Top 10 Applications for your PDA: Practicing Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Top 10 Applications for your PDA: Practicing Information Mastery at the Point of Care

Scott M. Strayer, MD, MPH

Department of Family Medicine

University of Virginia

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Learning Objectives

• What is Information Mastery and how to practice it at the point-of-care.

• Choosing the right Personal Digital Assistant for your practice.

• How to turn your Personal Digital Assistant into a Medical Digital Assistant.

• The top 10 applications for your Medical Digital Assistant for practicing Information Mastery at the point-of-care.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

How do we learn?

• Adults learn by solving problems

• Our “problems” = clinical questions

• CME can highlight advances and make us

aware of our deficits

• Answering clinical questions in the context

of a real case at the point of care is how we

learn

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Clinical questions• They’re common: Average 1 question for every other

patient • They’re important

– Only 1 in 3 questions pursued– Found “answer” 80% of time– Guess at 70-80% of information needs!– Journals only used to answer 2 of 1101 questions in busy

practice– Books, colleagues used most often

Ely JE. Analysis of questions asked by family doctors regarding patient care. BMJ 1999;319:358-61

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Clinical Questions

• Internal Medicine Residents– 2 for every 3 patients

– 29% pursued

– textbook (31%); journals (21%); attendings (17%)

• Patient expectation, fear of malpractice associated with seeking answer

• Lack of time (60%), forgot (29%).Am J Med

2000;109:218-33.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Information Mastery and Computers

Slawson DC, Shaughnessy AF, Bennett JH. Becoming a Medical Information Master:Feeling Good About Not Knowing Everything. The Journal of Family Practice 1994;38:505-13.

Can be reduced bycomputers

Usefulness = Relevance x Validity Work

Not always assessed by software

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Computers to Drill for the Best Information

Web, InfoRetriever

InfoRetriever, JournalWatch

Best Evidence

CogniQ, BMJ, FPIN

Unbound, Skyscape

Use

fuln

ess

CogniQ, SkyscapeMedline

Reviews/Textbooks

POEMs

Clinical EvidenceClinical Inquiries

Cochrane

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Choosing EBM Sources1. How is the information filtered?

– Patient- vs disease- oriented?– Specialty-specific?– Comprehensive? Which journals?– Does it matter (it should change my practice) or is

it simply news?

2. Is the information valid?– Is level or strength of evidence labeled?– Beware “Trojan Horse”!– How often updated?– Evidence or expert opinion

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Two Tools Needed to Master Information

• A method of being alerted to new information (foraging)

• A tool for finding the information again when you need it. (hunting)

• Without both:– You don’t know that new info. is available– You can’t find it when you do

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

So, Which Handheld Should I Buy?

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Pocket PC Models

Dell Axim X30 Dell Axim X50 HP IPaq 2215 HP IPaq hx4715

Casio EG800Premium Asus MyPal A716

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Website for PDA Comparisons

• http://www.healthsystem.virginia.edu/internet/library/services/computing/pda/

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Websites for Handheld Programs

• www.pdamd.com- great reviews, for physicians specifically

• www.palmgear.com-shareware, freeware and commercial programs.

• www.handango.com-shareware, freeware, and commercial programs.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Websites for Programs

• www.handbase.com-programs that run on the database program “HanDBase” (many of them are free)

• www.handheldmed.com-physician reviews for Palm Pilots and Windows CE handhelds

• Pbrain.hypermart.net-many useful programs.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

More Web Sites

• Medical Piloteer Ring healthypalmpilot.hypermart.net/webring

• www.pocketpc.com

• Many useful and convenient links for medical programs on the Palm Pilot.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

How to Download and Install Handheld Software

• See http://www.pdamd.com/vertical/tutorials/guides/installpalm.xml (for Palm OS)

• http://www.pdamd.com/vertical/tutorials/guides/installce.xml (for PocketPC)

• These are the best tutorials I have seen yet.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Presenting The Top 10….

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

#10 Your Favorite Textbook on your Handheld

• TextBooks: http://www.skyscape.com; www.unboundmedicine.com

• Merck Manual and 5 Minute Clinical consult on Palm or Pocket PC handhelds.

• Also available: Harrison’s, Neofax, PDR, Emergency Medicine (Cline), Surgical Pearls, DeGowin and DeGowin’s Diagnostic Examination, Obstetrical Pearls, Gynecological Pearls, Red Book, 5 Minute Pediatric Consult.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

#9 An Immunization Schedule

• Shots 2005-vaccination recommendations with information on all vaccines and catch-up schedules (available at www.immunizationed.org).

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Shots 2005 for Palm

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Shots 2005 for Pocket PC

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

#8 Medical Calculators

• MedCalc for Palm (www.palmgear.com)

• Archimedes for Pocket PC (www.skyscape.com)

• ABG Pro (www.stacworks.com)

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

MedCalc

• MedCalc-formulas for creatinine clearance, fractional excretion of sodium, IV fluid rates, number needed to treat, post-test probabilities, predicted peak flow, pregnancy calculator.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

MedCalc on Your PDA

Main Menu Calculating FENA

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Medical Calculator for the Pocket PC

• Archimedes-free calculator that has all the same calculations as MedCalc.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Archimedes on your Pocket PC

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

ABG Pro

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

#7 Information Mastery Calculators

• MedRules (http://pbrain.hypermart.net).

• Handheld Computer Smoking Intervention Tool (www.smokefree.gov/hp-hcsit.html).

• Fine’s Rule for Pneumonia (www.ahrq.gov)

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

MedRules

• Medrules-Gail breast cancer risk, bishop’s score, Goldman’s score, APACHE II scores, Sinusitis predictor, UTI predictor, Appendicitis score, Pharyngitis evaluation, Ottawa rules, and many more.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

MedRules on your PDA

Main Menu Bishop’s Score

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Handheld Computer Smoking Intervention Tool (HCSIT)

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Fine’s Rule for Pneumonia

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

#6 OB Wheels

• PregCalc Pro (www.medicaltoolbox.com).

• PregTrak (www.stacworks.com).

• Due Date Calc (www.handango.com).

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

OB Tools

• PregCalc Pro-allows you to enter LMP, EDD or U/S data to calculate EGA, EDC, etc. Allows you to save patients.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

PregPro

-Set LMP-Set EDD-Confirm U/S dating-Lab reminder-Saves patients

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

DueDateCalc

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

#5 Daily Updates from the Web

• AvantGo (www.avantgo.com)

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

AvantGo Mobile Internet

• Free! - http://www.avantgo.com• Web-based (content written in HTML)• Users subscribe to “channels” (specially-

formatted Web sites)– Commercial– Private

• Automatically updated with each HotSync

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

• Duke University Medical Center Library Evidence-Based Medicine File URL: http://www.mclibrary.duke.edu/respub/pdaformat/Author: Connie Schardt, MLS, AHIPOperating System: Palm OS, Pocket PC, WinCE

• Free PDA file of evidence-based medicine resources. Contains information on EBM terminology, how to construct a well-built clinical question, and how to evaluate various types of journal articles. A reference guide on searching Ovid MEDLINE is also included. Free AvantGo account required.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

AvantGo

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

#4 Your Favorite Websites at the Point-of-Care

• iSilo (www.isilo.com)

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Using Your Favorite Websites at the Point of Care

• iSilo-allows you to add web pages to your Palm Pilot. I.e. can add JFP Poems index (www.infopoems.com) or Iowa Family Practice Handbook (www.vh.org/providers/clinref/fphandbook/fpcontents.html)

• Get browser at www.isilo.com• Follow instructions on using iSilo web.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Cochrane Abstracts on iSilo

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

CDC Travel on Your Palm

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

#3 Database Program

• HanDBase (www.handbase.com).

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

CME Tracker on HanDBase

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Entering a Procedure in HanDBase

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

#2 A Good IM Reference

• InfoRetriever (www.infopoems.com)

• Unbound Medicine and Clinical Evidence from BMJ (www.unboundmedicine.com)

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

InfoRetriever 2005Windows 95/98/NT/ME/2000/XP, PocketPC, Palm and Web

Bayesian diagnostic test / H&P calculator (2000+)

Basic drug info by class and cost for 1200 drugs

Key evidence-basedtreatment guidelines

Cochrane Databaseof Systematic Reviews:over 1750+ abstracts

200+ clinical predictionrules

www.InfoPOEMs.com

2200+ short research synopses (400 added per year)

5 Minute Clinical Consult

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

InfoRetriever to help with treatment decisions

• A 46 y/o male, smoker– PMH significant for hypertension treated with HCTZ.

Most recent BP = 138/86. – FH: Both parents have HTN over age 70, no h/o CAD. – Lipids: Chol = 197; HDL = 41; LDL = 141.

• Questions:– What is his risk of an AMI or sudden cardiac death

in the next 10 years? – How much will lowering the SBP below 130 reduce

the risk? – How much will stopping smoking affect his risk?

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

InfoRetriever

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

InfoRetriever

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

InfoRetriever

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Should his SBP be lowered to <130?

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

What if he quit smoking instead?

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

A Patient Success Story

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Unbound Medicine

• http://www.unboundmedicine.com

• CogniQ platform enables installation of popular reference titles with auto-updating capability

• Has OVID searching capability with web-based management of knowledge

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

#1 A Good Drug Reference

• ePocrates qRx 6.0 (www.epocrates.com)

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Writing Prescriptions

• Epocrates qRX 6.0-comprehensive free drug database. Replaces PDR, Pocket Pharmacopiea. (www.epocrates.com go to “product information” and register )

• adult dosing, pediatric dosing, metabolism, pregnancy categories, drug interactions and contraindications.

• Notes section for your own comments.• Hotsync daily with web updates.

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Winchester Medical Center Grand Rounds 2005 ©2005, Scott M. Strayer, MD, MPH

Information Mastery at the Point of Care

Contact us:Scott Strayer

sstrayer@virginia.edu

Website:Center for Information

Masteryhttp://

www.healthsystem.virginia.edu/internet/familymed/docs/

info_mastery.cfm