The Results Are In: The PDA is Here to Stay

Might PDAs soon go the way of the dodo bird? It sure looks like it, at least according to a blog posted to the Ars Technica website on August 13, titled “PDA Sales Drop by 40 Percent in a Single Year, Vendors Bolt for Exit.” The post outlines a rather bleak future of declining success and popularity for the PDA. The author, Nate Anderson, not-so-subtly states that “there are two kinds of people in the world—those who believe in the power of the PDA and those who don’t— and the first group is shrinking faster than a cotton shirt in an industrial dryer.” An overall decline in PDA use may be a tough concept for many practitioners to wrap their minds around, especially when considering how useful the devices have proven to be in the healthcare setting.

It’s been said that numbers don’t lie, and, at first glance, the statistics in Anderson’s blog are hard to argue with. But he fails to take into account a couple of key caveats in the course of predicting the downfall of the PDA. One is that PDA use is actually increasing among certain key demographics, namely healthcare providers. His other oversight is a semantic one, but important nonetheless—PDA use is declining only if “PDA” is narrowly defined to encompass the technology as it existed in say, 2000. This, of course, misses the big picture. The ongoing success and shifting definition of “PDA” is being driven by new-generation devices with advanced capabilities and functionality.

Doctors Are Doing Their Part

The Journal of the American Medical Library published a study in October 2005 that examined how physicians use PDAs for clinical decision making, finding “that even occasional PDA use had an impact on their clinical decision making and treatment choices.” More than 50% of the physicians surveyed “indicated PDA use helped change a patient’s treatment.” Sixteen percent stated that “using a PDA helped avoid unnecessary medical tests;” 10% of physicians reported that PDA use “had helped change a patient’s diagnosis.” Clearly, PDAs can have a beneficial effect on clinical practice, but the extent of that benefit depends on how many physicians are using the devices in practice.

Evidence of the PDA’s popularity among healthcare professionals can be found in the results of a study published in 2006 in the Journal of Medical Internet Research (JMIR). The authors conducted a systemic review of 816 full-text articles, published between 2000 and 2006, on PDA use among healthcare providers. They found that “Younger physicians and residents and those working in large and hospital-based practices are more likely to use a PDA. The adoption rate is now at its highest rate of increase.” The study also revealed that PDA use was higher among those physicians who were wholly or partly hospital-based (33% and 29%, respectively) than among those who were office-based (23%). The authors predicted that hospitalists, who are younger as a group than other medical specialties, “will drive the [PDA] market in the next few years.”

Although the statistics reported in the JMIR article may be surprising to some, the authors point out that “a common problem with the evaluation of information technology [IT] is that use frequently precedes research. This is the case here, in which PDA adoption rates are already high and projections are for rapid growth in the short-term.” The article makes clear that, although PDA sales in general may be sputtering, physicians and other healthcare professionals are certainly not contributing to the drop.

You Say Tomato…

Another Ars Technica author, Eric Bangeman, warned way back in 2005 that PDA sales were sliding (not counting “integrated phone-PDA devices”), noting that shipments had fallen by 13% between 2003 and 2004. He also noted that while sales of standalone PDAs were declining, manufacturers were introducing smartphones and cell phones with “PDA functionality,” further siphoning off PDA market share. In response, PDA makers began adding new features, including “built-in WiFi connectivity, interface improvements, faster processors, and better color screens,” according to Bangeman.

“An increasing number of cell phones offer a lot of basic PDA functionality,” observed Bangeman. “Throw in a cheap camera and have the cellular provider subsidize the cost and PDAs look a lot less compelling.” So much so that smartphone sales were up 60% in 2006 and growing, according to InternetNews.com. “In fact, smartphone unit sales almost tripled from 2004 to 2005, and increased by 50 percent in the first half of 2006 over 2005.”

So, PDA sales are declining, smartphone sales are increasing, and yet both types of devices are increasingly incorporating similar features and functionality. It’s getting to where users can hardly tell some of the devices apart anymore. Are smartphones, in fact, really just PDAs with added telephone functionality? And are all smartphones created equal? Well, no. As InternetNews.com points out, “While many smartphones… serve as a combination phone and PDA and others have power and performance comparable to many laptops, most of the smartphones sold globally only enable the user to access the capabilities of basic wireless phones.” In other words, sometimes a smartphone is exactly that: a smart phone.

What explanation is there for the PDA’s drastic decline in popularity (except in the healthcare setting, of course)? There must be something about smartphones that led JupiterResearch to predict that smartphone sales “will grow at a compound annual growth rate of 28% through 2009,” accounting for nearly one in every 10 phones sold in 2009. One possible reason for the sharp contrast between the fortunes of these technologies is that standalone PDAs are incompatible with our increasingly interconnected world. As one Smart Computing writer so aptly put it, “what really sets the smartphone apart from the PDA is connectivity. It’s the ability of software developers to integrate connectivity into their applications that’s going to offer the biggest boon to the user.”

Is it All Hype?

We asked several MDNG editorial board members what they thought about all this and included their responses in a recent Web Exclusive article, titled “PDA Extinction? Not a Chance.” “It’s really a silly distinction, in my opinion,” said board member Daniel Z. Sands, MD, MPH, director of IBSG Healthcare and director of medical informatics for Cisco Systems. “The natural evolution of a handheld computer is from a device that just connects to a full-size computer toward one that connects with the Internet using wireless communication networks. As the price of these devices and the connections they require drops, users will trade in their PDAs for connected devices (smartphones). Smartphones perform all of the functions of standalone PDAs, but also are able to be used as communication devices and to connect to the Internet.”

We also surveyed MDNG readers to obtain their opinions on PDAs, related technology, and their role in the healthcare market going forward. Although 15% of our readers never have used a PDA in practice, the vast majority (74%) have a good 1-10 years’ worth of experience using handheld computing devices. When asked if they thought smartphones and other technology will eventually surpass PDAs in popularity among physicians for use in the clinical setting, 24% of surveyed MDNG readers said “no.” However, 71% of respondents do think newer devices such as the iPhone, Treo, and BlackBerry will live up to their considerable potential and prove increasingly useful in practice.

When asked if they thought PDAs would soon no longer continue to meet their professional needs, many respondents singled out smartphones as the obvious competitor. “The primary need is to minimize the number of devices carried,” said one of our physician voters. Another echoed this perception, stating that the combination of a phone and PDA functions in a smartphone is too convenient for a PDA-only device to compete with. As another physician respondent put it, “Why carry two boxes when one will do?”

However, not all of our readers were ready to abandon their trusty handhelds just yet. “I can’t imagine practice without my PDA. We are getting ready to implement an EMR that synchronizes with PDAs to capture hospital charges. I see the role of my PDA actually expanding,” said one physician. We also wondered whether readers were concerned that the shrinking PDA hardware market might soon lead to fewer new software titles being released each year. Fifty-one percent of respondents to our survey said “yes.”

Time Will Tell

Will PDAs eventually go the way of the pager and other onc-essential technologies whose time has past? Or will their features and functionality evolve to the point where they merge into the smartphone product line, erasing any meaningful distinction between the two? Will vendors develop more software for smartphones, making them even more useful for physicians? Only time will tell. For now, enjoy your device, whatever it may be.