Palmtops could soon provide a wealth of information about patients and appointments - plus instant access to a vast pool of data, says Jane Dudman

As mobile phones sweep the country, growing numbers of health workers are wondering whether new mobile-based data communications could make their working lives more efficient.

Mobile phones themselves have already brought huge advantages to health workers but, so far, only for voice calls or for short text messaging, both of which have limitations.

Now, new services are emerging. In particular, there has been huge interest in the idea of accessing the Internet from mobile phones, enabling customers to send e-mails or check the latest sport scores. If you can do all that from a mobile phone, why can't they be used to help make the health service more efficient?

The answer lies with a range of technical limitations, rather than any inherent refusal within the health service to recognise the benefits of mobile IT.

There have been many advances in this area over the past few years, but the latest changes in communications standards, most notably the wireless application protocol (WAP), should make a difference. It is becoming feasible for remote workers to dial in from wherever they are to centrally held data, rather than having to load small chunks of information on to portable devices and then feed back changes into the central system.

WAP phones promise much, and are becoming more widely available. In July, health workers were offered free WAP-enabled mobile phones by Carphone Warehouse, through a tieup with online health service provider HealthMedia.Net. More than 100,000 healthcare staff have expressed interest, says Health-Media.Net.

But as yet, WAP technology is more hype than reality. While it may be nice to check one's bank balance from a mobile phone, more complex transactions than that are limited by the tiny size of mobile phone screens. As yet, they display only text messages, rather than providing the Internet-browsing capabilities familiar to users of desktop machines.

'WAP as a concept is fine, but the platform it sits on is not viable, frankly, ' comments Michael Wilks, director of government and public sector business at wireless specialist, Symbol Technologies. Instead, he says, health managers should be looking at more suitable access devices such as laptops and personal digital assistants (PDAs) that will link staff to centrallyheld information.

This is certainly the way staff on the ground see the market moving. They want to be able to do more than just check appointment times or patient addresses for home visits. They would like also, for example, to be able to record realtime patient information and prescriptions.

Hand-held computers are a practical way to access information on the move, and devices from specialist companies such as Psion are already in wide use in the healthcare sector.

Standards like WAP, however, bring the possibilities of mobile computing and Internet access further into the mainstream than has hitherto been the case. 'WAP is the technology that brings wireless access to small devices, ' explains Mr Wilks. 'Eventually, people will have a single PDA-style device that allows them to access and interrogate information systems on the web.'

This vision of a more mobile world will require applications to run much faster over mobile networks than is now possible. With the introduction of next-generation wireless networks in the UK next year, and with the further development of even faster networks in a few years' time, that bit of the problem will be sorted. Meanwhile, the software that turns static systems into mobile data feeds also needs more work. This is based on the Internet XML standard for the way pages look on the web. A mobile version of XML is being used at the moment, but more work needs to be done before browsing on a small mobile device is just as fast as it would be on a desktop PC.

Software in other areas is moving on fast.

Microsoft, in particular, has further developed its Windows software. Initially, the company released a version of Windows for mobile computers, Windows CE, that was not compatible with the desktop versions of Windows. Amid general complaints and poor sales, Microsoft realised this wasn't particularly useful. It has now developed much better synchronisation capabilities between Windows on desktop machines and its Pocket PC software on hand-held or portable devices, so that information can be updated automatically when the portable devices connect into the central network. Community care workers in Wakefield and Pontefract were among the first users in the UK to move from Windows CE to the Pocket PC system. Each mobile device holds up to 3,000 patient records.

The real breakthrough, though, will have to wait for the development of general packet radio service (GPRS) mobile wireless technology, which will enable many mobile devices to access centrally held information in real time.

Kevin Eales is a director of Devon-based BDS Solutions, which recently supplied 300 district nurses in Manchester with HP Jornada palmtop computers as part of a big overhaul of Mancunian Community Health trust's existing networking facilities.

He says WAP technology isn't robust enough to convey large volumes of data. 'WAP technology is still primitive, ' he comments. 'But as the mobile phone market starts to provide the next generation of networks, and we get bigger screens and browser-type access, then mobile phones will provide a powerful mobile access tool.'

The real advantage, according to Mr Eales, will be putting WAP technology onto devices such as small palmtops and PDAs.

'The NHS has some way to go in terms of being able to deliver the information over a mobile network, ' he says. 'The access devices are still immature. But we are moving in the right direction.'

Despite this optimism, other big issues have to be tackled, with security right at the top of the list. 'If mobile phones are going to be used to access patient information, security will have to be addressed, ' says Mr Eales.

Steve Graham, operations director at healthcare IT company iSoft, says the NHS has been using various mobile devices for many years, particularly in community and mental health services.

'But these have mainly been used simply to record information, ' he comments. 'Now, not just WAP but a whole range of technologies have become more useful and are providing health workers with much more power.'

At the moment, says Mr Graham, some health workers are using WAP-enabled phones, but they aren't yet connecting up to real information on centrally-held systems. 'They are being used for remote access to information sources, rather than to run real applications, ' he points out. 'We've been trying to provide devices like palm stations with applications for real practical use. These can be as important for fixed-based workers - such as staff in hospitals - as they are for those working in the community.'

Using mobile phones within a hospital, however, is fraught with unresolved technical issues. While several hospitals have already installed wireless local area networks which enable staff to use systems via infra-red or other radio connections, mobile phones are taboo.

'There are no agreed protocols laying down which technologies are OK and which are not, ' agrees Mr Graham. 'But quite a lot of research is being carried out in this area. It is clearly not the case that every wireless network or WAP phone will cause a problem, but we need clear guidance on which transmissions are acceptable.'

WAP phones, with their ability to access data remotely, have the potential to make many health workers' lives a lot easier. Scheduling appointments, checking addresses, updating patient records, keeping track of stock - all these and more could be much more efficiently handled once it is possible to dial directly into a system from a mobile or hand-held device.

'This isn't rocket science, ' points out Mr Graham. 'If people can check their bank balance from a WAP phone, why can't health workers benefit from this technology?'

As yet, there are a number of good reasons why health workers aren't benefiting from WAP technology. But given a bit more development in a number of areas, the answer could soon look very different.

Who's winning the mobile race?

An interesting global race is shaping up as online services emerge in both the commercial and public sectors.

While the US is the undisputed champion of e-commerce (94 of the world's 100 most-visited websites are in the US), Europe has the highest proportion of mobile phone users.

By 2003, some analysts predict there will be more people accessing online services via mobile devices than from desktop machines. That puts Europe ahead as mobile online applications begin to take off. But the US and the Far East are both hard on Europe's heels. Mobile phone use in the Far East is not far behind Europe, and with less of a fixed IT and telecoms infrastructure, there is huge interest from the Far East in innovative new applications, from gambling to healthcare services.

In the US, meanwhile, although there is less ubiquitous use of mobile phones, the use of personal digital assistants (PDAs) is growing. Many experts think that when manufacturers finally come up with a combined PDA and mobile phone - which is not far off - mobile online services will take off in the US in a big way.