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Value of PDAs in Clinical Practice and Education My Internal Medicine Perspective

This article discusses the benefits and uses of PDAs (Personal Digital Assistants) in the medical field, including organizational tools, medical references, patient tracking, billing, and accessing information. It also explores teaching opportunities using PDAs for point-of-care references, textbooks, guidelines, and differential diagnosis reviews.

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Value of PDAs in Clinical Practice and Education My Internal Medicine Perspective

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  1. Value of PDAs in Clinical Practice and EducationMy Internal Medicine Perspective Lorenzo 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 • Organizational • 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 information • replaces “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. Palm 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. Window 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. EPOC 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 • Call schedules, conference dates, presentations, vacations etc… • To Do lists • Memo Pad • Read/Write/Store email

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

  10. PDA uses • Medical • Patient tracking • Patient billing • Reference • Prescription writing

  11. Patient Tracking • Patientkeeper (patientkeeper.com) • PatientTracker (handheldmed.com) • EPatient2000 (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 • internet=>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. Reference 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 2(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. Prescribing PDA  Internet Pharmacy • Ephysician (ephysician.com) • Iscribe (iscribe.com) • Allscripts* (allscripts.com) • Pocketscript* (pocketscript.com) *Pocket PC only

  22. Teaching Opportunitieswith PDAs • Point of Care Reference • Textbook • aortic dissection (HospMed) • Guidelines • bacterial meningitis rx (Sanfordguide) • Differential diagnosis • review lymphocytosis (Marik’s primer diff diag)

  23. Teaching Opportunitieswith PDAs • Prediction 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 PDAs • Medical Calculators • Common equations • ideal body weight (Medmath) • Complicated equations • change in plasma Na (MedCalc) • acid base evaluations(ABGpro)

  25. Teaching Opportunities with PDAs • Evidence 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 PDAs • Pharmacopoeias • 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 size • Invaluable to modern practicing physicians • Unlimited access to information • Potential to improve patient care • Potential to be used as a teaching tool

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