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Mobile (Point of Care) Computing

Mobile (Point of Care) Computing. Kathleen Carlson, MS, AHIP Jacque Doyle, MS, AHIP, FMLA Robert Marlow, MD MA Howard Silverman, MD, MS Thursday, June 21 ~ 9:30am – 11:00pm. Learning Objectives. Review commonly used mobile medical information resources.

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Mobile (Point of Care) Computing

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  1. Mobile (Point of Care) Computing Kathleen Carlson, MS, AHIP Jacque Doyle, MS, AHIP, FMLA Robert Marlow, MD MA Howard Silverman, MD, MS Thursday, June 21 ~ 9:30am – 11:00pm

  2. Learning Objectives • Review commonly used mobile medical information resources. • Compare and contrast the attributes of DOEs (Disease Oriented Evidence) and POEMS (Patient Oriented Evidence that Matters). • Review the content of various mobile decision support tools. • Demonstrate the ability to utilize mobile decision support/point of care tools in a variety of clinical scenarios.

  3. Mobile Devices Jacque Doyle & Kathleen Carlson

  4. What type of phone do you own? • iPhone • Android • Blackberry • Other Go to SPOARS http://ars.medicine.arizona.edu

  5. SPOARS Poll Results

  6. What tablet do you own? • I do not own a tablet • iPad • Kindle or Kindle Fire • Nook • Android Go to SPOARS http://ars.medicine.arizona.edu

  7. SPOARS Poll Results

  8. Apps versus WebsitesWhat’s the difference? Why does it matter? • An APP is a software program for your mobile phone or tablet that must be downloaded. May be hardware specific. May require personal subscription. • A website consists of browser-based HTML pages that are linked together and accessed over the Internet. Usually is universally accessible.

  9. Apps and Websites • “By 2020 the specificity of apps vs. Web vs. anything else will begin to fade.” • “We won’t care whether it’s an app, Web app, or other devoted software as long as it gets the task performed seamlessly.” Sam Punnett, President of FAD Research - http://www.pewinternet.org/Reports/2012/Future-of-Apps-and-Web/Main-Findings/User-interface-paradigm.aspx

  10. What laptop do you primarily use? • Mac or Mac with Windows • Windows PC • Android • Other Go to SPOARS http://ars.medicine.arizona.edu

  11. SPOARS Poll Results

  12. Then and Now

  13. Mobile Apps Robert Marlow, MD MA

  14. Point of Care Functions • 2007 study of third-year Family Medicine residents who had clinical questions as they were seeing patients got answers from: • 44% attending physicians • 23% consulting mobile device • 20% books Acad Med 2007; 82(3):298-303

  15. Some useful apps and websites

  16. A great variety

  17. Medical Apps http://www.epocrates.com/mobile/iphone http://dynamed.ebscohost.com/access/mobile(access from Arizona Med)

  18. More Medical Apps http://www.immunizationed.org/ http://tinyurl.com/7hjv9u5

  19. More Apps http://epss.ahrq.gov/PDA/index.jsp £4.99 http://tinyurl.com/2dbssjg

  20. More Apps http://tinyurl.com/7j66t8b $1.99 http://tinyurl.com/83cqers

  21. Dr. Marlowe’s Favorite Apps ABG Acid Base Eating Disorders http://tinyurl.com/82ok2r3http://tinyurl.com/6vhqhwl EFM Guide GBS Guide http://tinyurl.com/7zn2rohhttp://tinyurl.com/6nv7ntv

  22. Dr. Marlowe’s Favorite Apps PE & DVT dx Tool Pneumonia http://tinyurl.com/6pf76n4http://tinyurl.com/7rkym54 PreOpEval Warfarin http://tinyurl.com/7d4fqothttp://tinyurl.com/7ejenw9

  23. Mobile Computing: Assessing Relevance & Validity Robert Marlow, MD MA

  24. It’s not how much you know, it’s how fast you can find the answer.®

  25. Usefulness Equation = Usefulness Relevance x Validity Work

  26. Assessing Relevance • Will this information have a direct bearing on the health of my patient? • Is the population studied similar to my patient (or population)? • Would it change my practice?

  27. Applicability to Practice DOEs(disease oriented evidence) • Increases understanding of disease • How a “disease works” The information requires assuming POEMs (patient oriented evidence that matters) • Evidence that patients care about • Crucial to clinicians The information requires knowing

  28. POEM:Patient-Oriented Evidence that Matters What matters to patients and their doctors? • Morbidity (Fractures, MI) • Mortality • $ Example: HCTZ to treat hypertension lowers stroke, MI

  29. Comparing DOEs and POEMs

  30. Assessing Validity • Pay attention to the Methods • Is there fatal bias? • Do not jump immediately to the results or conclusion without first assessing validity

  31. Mobile Computing: Lab (Let’s Play!)

  32. Case studies and practice • You are in clinic and a family of four comes in to see you for an office visit • We will deal with one family member at a time • Use some of the tools we’ve mentioned

  33. Meet our family...

  34. P.G. is the dad • 50 yo white male • Hx hypertension: BP 145/84 • Nonsmoker • FHx early CAD • Central obesity • Fondness for doughnuts and beer

  35. His labs • Total Cholesterol 236 • HDL 42 • LDL 167 • Triglycerides 385 Does he need treatment for hyperlipidemia? • Yes • No Go to SPOARS for survey http://ars.medicine.arizona.edu

  36. SPOARS Poll Results

  37. If “Yes,” what treatment would you advise? • Diet, exercise, and weight management only for now • Nicotinic acid • Statin • Fibrate Go to SPOARS for survey http://ars.medicine.arizona.edu

  38. SPOARS Poll Results

  39. L.G. is the Mom • 36 yofemale • Ankle injury, hobbled to car • Walked with limp into office • No pain on exam over either lateral or medial malleolus • Slightly tender on exam over dorsal midfoot, but not at base of 5th metatarsal or at navicularbone Does she need an X-Ray? • Yes • No Go to SPOARS for survey http://ars.medicine.arizona.edu

  40. SPOARS Poll Results

  41. Her son, S.G. 6 Month Well Child exam • Has been healthy, last seen at 4 months of age • Was up-to-date on immunizations including the 4-month immunizations given at that visit

  42. Her son, S.G. 6 Month Well Child exam • Has been healthy, last seen at 4 months of age • Was up-to-date on immunizations including the 4-month immunizations given at that visit What immunizations would you order today? • DTaP, Hib, Rotavirus, PCV, IPV, influenza • DTaP, Hib, Rotavirus, PCV, HepB, influenza • DTaP, Hib, Rotavirus, PCV, HepB, IPV, influenza • DTaP, Hib, Rotavirus, PCV, HepB, IPV Go to SPOARS for survey http://ars.medicine.arizona.edu

  43. SPOARS Poll Results

  44. His weight is 16 pounds today • What dose of ibuprofen would you recommend to be given every 6 hours as needed for fever or irritability? • 80 MG • 160 MG • 40 MG Go to SPOARS for survey http://ars.medicine.arizona.edu

  45. SPOARS Poll Results

  46. C.G. 13 yo male Fell Skateboarding Scraped his elbow Picked at the scab for 3 days Now there is a honey colored crust

  47. You diagnose impetigo What antibiotic should you use? • Does not need antibiotic – keep clean with soap and water washes twice daily • Mupirocin ointment applied topically • Bacitracin ointment applied topically • Amoxicillin/clavulanate orally • Penicillin VK orally

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