Medical practice is increasingly being computerised. In our offices we use our PCs to prescribe electronically with fewer errors, automatic recognition of potential drug interactions and allergies, and more legible scripts. Clinical decision support software offers the potential to add rigour to our decision making. Many of us use real time web access to support this functionality. How can these important developments be extended to our work in the emergency department, on home visits, while caring for patients in institutions, and other settings where the practitioner is away from the office and its resources?

It is possible, although impractical, to take a laptop along and access the internet either via standard or mobile telephone. However, use of a hand-held computing device offers a much more palatable solution. There are many devices on the market. For months now I have used a Palm Pilot Vx (www.palm.com) weighing just over 100g and fitting into my shirt pocket as diary, address book and notepad, and it synchronises with my office PC easily’ through a cradle or infrared port. Recently’ I have also started using it in my medical practice.

Firstly, I installed a comprehensive clinical drug information guide that I now regularly use to check my prescribing when out of the office. The database is automatically updated daily through the web when I synchronise the Palm with my office PC. Thus, using the Palm to support my prescribing is quicker, more accurate, and much more accessible than any paper-based resource. My Palm now also has, among others, programs to calculate cardiovascular risk, intravenous drug doses, and gestational age . This weekend I found the Merck Manual (one of my favourite resources) available for free download in Palm format and the entire manual now resides on my Palm.

I saw 56 patients while on duty at the local hospital yesterday. I used the Palm to check prescribing 10 times and to inform my therapeutic decision making six times. Access was simple, easy, quick and unobtrusive to the clinical encounter.

I feel that I have entered a new era in my medical practice. For the first time I have evidence in easily accessible format at my fingertips wherever I am.