1. Value of PDAs in Clinical Practice and Education My 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 Teaching Opportunities Examples
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. Handspring Visor, Palm Pilot, TRG Pro, HandEra, Sony, IBM
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. Casio, Compaq, HP, NEC, Dell
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. Symbian, Psion, Ericsson, Oregon Scientific
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 To Do lists Memo Pad
Call schedules, conference dates, presentations, vacations etc…
To Do lists
Memo Pad
Read/Write/Store

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)
EPatient (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 Readers Plugins
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. Medical Calculators/Formulas/Prediction tools
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 (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. PDA  Internet Pharmacy
Prescribing
PDA  Internet Pharmacy
Ephysician (ephysician.com)
Iscribe (iscribe.com)
Allscripts* (allscripts.com)
Pocketscript* (pocketscript.com)
*Pocket PC only

22. Teaching Opportunities with 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 Opportunities with 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