Emerging Technologies: Role of Handheld Devices in Clinical Practice

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Emerging Technologies Role of Handheld Devices
in Clinical Practice

• CDR Miles Rudd, MD
• Warm Springs Service Unit
• Warm Springs, OR

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Objectives

• Describe the current role of handheld devices in
  the provision of clinical care.
• Review currently available clinical programs that
  rely on handheld devices.
• Describe two ways that medical errors can be
  reduced through the use of handheld devices.

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The Handheld Computer The Players
Windows HP Compaq Casio Toshiba Internec
Palmax

• Palm OS
• Palm
• Handspring
• Sony
• TRG
• Nokia
• Kyocera

Others Newton, Psion, Franklin, Linux
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Palm OS vs. Windows CE

• Palm
• Market Leader
• Software availability
• Small footprint
• OS for phones
• Downside
• Expandability is limited.
• Screen resolution is not as good.
• Slower processor

• WinCE
• Feature rich
• Native web browser
• Memory
• OS for tablet PCs
• Downside
• Less software availability
• Larger and heavier devices
• Low battery life

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Palm is the dominant operating system for
handheld devices
Palm OS 77.5 Share
Palm OS 86.0 Share
Source NPD Intelect as quoted in the Wall Street
Journal, January 25, 2001
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Palm OS has the most developers
135,000
Total Developers (in Thousands)
1999
2000
Source Palm
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Standard Applications

• Calendar
• Phonebook
• Notes
• To Do Lists

Expense Tracking E-Mail Calculator
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Palms In Medicine Today

• Drug References
• eBooks Medical Texts
• Peripheral Brain Tools
• Medical Calculators
• Trackers Patient, Billing, Procedures
• EMR
• CME

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Drug References

• ePocrates Thorough, easy, free
• qID Drug/ID Database from ePocrates
• LexiDrugs Comprehensive
• Apothecarium
• Physicians Drug Handbook
• Miscellaneous Guides

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Majority of MDs Using a Palm Device Are Using
ePocrates Software
Current and Projected Use of Palm Devices and
ePocrates Software
MDs with a Palm Device
MDs using ePocrates on a Palm Device
year end predictions
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qRx 4.0 Drug Reference

• Comprehensive and Accurate
• Current
• AutoUpdate feature ensures that physicians have
  the most up-to-date clinical information simply
  by HotSyncing their Palm OS device while
  connected to the Internet
• DocAlerts notify physicians when updates are
  made, such as new drug approvals, additional
  indications, recalls, etc.
• Intuitive
• Free

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qRx Drug Reference Features Adult Dosing

• Displays indication specific adult dosing
• Lists brand name, generic name and dosage forms

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qRx Drug Reference Features Pediatric Dosing

• Displays indication specific pediatric dosing by
  age
• Lists brand name, generic name and dosage forms

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qRx Drug Reference Features Contraindications/Cau
tions

• Displays absolute contraindications, followed by
  relative contraindications, followed by cautions

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qRx Drug Reference Features Drug-Drug
Interactions

• Tap on any listed interaction and you will view
  a pop-up window that describes the specific
  interaction

• Displays drugs that interact with selected drug

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qRx Drug Reference Features MultiCheck

What is MultiCheck?
MultiCheck allows you toselect up to 30
medications and instantly check for any
interactions between them
How to Launch MultiCheck
Step 1 - tap the menu icon Step 2 - tap Run
MultiCheck See the following page for a
MultiCheck example
Step 1
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qRx Drug Reference Features MultiCheck Example
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qRx Drug Reference Features Adverse Reactions

• Displays adverse reactions, listed as serious
  and common reactions
• Reactions are listed in order of relative
  frequency

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qRx Drug Reference Features Cost/Packaging Info

• Provides average retail pricing of each drug
• Describes different packaging and tablet sizes
  for which each drug can be prescribed

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qRx Drug Reference Features Mechanism of Action
and Other Info

• Safety in pregnancy and lactation, mechanism of
  action, metabolism and excretion are displayed on
  one simple screen

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qRx Drug Reference Features Personal Notes

• Write personal notes on any drug in the database
• Notes can be beamed to colleagues

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qRx Drug Reference Features Regimens and Tables
1. Search by class by tapping By Class button
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qRx Drug Reference Features Regimens and Tables
Example
5. 16 regimens and tables, including new ACLS
guidelines
4. Select the desired regimen/table from the list
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qID - A Companion Infectious Disease Application
For The Palm

• Find antimicrobial treatment recommendations in
  5 seconds or less
• Access information on over 400 pathogens and 400
  drugs
• Quickly search using intuitive and easy to use
  formats
• Seamlessly launch from qID to qRx 4.0 and back
  for more comprehensive detail
• FREE - qID is free to download at
  www.epocrates.com

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qID - An Overview of Features
1. qID thinks the way you do. Search by anatomic
location to arrive at your diagnosis within
seconds.
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qID - An Overview of Features
5. If a particular pathogen grows from a culture,
you can tailor your therapy and avoid resistance
by following the recommendations on the Specific
Treatment screen.
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qID - An Overview of Features
Drug Groups
7. If a Drug Group is indicated for a particular
infection, you can find the drugs in that group
by tapping the group name, which has a dotted
underline. The resulting popup window will also
have drug names which can launch into qRx.
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eTextbooks

• 5 Minute Clinical Consult
• Merck Manual
• 5 Minute Pediatric Consult
• Harrisons Companion
• Others

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Peripheral Brain Tools

• Notes
• Patient check out
• HanDBase
• (www.ddhsoftware.com)
• Simple database program
• Create programs for tracking procedures or
  clinical data

• Fireviewer
• (www.firepad.com)
• Viewer for image files
• TealDoc
• iSilo
• Documents to Go
• NCEP Tool
• NHLBI Obesity Tool

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iSilo

• iSilo (www.isilo.com)
• Document reader
• www.aafp.org - List of common ICD-9 codes in
  Family Practice

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TealDoc

• TealDoc (www.tealpoint.com)
• Document reader
• NHLBI guidelines on asthma

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Documents To Go

• Documents To Go (www.dataviz.com)
• Allows you to read or edit Word, Excel, or PDF
  files on palm device
• Good for carrying copies of copies of custom
  documents

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NCEP Guidelines Tool

• ATP III Cholesterol Management Guidelines
• (hin.nhlbi.nih.gov/atpiii/atp3palm.htm)
• Enter patient lab values and risk factors
• Generates treatment plan

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NHLBI Obesity Guidelines Tool

• NHLBI Obesity Education Initiative
• (hin.nhlbi.nih.gov/obgdpalm.htm)
• Enter patient measurements and risk factors
• Generates treatment plan

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Medical Calculators

• PregCalc Pro
• MedMath
• Medcalc
• ABGPro
• STAT Cardiac Risk

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PregCalc Pro

• PregCalc Pro
• (www.thenar.com)
• Electronic Pregnancy Wheel
• Allows saving list of patients and keeping notes
  (beamable)
• Has an editable tickler system

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MedMath

• MedMath
• (www.stanford.edu/pmcheng/medmath)
• Developed by Internist
• Built in keypad

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MedCalc

• MedCalc
• (medcalc.med-ia.net)
• More extensive options

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ABGPro

• ABGPro
• (www.stacworks.com)
• Calculates type of abnormalities (respiratory vs.
  metabolic, acidosis vs. alkalosis)
• Calculates anion gap

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STAT Cardiac Risk

• STAT Cardiac Risk
• (www.statcoder.com)
• Enter patient values and risk factors
• Calculates 10 year CHD risk

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Patient Trackers

• PatientKeeper
• Full Blown EMR Applications
• Web Based EMR/Rx Products

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Coding and Billing

• Stat EM Coder
• Stat CPT Coder
• STAT ICD-9 Coder
• Codemeister

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STAT E M Coder

• STAT EM Coder
• (www.statcoder.com)
• Enter elements of visit
• Calculates appropriate code and hints at further
  elements needed to up-code
• Uses Tealinfo reader

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STAT CPT Coder

• STAT CPT Coder
• (www.statcoder.com)
• Click through searchable tree to get to specific
  CPT code
• Uses Tealinfo reader

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STAT ICD-9 Coder

• STAT ICD-9 Coder
• (www.statcoder.com)
• Click through searchable tree to get to specific
  ICD-9 code
• Uses Tealinfo reader

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Codemeister

• Codemeister
• (www.fppalm.com/CodeMeister/CodeMeister.htm)
• Click through searchable tree to get to specific
  ICD-9-CM and CPT-4 code
• Uses iSilo reader

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