According to a 2001 market report, titled "The Cure Is in Hand," handheld computers, or personal digital assistants (PDAs), will "dramatically change the way that physicians practice medicine."1 Such enthusiasm has resulted in an extraordinarily rapid diffusion of PDAs into a wide range of clinical settings. One report states that 47 of internists use PDAs once a day with rates of daily usage reaching 70 for resident physicians.2 Another study found clinical usage as high as 85 in teaching hospitals.3 The rapidly expanding employment of PDAs, however, has been uneven. Some clinicians have explored the devices' benefits more thoroughly than their colleagues. Similarly, a number of potentially valuable uses of the handheld computer have been ignored or remain insufficiently developed by the medical community and the health delivery system at large. The use of PDAs is likely to bring much benefit to patients, society, and the medical profession. On one hand, delay in the use of a clearly beneficial technology is ethically, and potentially legally, problematic. On the other hand, precipitous adoption of such a powerful modality may preclude sufficient consideration of a broad range of clinical, professional, ethical, and legal issues that may not have yet fully surfaced. The identification and weighing of benefits, risks, harms, and implications of widespread proliferation of handheld computers into clinical practice is still a speculative endeavor. But it is the exploration that the medical profession and society should pursue in the lengthening shadow of a technology as consequential as handheld computers.
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