I couldn't agree more with Nelson and colleagues [1] about the need to build measurement and data collection into daily medical practice. The difficulty lies with implementation. While medicine is still wedded to the paper record, two things are happening that will change our approach to data collection.

First, medicine is becoming more evidence based. It is not sufficient to justify actions by stating "in my experience ... ." People want to know exactly what your experience is. Second is a greater expectation for data at the point of care. If my patient is in the emergency department, a chart in my office is of little use.

Our division of general internal medicine has taken advantage of the burgeoning palmtop technology to fulfill these expectations. Residents, nurses, and faculty involved in our hospitalist service, vascular access, and bioethics activities are outfitted with Hewlett-Packard 100/200 LX palmtop computers. These devices are DOS-based and have a built-in, modifiable database engine.

Data are collected "on the spot," and a chart-ready note is generated immediately from the palmtop. The value has become apparent because the palmtops are viewed as indispensable to the operations of these services. The vascular access service members have at their fingertips a summary of the 5000 peripherally inserted catheters placed, and the hospitalist service members have a summary of the 1200 patients admitted in the previous year. As these clinicians have become the core of the "data measurement team," a clear vestment in outcome issues has developed.

We have seen numerous practical advantages in implementing the principles presented by Nelson and colleagues. As we await more global computer-based systems, we can still "think big but start small." With palmtop technology growing exponentially, it should be possible to overcome almost all of the cost and technical barriers that have previously hindered otherwise well-intended clinical "measurement teams."