Supporting Your Practice with Portable Information Technologies

1. Supporting Your Practice with Portable Information Technologies Brent I. Fox, PharmD, PhDAssistant ProfessorDepartment of Pharmacy Care Systems Auburn University Harrison School of Pharmacy

2. Objectives • Describe the need for portable information technologies to support pharmacy practice • Describe evidence surrounding the use of software to support pharmacists’ decision-making • Describe the selection factors to consider when adopting a portable information device • Describe the array of portable information technologies available for pharmacists • Identify 3 portable information device accessories for purchase consideration • Develop a personal plan for device and software adoption

3. Awareness: The Focus is on Safety • Institute of Medicine (IOM) • To Err is Human: Building A Safer Health System (11/99) • Crossing the Quality Chasm: A New Health System for the 21st Century (3/01) • Health Professions Education: A Bridge to Quality (4/03) • Preventing Medication Errors (7/06)

4. Core Knowledge Schiff AJHP 2002

5. 1-7: 78% of errors Limited information access Information should be available to physicians, nurses, & pharmacists when and how it is needed Systems Failures and Attributed Errors (Leape, 1995)

6. Sackett et al. define evidence-based medicine as: "The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients; EBM de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research." Evidence-based Medicine Sackett, D.L. et al. (1996) Evidence based medicine: what it is and what it isn't. BMJ 312 (7023), 13 January, 71-72.

7. Why Practice EBM? • New types of evidence are now being generated which, when we know and understand them, create frequent, major changes in the way we care for patients. • Although we need new information daily, we usually fail to get it. • Our up-to-date knowledge and clinical performance deteriorate over time. • Traditional CE does not work. • A different approach has been shown to be more effective. David Nash, Wisconsin Quality and Safety Forum, 10/08

8. There were 6000+ new articles published globally in the biomedical literature in 1992. There are limits to our human memory, and we humans have a limited ability to incorporate information into our decision-making. We have opinions, but these opinions may be based on conjecture. David Eddy takes the position that, "The complexity of modern American medicine is exceeding the capacity of the unaided human mind." EBM: Challenges Davidoff F, Haynes B, Sackett D, Smith R. Evidence based medicine. BMJ. 1995;310:1085-1086. Evidence-based Health Care program presented at the University of California, San Diego, June 2002.

9. Any content Any device Any network Any time Our Commodity

10. Software Types • iPhone only • 2010 California Healthcare Foundation. How smartphones are changing health care for consumers and providers. http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf

11. Software Types: Medical Reference • iPhone only • 2010 California Healthcare Foundation. How smartphones are changing health care for consumers and providers. http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf

12. Software Considerations: General • Updating • Download or Web-based • Free/trial version • UI/functionality • *Features • Pricing (multi-year) • Linking across applications • Space requirements • Memory card support • Electronic version of paper reference? • A word about installation • Data plan costs • Drug interaction checking • Severity scale • Number • Pharma or other support? • Target users • Charts & tables • Notes • Training and support • All apps for all platforms? • Tablets? • Nonrenewal = stop?

13. Software Considerations: Features • Search • Brand/generic • Indication, ADR/SE • NDC • Drug class • Other • Patient education • Images • Pricing • Calculators • information • Formulary integration • IV compatibility • International products • Storage • Administration • Dosage forms and strengths • Dosing (special populations) • Other monograph content desired

14. Epocrates • Epocrates Rx • Epocrates Essentials • iPhone • BlackBerry • Palm WebOS • Android • Windows Mobile

15. Clinical Pharmacology • Website • iPhone • BlackBerry • Windows Mobile 6 • Android

16. Facts and Comparisons • A to Z Drug Facts • Unbound Medicine • Silver • Medications and updates • Gold • + Drug Interaction Facts • Platinum • + Review of Natural Products • Android • BlackBerry • Windows Mobile • Palm OS • A to Z Drug Facts • Skyscape • iFacts • Android • BlackBerry • iPhone • Palm OS • Symbian

17. mobile Micromedex • Revamped Jan 2010 • Wireless access via browser • Includes • DrugDex • DiseaseDex Emergency Med • DiseaseDex General Med • AltMedDex • Drug-Reax • IV Index • IdentiDex • Lab Avisor • Complimentary • Data plan required • iPhone • BlackBerry

18. Lexi-Comp • Individual databases (20+) • Packages • Handheld (+ Online) • Updates • Palm OS • Windows Mobile • BlackBerry* • iPhone • Palm WebOS* • Android

19. Lexi Complete Suite • Lexi-Drugs • Lexi-Interact • Lexi-Natural Products • Pediatric Lexi-Drugs • Lexi Poisoning and Toxicology • Lexi-Lab and Diagnostic Procedures • Lexi-Infectious Diseases • Lexi-Pharmacogenomics • Lexi-Calc • Dental Lexi-Drugs • Nursing Lexi-Drugs • Lexi-PALS • Nuclear, Biological, and Chemical Agent Exposures • Lexi-Companion Guides • Perioperative Nursing Lexi-Drugs • Lexi-I.V. Compatibility • Medical Abbreviations • Griffith’s 5 Minute Clinical Consult • Stedman’s Medical Dictionary • Pharmacotherapy Handbook (from McGraw Hill) ++

21. Computer Hardware Array (large to small) • Mainframes • Minicomputers • Micro-Computers • IBM and Clones • Apples • Desktops • Towers • Mini-Towers • Integrated • Notebooks • Tablets • Convertibles • COWs • Air Panels • Sub-notebooks • UMPC • Palmtop PDAs • SmartPhones

22. Personal Digital Assistants (PDAs) Shirt Pocket OS Options Screen Size Connectivity Storage Swappable Batteries Data Entry

23. Pure PDAs…

24. Smartphones Cellular Carrier Data Plans OS Options Data Input Storage Swappable Batteries Added Features

25. Palm WebOS (and Palm OS) • Legacy devices (T|X) • WebOS • Pre Plus • Pixi Plus • Elevation Partners • Sprint, Verizon, AT&T* • >2000 apps

26. iPhone and iPod Touch • Apple • Revolutionized smartphone market • Integration with other Apple products • AT&T • 185K apps

28. Android • Open OS • Google • Many hardware manufacturers • T-Mobile, Verizon, Sprint • >50K apps

29. Windows Phone 7* • Coming 4th qtr? • Completely new • Xbox LIVE and Zune integration • Tiles (vs Start) • Many hardware manufacturers • AT&T, Sprint, Verizon, T-Mobile • Apps?

30. BlackBerry • BlackBerry 6 (3rd qtr) • Trackball • Enterprise integration • Data plan • AT&T, Sprint, Verizon, T-Mobile • Apps? (>2000)

31. Mobile OS Comparison

32. Features Comparison http://cell-phones.toptenreviews.com/smartphones/

33. Types of Connections

34. Selection Criteria • Do you want 1 device or are you OK carrying 2? • If 2, get a PDA from eBay or an iPod Touch • If 1, read on…. • Status of current cellular contract • If you can not get out, select among your carrier’s devices (next slide) • If you can get out, next slide

35. Selection Criteria • If staying with your current provider, start with what you can afford • Device • Plan (voice and data) • If switching carriers, consider coverage and price

36. Selection Criteria: Features • Interaction • Touch screen vs Keyboard (Real/Virtual ) vs Both • Wireless • High speed data vsWiFi • Camera • Quality • Flash • GPS

37. Selection Criteria: Features • Bluetooth • Apps • Music/video • Memory • Battery life • Form factor = test drive • Verizon

38. Cost of Ownership Caveat: 10/28/09

40. Accessories

41. Additional Topics

42. Patient Education

43. Google Translate (34 languages)

44. Innovation in Wireless Products is Accelerating! • Apple iPhone, 3 Skype Phone, Amazon Kindle, Google…. • 91% of mobile users keep phone within 1 meter reach 24x7 • 15-25% of mobiles have GPS, 50% within 5 years Morgan Stanley – Web Trends 2007 –http://www.slideshare.net/misteroo/web2-139178?src=related_normal&rel=5944 California Healthcare Foundation. How smartphones are changing health care for consumers and providers. http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf

45. Where are Patients are Tuning In? California Healthcare Foundation. How smartphones are changing health care for consumers and providers. http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf

46. Connecting with Your Patients in the Future Web 2.0 Health 2.0 PHR EMR/EHR National Records Physician Practice Hospital Or IDN Inpatient EMR Clinical Data Repository Ambulatory EMR Electronic Medical Record Hospital Information System Payer EMR Member Clinical Summary Rx Claims History EHR Patient Payer Personal Health Record Managed Care Information System Pharmacy PBM PHR Clipboard PMR: Current Meds Pharmacy Management System Clinical Lab Information System Image Management System Pharmacy Lab Imaging PACS Archive Diagnostic Image Repository Prescription History Patient Lab History Blood Donor Repository Genetic Profiles California Healthcare Foundation. How smartphones are changing health care for consumers and providers. http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf

47. Questions Brent I. Fox, PharmD, PhDAssistant ProfessorDepartment of Pharmacy Care Systems Auburn University Harrison School of Pharmacy