A survey of personal digital assistant use in a sample of New Zealand doctors

Personal digital assistants (PDAs), also known as smartphones, are hand-held computers which can perform a wide variety of functions including access to the internet, scheduler, task list, phone-book, reference storage, camera, and telephone. In the health sector, PDAs have been used by doctors for over a decade to store clinical data, medication databases, access and store patient information and provide communication between other health providers with more applications growing by the year.PDAs are particularly useful for hospital doctors who often work in several different sites in their hospital or multiple hospitalswards, office, clinic rooms, procedural suite, and operating theatre. The mobility of the current workforce presents a challenge for DHBs to provide a familiar information technology (IT) working environment across multiple locations. PDAs have a part to play in addressing this.For junior doctors, white coats with large pockets previously contained their medical reference texts: drug references, local medical guidelines, local preferred medicines lists and medical references such as the Oxford Handbook of Clinical Medicine.1 Now all these can be accessed via a PDA, with room to spare.The past few years have seen considerable change in the handheld computing device area, and doctors use of these devices. Up until January 2007 the PDA-smartphone market had three dominant operating systems (OS)Palm 00ae OS, Windows 00ae Mobile (formerly Pocket PC), and Blackberry 00ae. In 2007, Apple released the iPhone 2122 and iOS (the OS used on the iPhone 2122), which has garnered strong sales. Also in 2007 the Android OS was unveiled. Palm 00ae released a new OS called WebOS 2122 mid-2009, and more recently Microsoft 00ae has released Windows 00ae Phone 7.As well as changes in software, hardware has also changed substantially. Technological advances have occurred in each component that makes up a PDA, to give an overall improved user experience compared with previous. New or improved software and hardware features are allowing new applications in medical practice.Methods Relevant literature2-5 on PDA usage and attitudes to usage was reviewed. Most data was from North America. Questions for the current survey were designed taking into account previous surveys, to allow a degree of comparison. The survey questions were entered onto an online survey tool - SurveyMonkey 2122 (www.surveymonkey.com). Contact was made with all DHBs in New Zealand, requesting distribution of an email containing a hyperlink to the survey to all hospital based doctors in their DHB. The email contained introductory information about the survey, for both communication managers and doctors. The survey was conducted during the period 27 June 2010 to 10 September 2010. Results were downloaded from SurveyMonkey 2122, compiled, and analysis performed. Results There were 850 responses to the survey. Demographics of the respondents are shown in Table 1. According to Medical Council of New Zealand (MCNZ) data6 there were 6668 doctors who listed themselves as junior medical staff (medical officers, house surgeons, registrars) or specialists/consultants in 2008. Characteristics of respondents Age and gender63% of respondents were male, 37% female. The mean age range was 36-45 years. Main work role51% were consultants, 45% either house surgeons or registrars. Other roles were medical officer special scale (MOSS; 3%) and other (1%). Main work type is shown in Table 1. Table 1. Main work type Internal medicine Surgery - all Anaesthesia Paediatrics Psychiatry Emergency medicine Radiology Intensive care Pathology Other or unspecified 227(27%) 149(18%) 86(10%) 82(10%) 75(9%) 57(7%) 36(4%) 20(2%) 16(2%) 102(12%) Total 850 Primary employer88% of those that completed the survey had their primary employer as a public hospital. The remainder worked in a government department or agency (6%), private practice (3%), university or polytechnic (2%), or other/unspecified (1%). See Table 2. Table 2. District health boards (DHBs) respondents mainly employed in DHB Responses Response rate as a proportion of non GP doctors working in DHB in 2008 (MCNZ statistics6) Auckland Bay of Plenty Canterbury Capital and Coast Counties Manukau Hawkes Bay Hutt Lakes Mid-Central Nelson Marlborough Northland Otago (Southern) South Canterbury Tairawhiti Taranaki Waikato Wairarapa Waitamata West Coast Whanganui Other or unspecified 205 29 125 24 89 37 32 18 31 39 17 53 12 11 1 14 0 91 4 5 13 12% 11% 14% 3% 20% 18% 21% 13% 13% 24% 9% 13% 21% 19% 1% 2% 0% 20% 19% 8% Total 850 Average response rate 15%. PDA usage Total51% (440/850) used a PDA or a mobile phone with PDA functions. Usage by gender59% of males and 38% of females used a PDA. Tables 3-5 show who uses them. Table 3. Usage by age Age ranges Usage 16-25 26-35 36-45 46-55 56-65 66-75 17/45 (38%) 153/295(52%) 127/233(55%) 103/185(56%) 35/79 (44%) 3/11 (27%) n=850. Table 4. Usage by main work role Main work role Usage House officer (including house surgeon, SHO) Registrar Medical officer (including MOSS) Consultant/specialist Other or unspecified 57/123 (46%) 123/251(49%) 14/30 (47%) 236/435(54%) 8/10 (80%) n=849 (1 skipped question); SHO=senior house officer; MOSS=medical officer special scale. Table 5. Usage by main work type Main work type Usage Radiology Anaesthesia Emergency medicine Internal medicine Paediatrics Intensive care medicine Surgery-all Psychiatry Pathology Other or unspecified 25/36 (69%) 54/86 (63%) 33/57 (58%) 119/227 (52%) 40/82 (49%) 9/20 (45%) 67/149 (45%) 29/75 (39%) 6/16 (38%) 45/79 (57%) n=827 (23 skipped question). Main DHB Usage varied by DHB, shown in Figure 1. Figure 1. Usage by DHB Whisker bars define 95% confidence interval. Only 1 response from Taranaki DHB - confidence interval not able to be calculated. Hardware In the 51% (440 users) who used a PDA, their hardware usage is outlined below. Table 5. PDA Operating Systems used by doctors Operating system Usage iOS (Apple 00ae) 49% Windows Mobile 00ae 23% Palm 00ae ( 2018old Palm 00ae OS) 10% Symbian 2122 (Nokia & others) 5% Blackberry 00ae 4% Android (\"Google 2122 phone\") 3% WebOS 2122 ( 2018new Palm 00ae OS) 1% Other or not sure 6% Of 440 users. Touch screen, camera87% of PDAs had a touch screen, 84% had a camera. Frequency of useOver 90% of PDA users used their PDA once a day or more Syncing (syncing or synchronising is the process of exchanging information with a host computer)33% synced once a day or more often. 36% synced once per week. 8% never synced. PDA reliability86% of respondents either never or seldom had their PDA or Phone/PDA 2018crash or become unusable (apart from flat batteries). About 5% had their PDA crash often or very often. Newer operating systems performed better than older ones. Security26% (115 respondents of 440) had patient related data on their PDA, and 4% didnt comment. Of those who had patient data on their PDA, 31% didnt have any password protection for that data. This 31% was comprised of those that realised they should protect the data (19%) and those that didnt know how (1%), didnt want to or found it too much trouble (1%), or said the data didnt need to be secured (1%). Respondents used a variety of encryption or password protection methods. Software usage The figures below show software usage in users of PDAs. Figure 2. Usage of organiser, document management and reference software in PDA users Figure 3. Usage of Education, Multimedia, Patient tracking and other software in PDA users Figure 4. Overall impressions for current users of PDAs Figure 5. Problems with use for current users of PDAs Non-users of PDAs 49% (410) of survey respondents didnt use a PDA, 35% of those that did not currently use a PDA had used one in the past. Barriers to use among non-users (multiple answers were allowed). See Table 6 below. Table 6. Barriers to PDA use identified by non-users or previous users of PDAs Reason Responses Too expensive Lack of integration and institutional supports Difficult to carry around, or too big PDAs function is performed by other hardware (e.g. PCs) or methods Data entry problems (clumsy/slow) I prefer manual method/paper No training available Screen size or buttons too small or fiddly No local expert or help desk Short battery life Applications or functions are unnecessary Difficult user interface I dont want to become too dependant on a PDA The PDA is too easy to break Not reliable enough The PDAs function is performed by other personnel I have tried PDAs before and it didnt agree with me Other 44% 39% 28% 28% 22%