How to get the Whole Medical World in the Palm of your Hand

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How to get the Whole Medical World in the Palm of
your Hand

• Scott Hamstra, MD,
• National Medical Informatics Consultant
• LT Christopher C. Lamer, PharmD, CDE

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Objectives

• At the end of this presentation, you will
• Be able to differentiate and recognize various
  PDA (personal digital assistant) hardware and
  operating system technologies available.
• Understand and be able to illustrate how PDA
  reference information software programs are used
  in clinical practice and to incorporate PDAs into
  a variety of practices and work settings.
• Review initial survey data on the use of PDA
  hardware/software by IHS clinicians and discuss
  various roles for PDAs throughout the IHS.
• Discuss the advantages and disadvantages of PDAs
  and appraise necessary resources needed to
  implement a PDA program.

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Evaluation of PDA EffectivenessPDA vs. PDR vs.
Internet
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The Question

• A 45 year old male comes into the ER complaining
  of chest pain radiating to his jaw and arm. ECG
  and lab results confirm a diagnosis of Myocardial
  Infarction. He weighs 72kg. You decide to use a
  thrombolytic
• The newest addition to the formulary is
  TNKase

What dose do you give?
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Step 1
Turn on your PDA and select ePocrates by tapping
on the icon.
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Drugs
?All
Step 2
Drug Drug Drug TNKase Drug Look Up_____________
Write the drug name using graffiti or tap on the
abc to get a keyboard that you can type on
using the stylus. Select TNKase.
tnk
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Tenecteplase (IV) Myocardial infarction,
acute wtlt60kg Dose 30mg IV x 1 Max 50 mg wt
60-69kg Dose 35mg IV x 1 Max 50mg wt
70-79kg Dose 40mg IV x 1 Max 50 mg
Step 3
Read answer. Its that simple!
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The Winner
Updated Daily Easy index Easy search
capabilities Fast results
The Loser. Updated yearly Difficult index Time
consuming to flip through pages Must read
passages to find information
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ePocrates highlighted in the Wall Street Journal
as being faster than the PDR
"The study, published in the most recent Journal
of the American Medical Informatics Association,
indicated that 50 of ePocrates physicians who
were surveyed reported that the devices and guide
prevent one to two errors a week, and help
doctors keep track of the constant barrage of new
drugs and changing treatment guidelines. The
study also showed that doctors can look up drug
information much faster using ePocrates than with
traditional sources such as the Physicians' Desk
Reference 60 of physicians surveyed reported
that it took them 10 seconds or less to find
information using ePocrates compared with one to
five minutes for traditional methods."
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Anatomy and Physiology of the PDA (Personal
Digital Assistant)
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Palm OS and Windows CE
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Palm and Handspring
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Clinical Applications

• ePocrates
• ePocrates QID
• Tarascon
• ePharmacopoeia
• ACLS2000
• 5-Minute Clinical Consult
• BMI Calculator
• Mobile Micromedex
• Shots 2002

• Lexi Comp
• MedCalc
• Pregnancy Wheel
• Do-in
• Growth Rates
• MedRules
• Obesity Calculator
• ATP III

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Epocrates
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Updatable Daily

• Hot sync PDA daily to obtain the latest
  up-to-date medication information
• PDR is updated yearly

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Searchable by class or drug
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Adult Dosing, Pediatric Dosing,
Contraindications, Cautions
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Drug Interactions
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Adverse Reactions
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Cost Other Information
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Multi-Check
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Customizable Notes
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Non-Clinical Applications

• Address Book
• Calendar
• Date book
• Appointments
• Reminders
• Alarms
• Calculator
• Memo pad
• To do list
• Mail
• Expense Log

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PDA use in the IHS
Cherokee Warm Springs White River Others
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PDA Surveys

• Provided to assess the use of PDAs in the Indian
  Health Service
• Looked at
• PDA device used
• Software used
• Likes / Dislikes
• Problems
• Preliminary results are coming in
• A second survey will be released in 6 mos

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Survey Results

• Major uses
• Address Book
• Treatment Algorithms
• Satisfaction 33 yes vs. 3 OK
• Most used clinical applications
• ePocrates (Rx and QID)
• 5 Minute Clinical Consult

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Survey Results

• Benefits
• Availability and accessibility of data
• Easy to document information (coding)
• Access to drug information
• Faster than the internet
• indispensable
• Time saving
• Easy to use
• Keeps you organized

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Survey Results

• Problems
• Transmission difficulties hot syncing
• Permission to use PDA software at work
• Battery life
• Difficulty writing with graffiti
• Limited memory
• Hard to carry clunky
• Screen too small

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National Surveys

• in a survey of physicians using (ePocrates) qRx,
  a set of knowledge resources available on a PDA
  found that
• 60 used qRX more than twice a day
• 81 report improved drug-related decisions
• 46 report three or more drug decisions per week
  were affected
• 71 report improved inpatient efficiency
• 69 report improved outpatient efficiency
• Rothschild (Journal of Healthcare Information
  Management

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PDAs and Patient Education

• Purpose
• There are too many codes to remember them all!
• PDAs serve as a database containing patient
  education codes
• To determine if PDAs would
• Increase the documentation of patient education
  on patient medical records
• Increase provider accessibility to medication
  information
• Increase provider satisfaction

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PDAs and Patient Education

• Background
• A proposal was submitted to the National Patient
  Education Program (Mary Wachacha) requesting PDAs
  to increase documentation of patient education.
• Approval for a pilot project of 15 PDAs was
  granted
• Cost per PDA 299.00
• Total Cost 4,485.00

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PDAs and Patient Education

• Methods
• Handspring Visor Prisms were purchased
• Competitive pricing in relation to Palm
  Handhelds.
• Less expensive than Windows CE based PDAs.
• Springboard Module Expansion slot makes
  exploration of various uses, functions, and
  upgradeability possible.
• Color handhelds had not yet been evaluated by
  the National IHS PDA Initiative.
• Computer operations ordered it.

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• A variety of applications suited to the provision
  of health care were added to the PDAs
• Epocrates
• Epocrates ID
• Medcalc
• NHLBI guidelines (COPD, Asthma, ATP III (lipids),
  Obesity)
• Pregnancy Wheel
• Growth Charts
• PDA users were encouraged to become
• familiar with their various applications.

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• Various database and document applications were
  evaluated to add patient education codes to the
  PDAs.
• Quickoffice was obtained through additional
  funding from the National IHS Palm Initiative
  program.
• Quickoffice is a productivity suite that allows
  PDA users to import Microsoft Word and Excel
  documents onto their PDAs.
• Quickoffice enabled an easy solution to adding
• the Patient Education Codes to PDAs and by
• providing a simple means to add/update
• the codes.

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PDAs and Patient Education

• Design
• 15 PDAs were distributed to clinical staff
  including MDs, PACs, and FNPs.
• PDAs were checked in by computer operations and
  approved software was loaded on.
• PDAs were distributed and utilized for a number
  of weeks.

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• After a break in time, PDAs began to require
  Hot-Syncing to maintain up-to-date medication
  information.
• Some difficulties arose
• Problems hot-syncing - notably with ePocrates
• ePocrates had to be loaded on each computer
  individually for auto-update to work
  appropriately. Batch loading was not productive.
• ePocrates was reinstalled on problem PDAs and no
  further problems arose.
• Quickoffice was installed on all (most) PDAs by
  Computer Operations.

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PDAs and Patient Education

• Measures
• A primary survey was distributed to all clinical
  staff who utilized a PDA in the course of their
  work (15 providers who received PDAs and 4
  pharmacists who are using PDAs).
• Patient education hits were recorded in the
  Resource Patient Management System, (RPMS),
  database

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PDAs and Patient Education

• Initial Results
• Of the 13 returned surveys, 12 responders stated
  that they were familiar with the IHS patient
  education codes and one responder was not.
• 13 (100) of responders have used the patient
  education codes in the past.
• 10 responders stated that they had access to a
  computer with Quickoffice installed
• 9 have Quickoffice Patient Education codes
  installed on their PDAs.
• 3 responders installed the codes from a CD
• 1 responder installed the codes from the hard
  drive
• 5 responders installed the codes through beaming

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PDAs and Patient Education

• The PDA codes are used
• More than twice daily 3
• Once a day 1
• A few times a week 2
• A few times a month 1
• Never 4
• The PDA education codes are used to
• Look up education codes 5
• Increase documentation 5
• See if an education code exists 4
• Find more education codes 3
• Not familiar with the education codes 3
• Do not use patient education codes 1

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PDAs and Patient Education

• Were the codes clinically helpful?
• Yes 10 No 1
• Have the codes increased your documentation?
• Yes 7 No 0
• What other applications help to increase patient
  education documentation?
• ePocrates 12
• Tarascon 5
• Shots 2002 4
• Micromedex 1
• 5 MCC 5

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PDAs and Patient Education

• Patient Education HITS
• 2000 12,607 patient ed hits
• 2001 21,336 patient ed hits
• 2002 8,888 hits for the first quarter
• anticipated 35,552 hits
• Why are they increasing??
• PDAs, PCC, Yellow tab cheat sheets, nagging

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Patient Confidentiality
HIPPA Warm Springs Policy
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Setting up a PDA Program

• Some PDA Issues to consider
• Hardware issues
• Costs
• PDA which one? Expandability? OS? Memory?
  Color?
• Cradle uniformity
• Warrenties broken or lost PDAs
• Software Issues
• Clinical and non-clinical which ones to use?
• Who pays for it? User or I/T/U
• Who installs it?
• Training by whom? Group or one-on-one?
• Personnel issues
• Computer specialists for installation,
  troubleshooting

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ITSC Home Page
home.IHS.gov/ITSC-CIO/index.asp
www.ihs.gov/CIO/InfoTech_index.asp
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Conclusions
Questions?