1 Value of PDAs in Clinical Practice and Education My Internal Medicine PerspectiveLorenzo Di Francesco, MD, FACP Assistant Professor of Medicine Associate Program Director, GMH Co-Director, Hospital Medicine Unit Emory University School of Medicine March 27, 2003

2 Outline Overview of PDAs PDA uses Teaching Opportunities ExamplesOrganizational Medical Teaching Opportunities Examples Quick reference Prediction rules Medical calculators EBM Pharmacopoeias

3 Key Points The Benefits of a PDA in Medicine point of care informationreplaces “lab coat syndrome” reduces need to memorize complex information encourages more “critical thinking” improves efficiency and safety of care promotes self learning and information sharing

4 PDA Types Operating System Palm OS Windows OS EPOC OS

5 Handspring Visor, Palm Pilot, TRG Pro, HandEra, Sony, IBMPalm OS Handspring Visor, Palm Pilot, TRG Pro, HandEra, Sony, IBM Advantages Cheap, small, track patients, abundant medical references Disadvantages Slower than Windows/EPOC. Screen smaller. Keyboard +/-

6 Casio, Compaq, HP, NEC, DellWindow CE OS Casio, Compaq, HP, NEC, Dell Advantages More complex multimedia capacity. Full sized colored screens, slots/ports for expansion. Disadvantages Larger, more expensive with less medical software to date. Battery life?

7 Symbian, Psion, Ericsson, Oregon ScientificEPOC OS Symbian, Psion, Ericsson, Oregon Scientific Advantages Most advanced (word processing, spread sheets, voice recording). Built in keyboards, long battery life. Disadvantages Larger, more expensive. Less software than Palm or Windows.

8 PDA uses Organizational Address book Calendar To Do lists Memo PadCall schedules, conference dates, presentations, vacations etc… To Do lists Memo Pad Read/Write/Store

9 PDA uses Organizational Procedure LogsLog Procedures (hometown.aol.com/roboh98/palm.html) Free Editable Ob/Surg logs requires HanDbase program

10 PDA uses Medical Patient tracking Patient billing ReferencePrescription writing

11 Patient Tracking Patientkeeper (patientkeeper.com)PatientTracker (handheldmed.com) EPatient (iatrosoft.com) Wardwatch (watch.aust.com) Raphael (pdamed.com) Mobile MedData (medcomsys.com) Rounder (synapsesoft.com) DDH HandEchart (ddhsoftware.com) DDH Patient HandChart (ddhsoftware.com) Hospital Rounds Database (solersys.com) OfficeNotes (midsouth.rr.com)

12 Patient Tracking Patientkeeper (patientkeeper.com)Versatile, powerful, modifiable Patient lists Patient H/P, SOAP notes Print Patient H/P, SOAP, checkout lists Beamable to other physicians

13 Billing IngeniousMed (Ingeniousmed.com) ZapBill (Zapmed.com)Pocketbilling (Pocketmed.com) MDcoder (mobiledesigntech.com) Chargekeeper (patientkeeper.com)

14 PDA information Accessing information Direct download Readers Pluginsinternet=>computer=>loaded to PDA with icon Readers internet=>computer=>loaded to PDA need a reader to view. Plugins SD/CF/springboard modules pre-loaded Internet connectivity wireless connection to internet=>PDA

15 Palm OS readers Doc readers isilo3 (isilo.com) Tealdoc (tealpoint.com)HanDbase (ddhsoftware.com) Jfile/Jfile Pro (land-j.com/jfile.html)

16 Reference Medical Textbooks Harrison’s (franklin.com)Cecil’s (skyscape.com) Merck Manual (handheldmed.com) 5 min consult (skyscape.com) Washington Manual (franklin.com)

17 Medical Calculators/Formulas/Prediction toolsReference Medical Calculators/Formulas/Prediction tools ABG pro (abgpro.com) MedMath (smiweb.stanford.edu/people/pcheng/medmath/) BreastCa (smiweb.stanford.edu/people/pcheng/medmath/) MedCalc (medcalc.med.ia.net) Medrules (pbrain.hypermart.net/) TIMI Risk Calculator (timi.org) Cardiac Clearance (statcoder.com) PregCalc (thenar.com) Anticoagulation Advisor (anticoagulation-advisor.com)

18 Reference ACC infoguide (infoguidecenter.com/acc)Stable Angina Cardiac Pacemakers Valvular Heart Disease MI Unstable angina NCI Cancer Staging and Tx (memoware.com) uses isilo Marik’s Differential Diagnosis (memoware.com) uses Isilo Lab Values (memoware.com) uses HanDbase. Path Interpretation (memoware.com) uses HanDbase

19 Palm Image Viewers Fireviewer (firepad.com)Tinyviewer (righto.com/pilot/tv.html)

20 Reference Drug information Epocrates/QID (epocrates.com)A2zDrugs (skyscape.com) DrDrugs (skyscape.com) Mobilemicromedex (micromedex.com) Lexidrugs Platinum (lexi.com) PDR (pdr.com)

21 PDA  Internet PharmacyPrescribing PDA  Internet Pharmacy Ephysician (ephysician.com) Iscribe (iscribe.com) Allscripts* (allscripts.com) Pocketscript* (pocketscript.com) *Pocket PC only

22 Teaching Opportunities with PDAsPoint of Care Reference Textbook aortic dissection (HospMed) Guidelines bacterial meningitis rx (Sanfordguide) Differential diagnosis review lymphocytosis (Marik’s primer diff diag)

23 Teaching Opportunities with PDAsPrediction Rules Pre-test probability of disease predicting deep venous thrombosis (Medrules) Risk of disease predicting risk of breast cancer (BreastCa) Risk stratification stratify risk in unstable angina (TIMIcalc)

24 Teaching Opportunities with PDAsMedical Calculators Common equations ideal body weight (Medmath) Complicated equations change in plasma Na (MedCalc) acid base evaluations (ABGpro)

25 Teaching Opportunities with PDAsEvidence Based Medicine Post-test probability of disease pulmonary embolus spiral CT neg-sens 70% spec of 90% (Medmath) Number needed to treat beta blockers in chronic heart failure (EBM tables) Sensitivity and specificity Ottawa rules & ankle/midfoot fractures (EBM tables)

26 Teaching Opportunities with PDAsPharmacopoeias Drug drug interactions (epocrates Rx) multiple drug interactions Cost effective prescribing motrin versus vioxx Prescribing safely in pregnancy/nursing bactrim

27 PDAs in Medicine Summary Inexpensive and pocket sizeInvaluable to modern practicing physicians Unlimited access to information Potential to improve patient care Potential to be used as a teaching tool