PDAs and Medicine

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PDAs and Medicine

• UM-AMIA (American Medical Informatics
  Association)
• September 20, 2004

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AMIA

• American Medical Informatics Association
• dedicated to the development and application of
  medical informatics in the support of patient
  care, teaching, research, and health care
  administration.
• Working Groups
• Clinical Info Systems
• Clinical Trials
• Consumer Health
• Medical Imaging
• Meetings Annual Symposium, MedInfo,
  Spring Congress (April 2005 in Boston)
• www.amia.org

• - Prevention and Public Health
• - Primary Care
• - Student

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UM-AMIA

• Student interest in Medical Informatics
• Membership in AMIA not required, but encouraged
• Executive Board
• President Richard Month, MS-3
• VP/Treasurer Jorge Alex Alvarez, MD/PhD
• VP/Secretary Nathan Connell, MS-2
• Advisor Dr. Mark OConnell
• Elections in April
• Presentations
• Invited Speakers
• Journal Club
• Field Trips!!!

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Why do you need a PDA?
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The Clinical Need Access to Constantly Changing
Information

• Need to increase access to burgeoning amount of
  clinical information 40,000 Medline citations
  added monthly
• 1-2 new drugs approved on average each week
• Rapidly increasing number of genetic, cellular
  and other diagnostic tests

A physician who reads all day long for 6 weeks
will already be a century behind. (Criswell,
JAIA 2002)
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Explosion in Physician Use

• Approximately 40 of U.S. doctors use PDAs
  (Forrester Research 2003)
• An increase of 50 since 2001
• This is projected to grow to gt50 by end of 2004
  and gt75 by 2007 (Gartner Research 2002)
• Usage high for both PCPs and Specialists
• ACP/ASIM found nearly half of members using PDAs
  in 2001
• Specialist use high among cardiologists,
  anesthesiologists, psychiatrists, oncologists
  (Rowan Group, 2001)

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How MDs use PDAs
MDs Using the Function
Source Health Information and Management Systems
Society, 2002
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BenefitsMobile Technology

• At the point of careit goes where you go
• Access to extensive information
• Integrated, all-in-one-place functionality
• Up to date, event breaking, clinical developments
  
• Potential for mass customization

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Decision Criteria

• Key Decision Criteria
• Operating System
• Palm vs Microsoft PocketPC
• Device Functionality
• Smartphone vs PDA
• Premium Features
• Available memory
• Expansion Card
• Keyboard
• Screen resolution/color
• Other features (e.g., Wi-Fi, camera)

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Features

• Functionality
• Smartphone Advantages
• Single, all-in-one device with mobile web
  browsing/updates
• PDA Advantages
• Cheaper no monthly charges (lt100-300) and
  better battery life
• Premium Features
• Expanded Memory 16 MB is low end, 128 high end
• Thumb Keyboard
• Easier to learn and usually faster but bulky and
  more expensive
• Other Features
• Camera (Better resolution/color)
• MP3 player
• Connects to computer networks (Bluetooth, Wi-Fi)

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PDA 101

• Theres more than one kind
• Palm OS (Operating System)
• PalmOne www.palmone.com
• Sony Clie www.sony.com
• Windows Pocket PC
• HP iPaq www.hpshopping.com
• Dell Axim www.dell.com
• Toshiba www.toshiba.com

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Palm One
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Sony Clie
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HP iPaq
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Dell Axim
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Toshiba
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Memory

• Sony Memory Stick
• Sony Clie
• SD (Secure Digital)
• Palm, Dell, HP, Toshiba

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Palm Applications

• Telephone book
• Schedule
• Notes
• Photos
• Documents www.dataviz.com
• Email
• Wireless Internet

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Palm Applications

• Study Guides - flash cards
• Medicines
• By name, class, bug/system, formulary
• Diagnosis
• Calculations
• Patient Information Storage
• Decision Support

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MS 12 MS 34

• Epocrates
• Rx, Medtools
• Flash cards
• Make your own
• Buy a module
• With Kaplan Q-bank
• Mnemonics

• Epocrates
• Rx, MedTools, Dx, ID, Tables
• Johns Hopkins Antibiotics guidewww.hopkins-abxgui
  de.org
• Patient Keeperwww.pkpersonal.com

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Epocrates

• Epocrates Rx, MedTools (FREE)
• Epocrates Dx, ID, Tables (Sold separately or
  with Pro)
• Epocrates Essentials (All Modules)

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Epocrates Essentials
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Epocrates

• Infectious Disease
• Tables

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Epocrates

• Lab

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Epocrates

• Dx

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Epocrates

• Framingham Risk Calculator

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Patient Keeper
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Accurate Information

• Insufficient drug and drug interaction
  information are the most common causes of serious
  medication errors
• Ideal use for handheld devices as drug specs can
  be obtained during the patient encounter,
  reducing errors and need for patient/pharmacy
  callbacks
• Available drug reference information includes
• Dosing calculator
• Drug interactions
• On and off-label use
• Formulary and pricing
• Adult and pediatric dosing
• Detailed drug and alternative medicine monographs

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Information Efficiency

• Allows physicians to spend more time focused on
  patient interaction reduces information overload
  
• Information readily updatable so that clinical
  knowledge remains current
• Information functions, sources include
• Disease compendia, laboratory diagnostic guides,
  specialty guidelines
• Medline/medical literature access
• Goal is to make information more manageable
• Speed and ease of use are the key

Medication look up takes 15 seconds. Checking
for interactions? Another 10 seconds. Open the
chapter in 5-Minute Clinical Consult on atrial
fibrillation -- another 15 seconds. Reider,
Medscape 2002
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Patient Safety and IT

• Lab Values and Decision Support
• Communication and Access to Information
• Calculations

From Bates and Gawande (2003) NEJM 348
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Error Reduction

• Physicians reported that use of PDA-based
  applications prevented an average of 2 adverse
  drug events
• (Bates, JAMIA 2001)

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Tracking and Monitoring

• Numerous reports suggest that use of mobile or
  wireless technology can improve patient tracking
  and exchange of patient information among medical
  staff
• Applications include
• Sending wireless alerts for physiologic,
  laboratory and medication data
• Managing transition between house staff
• Reducing transcription error by handheld data
  entry

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Patient Experience

• Anecdotal experience indicates that patients
  accept -- and view positively -- use of
  handhelds in the physician encounter
• Appreciate that doctor is being careful and
  precise and accessing the latest information
• Welcome opportunity to obtain information on the
  spot (e.g., drug interactions, cost/reimbursement)

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The Future

• Emerging Applications
• e-prescribing
• Wireless alerts
• New Applications
• CME Allow doctors to do CME on the go
• Advances in functionality
• Adoption/spread of wireless networks
• Introduction of systemic/institutional
  paradigms/protocols

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Conclusions

• Adoption increasing rapidly Physicians now past
  early adopter phase and into early majority phase
• POC access to information shown to increase
  evidence-based decision making
• Handhelds more convenient than paper/web
• POC drug reference critical for reducing
  medication errors
• Handhelds offer other advantages in the clinical
  interaction, including the ability to involve the
  patient in disease management

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Conclusions

• Current applications used include drug
  references, medical calculators and patient notes
• Emerging/future applications include
  e-prescribing, clinical alerts and CME
• Easy to see how in the not too distant future
  handheld devices will be as ubiquitous and
  essential in the medical suite as stethoscopes
  are today

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Links

• More PDA Info www.pdaMD.com
• www.medicalmnemonics.com
• Tech shopping www.cnet.com
• Price/Product comparisons, reviews

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