when I scroll down to ‘calendar,’ it retrieves the absolute latest version and gives it to me right there.”

BlackBerry’s e-mail technology acts like an always-on Internet connection, automatically “pushing” your e-mail from your home e-mail account directly into your inbox without prompting.

“The BlackBerry smartphone does a tremendous job of accessing e-mail,” Dr. Mabry says. “It’s so smart that if I receive a message that reads “Call Dave at 204-555-1212,” I just scroll over the number and press a button. The system identifies it as a telephone number, and bang—it calls the number for me.”


Dr. Mabrey also appreciates the fact that his 7100 phone is enabled with Bluetooth—a very short-range wireless protocol.

“I’m able to use a wireless Bluetooth headset, so I’m not always holding the phone up to my ear,” he says. “My car is also Bluetooth-enabled, so when I get in the car it recognizes my Bluetooth phone, and my stereo immediately starts functioning as my telephone. When a call comes in, I just press a button on my steering wheel to pick it up. It’s very straightforward.”

Baylor docs love their BlackBerrys

“All of the administrators and physicians who are employed at Baylor University Medical Center have either a BlackBerry PDA or a BlackBerry smartphone,” Dr. Mabrey says.

Baylor’s server runs the whole system, he explains. “All the calendar appointments go through Outlook, so I get a notification if there’s a meeting I need to attend. Administratively, it’s quite a timesaver.”

The devices are so prevalent at Baylor that the hospital recently instituted a rule barring BlackBerry usage during meetings. “It was getting to the point where no one was paying any attention at the meetings—they were all answering each others’ e-mails,” he says.

In the future, Baylor intends to use the system for laboratory notification as well. “The lab computers will print out automatic notifications of adverse results, so if your patient has a very low hematocrit, you’re notified right away,” Dr. Mabrey says.

The system is especially beneficial for a larger organization, he adds. “I move all over the campus, so it makes sense to have this technology. Plus, I can be anywhere in the country and still answer my e-mail. When I’m on the road I just e-mail people instead of being on the phone all the time.”

What’s the price tag?

The price range for a smartphone varies depending on promotions and features offered; most devices run around $300 to $400, although some can cost more than $500, according to Dr. Mabrey.

As better technology emerges, the new devices and their enhanced functionality will appeal to physicians who don’t use PDAs in the office now, experts predict.

“When I got my smartphone, I immediately got rid of my PDA, my regular BlackBerry and my pager,” Dr. Mabrey says. “Smartphones may become a physician’s one and only necessary mode of communication.”

Smartphones currently on the market*


Audiovox SMT 5600 Smartphone

BlackBerry 7100g

BlackBerry 7290

PalmOne Treo 650

Siemens SX66


Samsung i500

PalmOne Treo 600

PalmOne Treo 650


Samsung SP-i600


BlackBerry 7100t

BlackBerry 6230

Sidekick II

BlackBerry 7230

BlackBerry 7730

PalmOne Treo 600

BlackBerry 7290

HP iPaq h6315

Verizon Wireless:

Blackberry 6750

PalmOne Treo 600 with and without camera

Blackberry 7750

BlackBerry 7250

Samsung i700 PocketPC

Samsung i600

Audiovox XV6600 with and without camera

Smartphones Not Sold by Carrier:

Sony Ericsson P910a

Nokia 9300 Communicator

*This list is not all inclusive of the smartphones currently available, nor does it imply an endorsement for any product

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