141 TELEMEDICINE JOURNAL AND e-HEALTH Volume 9, Number 2, 2003 © Mary Ann Liebert, Inc. The PDA as a Portal to Knowledge Sources in a Wireless Setting PAUL FONTELO, M.D., M.P.H., 1 MICHAEL ACKERMAN, Ph.D., 1 GEORGE KIM, M.D., 2 and CRAIG LOCATIS, Ph.D. 1 ABSTRACT Two recent parallel developments, the widespread deployment of wireless networks and in- creased use of handheld devices like the personal digital assistant (PDA), have contributed to the development of mobile access to the Internet. Recent surveys show that approximately 25% or more of physicians use PDAs. Although used mainly for personal information man- agement and static medical applications, PDAs have capabilities to connect to the Internet. We studied the use of handheld devices to access MEDLINE and other knowledge sources in a wireless setting. 1 Office of High Performance Computing and Communications and, 2 Cognitive Science Branch, Lister Hill National Center for Biomedical Communications National Library of Medicine, Bethesda, Maryland. INTRODUCTION H EALTHCARE PRACTITIONERS in the 21st century face an unprecedented growth of medical information. Currently, MEDLINE contains over 11 million citations, with some 35,000 citations more added every month, in- cluding bibliographic citations and author ab- stracts from more than 4300 biomedical jour- nals published in the United States and 70 other countries. Disease diagnosis and patient man- agement have evolved rapidly, brought about by information discovered through molecular biology and the decoding of the human ge- nome. New therapies, including specific dis- ease-targeted drugs, are being developed rapidly based on cellular and molecular dis- coveries from these new technologies. The practice of medicine is becoming more complex. The physician needs resources to ac- cess knowledge repositories at the point of care and need. Sackett and Straus 1 have shown that allowing doctors easy access to evidence-based resources while making rounds increased the extent to which evidence was sought and in- corporated into patient care decisions. Two recent developments may help the clinician to access essential information at the point-of-need: handheld devices such as per- sonal digital assistants (PDAs) and the in- creasing ability to connect to the Internet through wireless networks. These enabling technologies may have a positive impact on the mobile healthcare worker’s ability to access electronic healthcare data and resources, and the practice of telemedicine. PDA ownership among physicians is high. A Forrester Technographics Benchmark 2001 Sur- vey 2 showed that 25% of physicians owned a PDA, whereas only 4% of nonphysicians did. The American Medical Association (AMA) reported 3 that in 23% of physician practices someone in the office used a handheld device. Most used the devices for personal or office in-