Abstract Laboratory specialists currently need to accessscientific-based information at anytime and anywhere. Aconsiderable period of time and too much effort arerequired to access this information through existing accu-mulated data. Personal digital assistants (PDA) are sup-posed to provide an effective solution with commercialsoftware for this problem. In this study, 11 commercialsoftware products (UpToDate, ePocrates, Inforetrive,Pepid, eMedicine, FIRST Consult, and 5 laboratory e-books released by Skyscape and/or Isilo) were selectedand the benefits of their use were evaluated by seven lab-oratory specialists. The assessment of the software wasperformed based on the number of the tests included, thesoftware content of detailed information for each test-likeprocess, method, interpretation of results, referenceranges, critical values, interferences, equations, patho-physiology, supplementary technical details such as sam-

ple collection principles, and additional information suchas linked references, evidence-based data, test cost, etc.In terms of technique, the following items are consid-ered: the amount of memory required to run the software,the graphical user interface, which is a user-friendlyinstrument, and the frequency of new and/or up-datereleases. There is still no perfect program, as we haveanticipated. Interpretation of laboratory results mayrequire software with an integrated program. However,methodological data are mostly not included in the soft-ware evaluated. It seems that these shortcomings will befixed in the near future, and PDAs and relevant medicalapplications will also become indispensable for all physi-cians including laboratory specialists in the field of train-ing/education and in patient care.

Keywords Personal digital assistants (PDA) · Medicalsoftware

Introduction

The abundance of information in biomedical sciences andits continuous change mean that it is impossible to keeptraditional information resources up to date. Most clini-cians use mobile devices for a variety of purposes, includ-ing accessing evidence-based guidelines, medical refer-ences, drug references, patient information and laborato-ry assessments. Personal Digital Assistants (PDAs) arethe most popular mobile devices among physicians [1–4].

PDAs, handheld computers, handheld PCs and pocketPCs are all terms that refer to similar devices with compa-rable capabilities. PDAs are compact, handheld comput-ers that literally fit into one’s palm or pocket [1, 3].

Health-care professionals and students must use theirknowledge, which is built on ever increasing and con-

Clin Exp Med (2008) 8:117–122DOI 10.1007/s10238-008-0166-y

O R I G I N A L

Rapid access to information resources in clinical biochemistry:medical applications of Personal Digital Assistants (PDA)

Muhittin A. Serdar • Mustafa Turan • Murat Cihan

Received: 8 August 2007 / Accepted: 22 January 2008© Springer-Verlag 2008

M.A. Serdar (�) · M. Turan · M. CihanDepartment of Clinical Biochemistry,Gulhane School of Medicine,GATA, Ankara 06018, Turkeye-mail: maserdar@gata.edu.tr

stantly changing information, to treat their patient andshould associate the patient data with the most recentdiagnostic and therapeutic recommendations and man-agement options to make sound decisions. Traditionally,health-care professionals consulted collected personalnotebooks and article cut-outs, pocket manuals, sub-scribed journals, medical reference books or electronicreferences on desktop computers. To keep these informa-tion resources up-to-date and organised requires a hugeamount of effort and is impractical. PDAs have a greatpotential to offer a versatile, quick and cost-effectivesolution to this problem if the appropriate combination ofhardware and software can be made [1, 3].

In this study, seven clinical experts examined a selec-tion of optimised PDAs and evaluate 11 software prod-ucts.

Materials and method

We evaluated 11 commercial laboratory medicine softwareproducts. These products are UpToDate (UpToDate, 95Sawyer Road Waltham, MA 02453, USA,http://www.uptodate.com), ePocrates (Epocrates, Inc.,1800 Gateway Drive Suite 300, San Mateo, CA 94404,http://www2.epocrates.com), Inforetrieve (Wiley/Inter -science, New York, NY, USA, 780http://www.infopoems.com/), Firstconsult (Elsevier Co.,125 Park Avenue 23rd Floor, New York, NY 10017, USA,http://www.fir stconsult.com ), Pepid (PEPID, LLC 1840Oak Ave. Suite 100, Evanston, IL 60201, USA,www.pepid.com), Skyscape books (Skyscape Inc., 100Locke Drive, Marlborough, MA 01752,http://www.skyscape.com) and Isilo readers (Isilo Com,http://www.isi lo.com). Skyscapes books included in thestudy are: (1) Baker man’s ABC’s of InterpretiveLaboratory Data, 4th Edn., Seymour Bakerman, PaulBakerman, Paul Strausbauch, Interpretive Laboratory Data,Inc., (2) Pocket Guide to Diagnostic Tests, Diana Nicoll,Stephen J. McPhee, Michael Pignone, The McGraw-HillCompanies, Inc., (3) Mosby’s Diagnostic and Lab TestReference, 7th Edn., Kathleen Deska Pagana, Timothy J.Pagana, Mosby – An Elsevier Health Sciences Company,(4) Ferri’s Best Test – A Practical Guide to ClinicalLaboratory Medicine and Diagnostic Imaging, Fred Ferri,Mosby – An Elsevier Health Sciences Company, (5)Nurse’s Manual of Laboratory and Diagnostic Tests, 4thEdn., Bonita Morrow Cavanaugh, F.A. Davis Company.Isilo is used while reading Interpretation of Diagnostic test,Jacques Wallach, Lippincott Williams & Williams.

Test content, description, interpretation, methodproperties, reference ranges, related tests/strategy/paneltest, interferences, equations, pathophysiology, technicalinfo (collection methodology and guidelines), criticalvalues, linked references and evidence-based data includ-

ed in each software and their price, update frequency,collaboration/integration, memory requirement, practi-cality and other specialties were evaluated individuallyand graded (+++, very good; ++, good; +, weak; (–), notavailable).

Results

A comparison of the software included in the study isgiven in Table 1.

Discussion

PDAs can be used in medicine to realise different goals.

Education

Higher education is becoming more and more reliant onthe use of computer technology. PDAs successfully com-ply with the concepts of contemporary education theoriesand it is not surprising that the students are among theearliest adopters of PDA use [5–14]. Several programsfor junior doctors at the leading US academic institutions(such as Harvard Medical School and GeorgetownUniversity Medical School) are the early adopters ofPDAs and provide their junior doctors with PDAs andbundled software [3].

However, large randomised controlled trials compar-ing PDA-users with non-PDA-users and with objectiveoutcome measures, such as performance in in-house orboard examinations, are needed to substantiate theseearly observations. Another important aspect of hand-held computer-assisted learning is the integration of fac-ulty staff who are traditionally more reluctant to adoptnew technology than students [15].

Quality of care

Quality of care can be improved by implementing clini-cal-decision support software, evidence-based medicine,other critically appraised publications and alerting sys-tems in PDAs. The use of PDA-based decision supportdevices has been reported to be useful or advantageous inmany clinical settings such as emergency and mass casu-alty triage, data management of transplantation patients,management of patients with stroke, infection control,enforcement of institution-specific, rational medicine useand patient data management [16–20]. The usefulness ofPDA-based drug references, including parenteral nutri-tion, blood products, chemotherapy and drug interactionchecks, has been examined in several studies [21–26].

118 Clin Exp Med (2008) 8:117–122

119Clin Exp Med (2008) 8:117–122

Con

t.→

Tabl

e 1

A c

ompa

riso

n of

med

ical

app

licat

ion

UpT

oDat

eE

pocr

ates

Pepi

dIn

fo r

etri

eve

Firs

t con

sult

Skys

cape

and

/or

Isilo

(ess

entia

lly)

(Lab

orat

ory)

man

ual

Bak

erm

an’s

Pock

etM

osby

’sFe

rris

bes

tM

anua

l of

Inte

rpre

tati

onA

BC

’s o

fG

uide

to

Dia

g &

Lab

test

: A

Lab

orat

ory

and

of D

iagn

osti

cIn

terp

reti

veD

iagn

osti

cTe

st R

efer

ence

Pra

ctic

alD

iagn

osti

cTe

stL

abor

ator

yTe

stG

uide

to

Test

sD

ata

Cli

nica

lL

abor

ator

yM

edic

ine

and

Dia

gnos

tic

Imag

ing

Con

tent

(the

num

ber

++

++

++

(>

300

test

)+

++

(>

300

test

)+

++

++

++

+ (

>50

0)+

++

(>

350)

++

++

++

(>

200)

++

++

++

(>

350)

of te

sts)

Info

rmat

ion

for

each

test

++

++

++

++

++

++

++

++

++

++

++

++

++

++

++

++

Inte

rpre

tatio

n of

res

ults

++

++

++

++

++

++

++

++

++

++

++

++

++

++

+M

etho

d fe

atur

e (s

ensi

tivity

,+

++

++

++

++

++

++

++

++

–+

++

+sp

ecif

icity

, scr

eeni

ng, e

tc.)

Ref

eren

ce r

ange

s+

++

++

++

++

++

++

++

++

++

++

++

++

++

++

+(s

ex a

nd a

ge r

elat

ed)

Rel

ated

test

s/+

++

++

++

++

++

++

++

++

++

++

++

++

++

++

stra

tegi

es/p

anel

test

sIn

terf

eren

ces

++

++

++

++

++

++

++

++

+E

quat

ions

/cal

cula

tors

++

++

++

++

++

–+

++

++

+Pa

thop

hysi

olog

y+

++

++

++

++

++

–+

++

++

–+

++

++

Tech

nica

l dat

a (s

ampl

e+

++

++

++

–+

++

++

++

++

++

–+

++

+co

llect

ion,

met

hodo

logy

)C

ritic

al v

alue

s+

++

++

++

+–

++

++

–+

++

++

+L

inke

d re

fere

nces

++

++

++

++

+–

++

++

++

++

Evi

denc

e-ba

sed

data

++

++

++

++

++

++

++

++

++

+(m

eta-

anal

ysis

, etc

.)Pr

ice

($)

495

per

year

59 f

or la

b,40

(on

ly24

9 pe

r 14

9 pe

r43

.96

39.9

544

.95

39.9

544

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20.5

514

9 fo

rla

b)ye

arye

arco

mpl

ete

Upd

ate

freq

uenc

y6

mon

ths

Dai

ly3

mon

ths

Dai

lyW

eekl

ya

aa

aa

aC

olla

bora

tion/

inte

grat

ion

++

++

++

+ p

ay p

er+

++

++

+b

bb

bb

b(w

ith o

ther

dis

cipl

ines

)gr

oup

Mem

ory

requ

irem

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Mb)

~100

08

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11.3

6.2

10.7

8.24

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Use

r fr

iend

ly+

++

++

++

++

++

++

++

++

++

++

++

++

++

++

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ther

sTo

pics

are

Epo

crat

esSu

bjec

t to

Abs

trac

ts o

fD

iagn

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Mor

e th

anB

asic

25 n

ew te

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biol

ogic

wri

tten

byE

ssen

tial

sad

ditio

nal

Coc

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eta

bles

1000

ent

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prin

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es o

fen

trie

sth

e m

ost

labo

rato

ry,

labo

rato

ry,

near

ly 3

000

cons

ist o

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ally

test

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ion

and

com

plai

nts.

cata

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ed in

Mic

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olog

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infe

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rcy

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gy a

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clud

ed:

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ease

s;tr

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pics

diag

nost

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ts, b

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dia

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pocr

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mbe

dded

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ctro

card

iogr

am.

test

ing,

sex

ual

indi

catio

ns,

test

s,

120 Clin Exp Med (2008) 8:117–122C

ont.

Tab

le 1

UpT

oDat

eE

pocr

ates

Pepi

dIn

fo r

etri

eve

Firs

t con

sult

Skys

cape

and

/or

Isilo

(ess

entia

lly)

(Lab

orat

ory)

man

ual

Bak

erm

an’s

Pock

etM

osby

’sFe

rris

bes

tM

anua

l of

Inte

rpre

tati

onA

BC

’s o

fG

uide

to

Dia

g &

Lab

test

: A

Lab

orat

ory

and

of D

iagn

osti

cIn

terp

reti

veD

iagn

osti

cTe

st R

efer

ence

Pra

ctic

alD

iagn

osti

cTe

stL

abor

ator

yTe

stG

uide

to

Test

sD

ata

Cli

nica

lL

abor

ator

yM

edic

ine

and

Dia

gnos

tic

Imag

ing

med

icin

e,va

riet

y W

eapo

ns o

f 5-

Min

ute

high

lypa

nel t

ests

Alg

orith

ms.

assa

ult t

estin

g,ad

vant

ages

,pu

lmon

ary

gast

roen

tero

logy

,ta

bles

and

,m

ass

dest

ruct

ion.

Clin

ical

stru

ctur

ed,

incl

uded

inN

omog

ram

lar.

and

virt

ual

disa

dvan

tage

sfu

nctio

n te

st.

haem

atol

ogy,

calc

ulat

ions

etc

Illu

stra

tions

Con

sult.

cond

ition

-th

e po

pula

rFi

gure

s of

colo

nosc

opy

and

Prot

ocol

s fo

rin

fect

ious

Patie

ntsp

ecif

icha

rdco

pyur

ine

mic

rosc

opy.

pres

ent t

heap

prox

imat

eco

llect

ing

dise

ases

,E

duca

tion

med

ical

man

ual.

Def

initi

ons

are

late

st te

sts

cost

s. 2

22sa

liva,

neph

rolo

gy,

Han

dout

sto

pics

.gi

ven

inan

d pr

oced

ures

com

mon

brea

th,

obst

etri

cs,

tabl

es w

hich

dise

ases

and

nail

and

hair

gyna

ecol

ogy

mak

es it

diso

rder

ssp

ecim

ens

and

wom

en’s

diff

icul

t to

read

and

fore

nsic

heal

th,

from

the

disp

lay.

evid

entia

ryon

colo

gy,

spec

imen

s.pa

edia

tric

s,pu

lmon

ary

and

criti

cal c

are

med

icin

e,rh

eum

atol

ogy,

alle

rgy

and

imm

unol

ogy,

emer

genc

ym

edic

ine,

neur

olog

y

++

+ve

ry g

ood,

++

good

, +w

eak,

–no

t ava

ilabl

ea

The

sof

twar

e co

mes

with

the

offe

r of

fre

e up

date

s fo

r 12

mon

ths,

or

until

a n

ew e

ditio

n is

rel

ease

db

Eac

h so

ftw

are

prod

uct i

nter

acts

with

the

othe

r so

ftw

are

prod

ucts

fro

m th

e sa

me

grou

p

PDA use in data collection and processing

Several studies in medical specialties including anaesthe-sia, emergency medicine, family practice, general surgery,internal medicine, neurology, obstetrics and gynaecology,radiology, urology and neonatal care have demonstratedthat the use of PDAs simplifies data collection and assess-ment of doctor and programme performances [27–31].

The use of PDAs improves trial efficacy, quickensdata analysis and even improves patient safety due to ear-lier availability of results of interim analyses.

Others

A significant increase in self-efficacy in the groups isshown where personal digital assistants are used [32].PDA-based medical information management could evenhave an environmental effect that goes beyond paper-sav-ing [33].

The use of PDAs is increasing in society. Today,PDAs are widely used by clinical specialists, junior doc-tors and medical students for a variety of purposes. Thereis insufficient study, however, related to the use of PDAby laboratory specialists.

In our study, 11 different commercial software prod-ucts and programs that are popular among laboratoryspecialists are evaluated by seven laboratory experts.

Laboratory books are important for laboratory expertsand related parts of Epocrates, Pepid and Skyscape soft-ware are found to be satisfactory regarding their test con-tent and their interpretation. UpToDate, Pepid andEpocrates are becoming prominent when the primary con-cern is to integrate the test result with the clinical informa-tion. None of the software included in the study is found tobe satisfactory regarding appropriate definitions of testsample types and the critical values of the tests. Meta-analyses are included and the reference documents areindicated appropriately in UpToDate, Inforetrieve, Pepidand Epocrates software whereas Skyscape e-books arefound to be weak. All software included in the study isupgraded frequently enough and has user-friendly inter-faces. The most important problem with UpToDate,Inforetrieve and Firstconsult is their high costs (Table 1).

Regarding our evaluation results, unique software isnot available which combines evidence-based clinicaland laboratory data (Table 1). Accordingly, it is neces-sary to keep several software products in our PDAs tomeet our demands. For example, combining UpToDatewith ePocrates or combining Pepid with a Skyscape e-book would be appropriate.

In conclusion, it is not wrong to claim that the use ofPDAs will facilitate medical applications, constitute aninformation base for new learning and make learningmore pleasant. Several studies have supported these argu-

ments. However, most of the available studies are notrandomised, controlled or have a multicentre design [34].In the near future, we believe, PDAs will become a cru-cial tool for laboratory experts.

Acknowledgements I would like to thank Ugur Kucuk M.D.,UpToDate, Epocrates, Inc. and Skyscape Inc. for providing informa-tion about their products and technologies.

Conflict of interest The authors declare that they have no conflict ofinterest related to the publication of this manuscript.

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