# Presentation: 110136

## Emerging Technologies: Role of Handheld Devices in Clinical Practice

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

## 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.

## The Handheld Computer – The Players

- Palm OS
- Palm
- Handspring
- Sony
- TRG
- Nokia
- Kyocera

- Others: Newton, Psion, Franklin, Linux

- Windows
- HP
- Compaq
- Casio
- Toshiba
- Internec
- Palmax

## 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

## Palm is the dominant operating system for handheld devices

- Source: NPD Intelect as quoted in the *Wall Street Journal,* January 25, 2001

- Palm OS = 77.5% Share

- Palm OS = 86.0% Share

## Palm OS has the most developers

**Total Developers**
**(in Thousands)**

**135,000+**

**1999**

**2000**

- Source: Palm

## Standard Applications

- Calendar
- Phonebook
- Notes
- To Do Lists

- Expense Tracking
- E-Mail
- Calculator

## Palms In Medicine Today

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

## Drug References

- ePocrates – Thorough, easy, free
- qID – Drug/ID Database from ePocrates
- LexiDrugs – Comprehensive
- Apothecarium
- Physician’s Drug Handbook
- Miscellaneous Guides

## Majority of MD’s Using a Palm Device Are Using ePocrates’ Software

**#MD’s with a Palm Device**

**#MD’s using ePocrates**
** ****on a Palm Device**

- Current and Projected Use of Palm Devices and ePocrates Software*

- *year end predictions

*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***

*qRx Drug Reference Features:  **Adult Dosing*

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

*qRx Drug Reference Features: **Pediatric Dosing*

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

## qRx Drug Reference Features: Contraindications/Cautions

*qRx Drug Reference Features: **Contraindications/Cautions*

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

## qRx Drug Reference Features:   Drug-Drug Interactions

*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

## qRx Drug Reference Features: MultiCheckTM

*qRx Drug Reference Features: **MultiCheckTM*

- Step 1

-  Step 1 - tap the menu icon
-  Step 2 - tap “Run MultiCheck”
-  See the following page for a MultiCheck example

- MultiCheck allows you toselect up to 30 medications and instantly check for any interactions between them

**How to Launch MultiCheck**

**What is MultiCheck?**

## qRx Drug Reference Features: MultiCheck Example

*qRx Drug Reference Features: **MultiCheck Example*

## qRx Drug Reference Features: Adverse Reactions

*qRx Drug Reference Features: **Adverse Reactions*

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

## qRx Drug Reference Features: Cost/Packaging Info

*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

## qRx Drug Reference Features: Mechanism of Action and Other Info

*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

## qRx Drug Reference Features: Personal Notes

*qRx Drug Reference Features: **Personal Notes*

-  Write personal notes on any drug in the database
-  Notes can be “beamed” to colleagues

## qRx Drug Reference Features: Regimens and Tables

*qRx Drug Reference Features: **Regimens and Tables*

**1. Search by class by tapping “By Class” button**

## qRx Drug Reference Features: Regimens and Tables Example

*qRx Drug Reference Features: **Regimens and Tables Example*

**4. Select the desired regimen/table from the list**

**5. 16 regimens and tables, including new ACLS guidelines**

## 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

## qID - An Overview of Features

*qID - An Overview of Features*

**1. **qID thinks the way you do.  Search by anatomic location to arrive at your diagnosis within seconds.

## qID - An Overview of Features

*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.

## qID - An Overview of Features

*qID - An Overview of Features*

**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.

**Drug Groups**

## eTextbooks

- 5 Minute Clinical Consult
- Merck Manual
- 5 Minute Pediatric Consult
- Harrison’s Companion
- Others

## 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](http://www.firepad.com/)_)
- Viewer for image files
- TealDoc
- iSilo
- Documents to Go
- NCEP Tool
- NHLBI Obesity Tool

## iSilo

**iSilo** (www.isilo.com)
- Document reader
- _[www.aafp.org](http://www.aafp.org/)_ - List of common ICD-9 codes in Family Practice

## TealDoc

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

## 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

## 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

## NHLBI Obesity Guidelines Tool

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

## Medical Calculators

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

## PregCalc Pro

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

## MedMath

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

## MedCalc

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

## ABGPro

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

## STAT Cardiac Risk

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

## Patient Trackers

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

## Coding and Billing

- Stat E&M Coder
- Stat CPT Coder
- STAT ICD-9 Coder
- Codemeister

## STAT E& M Coder

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

## STAT CPT Coder

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

## 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

## 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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