how to get the whole medical world in the palm of your hand scott hamstra, md, national medical...
TRANSCRIPT
How to get the Whole Medical World in the Palm of your
Hand
How to get the Whole Medical World in the Palm of your
Hand
Scott Hamstra, MD, National Medical Informatics ConsultantLT Christopher C. Lamer, PharmD, CDE
Scott Hamstra, MD, National Medical Informatics ConsultantLT Christopher C. Lamer, PharmD, CDE
ObjectivesObjectivesAt 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.
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.
Evaluation of PDA Effectiveness
PDA vs. PDR vs. InternetEvaluation of PDA Effectiveness
PDA vs. PDR vs. Internet
The QuestionThe 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…
• 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?
Step 1
Turn on your PDA and select ePocrates by tapping on the icon.
Drugs All
Drug
Drug
Drug
TNKase
Drug
Look Up:_____________tnk
Step 2Write the drug name using graffiti or tap on the ‘abc’ to get a keyboard that you can ‘type’ on using the stylus.
Select TNKase.
Tenecteplase
(IV)
Myocardial infarction, acute
[wt<60kg]
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
Read answer.
It’s that simple!
Step 3
The Winner…The Winner…Updated Daily
Easy index
Easy search capabilities
Fast results
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
The Loser….
Updated yearly
Difficult index
Time consuming to flip through pages
Must read passages to find information
ePocrates highlighted in the Wall Street Journal as being faster than
the PDR
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."
Anatomy and Physiology of the PDA
(Personal Digital Assistant)
Anatomy and Physiology of the PDA
(Personal Digital Assistant)
Palm OS and Windows CEPalm OS and Windows CE
Palm and HandspringPalm and Handspring
Clinical ApplicationsClinical Applications
• ePocrates• ePocrates QID• Tarascon• ePharmacopoeia• ACLS2000• 5-Minute Clinical
Consult• BMI Calculator• Mobile Micromedex• Shots 2002
• 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
EpocratesEpocrates
Updatable DailyUpdatable Daily
• Hot sync PDA daily to obtain the latest up-to-date medication information
• PDR is updated yearly
• Hot sync PDA daily to obtain the latest up-to-date medication information
• PDR is updated yearly
Searchable by class or drugSearchable by class or drug
Adult Dosing, Pediatric Dosing, Contraindications, Cautions…Adult Dosing, Pediatric Dosing, Contraindications, Cautions…
Drug InteractionsDrug Interactions
Adverse ReactionsAdverse Reactions
Cost & Other InformationCost & Other Information
Multi-CheckMulti-Check
Customizable NotesCustomizable Notes
Non-Clinical ApplicationsNon-Clinical Applications
• Address Book• Calendar
– Date book– Appointments– Reminders– Alarms
• Calculator• Memo pad• To do list• Mail• Expense Log
• Address Book• Calendar
– Date book– Appointments– Reminders– Alarms
• Calculator• Memo pad• To do list• Mail• Expense Log
PDA use in the IHS PDA use in the IHS
Cherokee
Warm Springs
White River
Others…
PDA SurveysPDA 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
• 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
Survey ResultsSurvey 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
• Major uses:
– Address Book
– Treatment Algorithms
• Satisfaction 33 yes vs. 3 OK
• Most used clinical applications
– ePocrates (Rx and QID)
– 5 Minute Clinical Consult
Survey ResultsSurvey 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
• 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
Survey ResultsSurvey 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
• 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
National SurveysNational 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
“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
PDAs and Patient EducationPDAs 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
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
PDAs and Patient EducationPDAs 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
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
PDAs and Patient EducationPDAs 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.
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.
• 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.
• 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.
• 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.
• 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.
PDAs and Patient EducationPDAs 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.
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.
• 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.
• 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.
PDAs and Patient EducationPDAs 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
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
PDAs and Patient EducationPDAs 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’
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’
PDAs and Patient EducationPDAs 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
• 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
PDAs and Patient EducationPDAs 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
• 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
PDAs and Patient EducationPDAs 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…
• 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…
Patient ConfidentialityPatient Confidentiality
HIPPA
Warm Springs’ Policy
Setting up a PDA ProgramSetting 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
• 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
ITSC Home PageITSC Home Page
home.IHS.gov/ITSC-CIO/index.asphome.IHS.gov/ITSC-CIO/index.asp
www.ihs.gov/CIO/InfoTech_index.aspwww.ihs.gov/CIO/InfoTech_index.asp
