Digital signing of prescriptions

Mobile Health Data reports that Dallas-based eMedRx has partnered with Baltimore-based Health Resources Inc. to enable pharmacists to access electronic prescriptions that employ electronic signatures.
The agreement will enable the pharmacies in Health Resources' network to use software from eMedRx to access prescriptions written by physicians using the vendor's electronic prescription service. The application enables physicians to use PDAs to sign prescriptions with digital biometric technology. The prescription is sent to a centralized eMedRx server to be validated. It's then encrypted and sent to a patient's pharmacy. The agreement will enable Health Resources pharmacists to access the vendor's server and retrieve and decrypt prescriptions for their patients.

By digital biometric technology I suppose the company means fingerprint recognition technology, voice recognition or retina scans. How foolproof is this I wonder? There will still be security problems with biometrics.

Verifying specimens with PDAs

If you work in a busy hospital you can appreciate how easily the problem with mixed up specimens can occur. The blood collection team could collect the specimen from a patient into a wrongly labelled tube belonging to another patient. The end result could be extremely disastrous, say if it were a cross match sample.
PDAs with bar code scanning features such as those produced by Symbol can now be used to reduce such errors in the collection process. Mobile Health Data reports that Washington Hospital Center is using PDAs to help increase patient safety during specimen collection and lab results reporting by using the new wCareCollect bar-coding software from McLean, Va.-based Care Fusion for its safety initiative. The software is designed to enable caregivers to scan a patient's bar coded wristband with a PDA to help match their information to an order and their specimen. The software also offers bar coded label printing functionality, for accurate labeling of specimen containers.

Mobility Helps Hospital, Students

Birmingham, Ala.-based Children's Health System has achieved 100% compliance with a new residency program mandate with the help of mobile software, organization executives say.
The 275-bed, not-for-profit hospital implemented the MData Enterprise System from Durham, N.C.-based Mercury MD Inc. about a year ago. Within two months of implementation, the software helped the hospital's residents reduce time previously spent gathering data from 50% to 19% of their work day, executives report. As a result, the residents have been able to complete required work while spending less time at the hospital.
Residents' reduced work hours also have helped the hospital comply with a mandate from the Accreditation Council for Graduate Medical Education that went into effect last summer. The rule includes an 80-hour limit on the time residents can work at their hospitals.
Residents at Children's Health System are using the MData software on PDAs from: Dell Inc., Round Rock, Texas; palmOne Inc., Milpitas, Calif.; Hewlett-Packard Co, Palo Alto, Calif.; Toshiba America Information Systems Inc., Irvine, Calif.; and Sony Corp. of America Inc., New York.


Source: Mobile Health Data

Healthy Living in the 21st Century 2004

This is a free e-book from Pacific Primary Care with great examples on how to get started on healthy eating, regular physical fitness and details stress management for persons of all ages. The Chapters include The Best (Recommended) "Diet" Advice | Exercise for Life Tips | The Obesity Epidemic | Stress Management | Basic Nutrients and Special Diets.
It looks like an okay read but has a large section advertising Pacific Primary Care's other (excellent) Medical Books.

Radproc



Radproc is a new release from Skyscape

RadProc (Handbook of Interventional Radiologic Procedures, Third Edition) is the PDA version of the #1 handbook in interventional radiology covers all current procedures--from venous access techniques and embolizations to stent-grafts and carbon dioxide angiography. It provides instant access to information on protocols and equipment; indications, complications, and clinical outcomes; drugs and dosages; and noninvasive studies and laboratory values.

PDA-based Claims Check

PracticeXpert Inc. has released a PDA version of its revenue management information system that enables point-of-care claims review. The PXpert application is designed for group practices and is integrated with the practice management system from Horsham, Pa.-based NextGen Healthcare Information Systems.
Its a Windows mobile based system.

Read more from Mobile Health Data

Best Drug Interaction Software?

Got this press release in the mail:

Mobile Medical Reference Leader Receives Top Scores for Accuracy, Comprehensiveness and Ease-of-Use

HUDSON, Mass.-March 23, 2004-Skyscape (R), Inc. (www.skyscape.com), the leading provider of enterprise-wide mobile medical and nursing solutions, today announced that a recently released study in the American Journal of Health-System Pharmacists found that Skyscape-powered references were the best drug interaction software available for PDAs.

The independent study evaluated nine drug interaction software programs for handheld computers from seven companies, including Skyscape and ePocrates.
The study rated them based on their ease-of-use, comprehensiveness and accuracy. Skyscape-powered iFacts™ (Facts & Comparisons’ Drug Interaction Facts) was recognized as the best software program overall and received a perfect score in terms of comprehensiveness and a ranking of 390 out of 400 for accuracy, which was the highest ranking for accuracy.

By comparison, five of the nine references reviewed received a comprehensiveness score of 100 or less out of 200, with a popular free drug interaction reference receiving only 50 out of 200 points for its comprehensiveness.

Two of Skyscape’s references, Mosby’s Drug Consult and iFacts, were ranked first and second in terms of ease-of-use. The February 2004 study stated that, “The exceptionally easy-to-use interface of Mosby’s Drug Consult software and iFacts (both by Skyscape) proved fastest in determining management of relevant interactions.”

I don't quite agree. I don't believe there is a perfect drug interaction program for PDAs out there yet and each has their strength and weaknesses. Certainly iFacts is not comprehensive and neither are the rest.
I have chronicled some of my drug interaction checking experiences before.

In Drug Interaction Revisited, both iFacts and ePocrates fell short of the ability to pick up the interaction between leucoverin and cotrimoxazole whereas MIMs Interact and Lexidrugs did.
On the other hand, iFacts did pick up the interaction between lamotrigine and carbamazepine whereby carbamazepine toxicity is increased by lamotrigine .ePocrates also picked up an interaction but instead warns of decreasing lamotrigine levels. MIMs Interact correctly predicts increased carbamazepine toxicity.
I recently also tried to look up the interaction between Imatinib mesylate and Amitriptyline. ePocrates did pick up a possible interaction. Imatinib is not even listed in iFacts. MIMs Interact kept producing an interaction between Amitiptyline and Alcohol despite choosing Amitriptyline and Imatinib.
So my overall impression is that there is no perfect drug interaction checker for the PDA. You are better off having more than one to double check the checker.

Lipid Calc

Lipid Calc 2003 v1.1 has been updated. It's completely freeware.


Description:
Calculates lipids and metabolic syndrome.
Menu has screening, medication, waist measurement using Framingham and Canadian 2003 guidelines. SI units only.

Update Description:
- Now takes family history into account i.e. X1.7 or X2 multiple of points.
- Removed points from screen to make room for this.

OnTimeRx updated



OnTimeRx is a great medication reminder. If you use your PDA properly, then you'll find it hard to forget your pills!

Version 2.3 has just been released and the updates include:
- Security and Privacy options in Preferences - Lockout PIN# and plain Icon.
- Alarm Mute - temporarily silences audible OTRx alarms for a fixed period of time.
- Treo 600 - optimized to utilize 5-way nav and KeyGuard options.
- Doctor and Phone dropdown list added on More screen.
- and more .....

OncoNetGuide

Todd Kunkler, Managing Editor of Oncology Net Guide wrote to tell me that HaemOncRules is actually listed in Oncology Net Guide as HemOncRules. OK, I looked again and I found it in the January/February issue specifically in the PDA Resources page.
I note though that it links it to HealthyPalmPilot's website which inaccurately describes it as version 1.0 with 14 modules. HaemOncRules is currently in version 1.2 with 18 modules (with more to come when I have the time!). You can always download the latest version (freeware) from Palmgear.

Todd also asks:
On a related note, what did you think of our site in general (www.oncng.com), and the PDA resources we profile in particular? Are there any programs we have missed that you feel merit inclusion, either for their overall clinical utility, or because they have some unique feature that makes practicing medicine easier, better, or more efficient? I look forward to hearing your thoughts on these matters

Well, Todd, I think OncoNetGuide is an excellent resource - I was not previously aware of it and have bookmarked it now! It looks like a nice balanced e-magazine for those in Oncology. I like the PDA resources feature - very handy indeed. It would be nice to have an XML/RSS feed for those of us too lazy to keep surfing to multiple websites for info! Keep up the good work.

Oncology software

Matthew Huntsinger wrote:

Where can I find the Pocket PC version of HaemOncRules? Oncology Net Guide, oncng.com, says there are both Palm OS and Pocket PC versions

I'm sorry Matt. But I only have NSBasic for PalmOS which was the platform I used to write Haemoncrules. If anyone would like to donate the WinCE version of NSBasic to me, I would be happy to consider porting it over to PPC ;)


Anyway thanks for the feedback. I have been pleased that there has been at least some interest! I wrote this out of a personal need to carry some haem-onc algorithms and the ability to work out complex formulae such as the Sokal and Hasford prognostic scores for CML. This is still a work in progress and I have been busy but I intend to release a new version in the next few months with a few new modules.

Speaking of OncoNetGuide, I went to the website and I could not find any mention of HaemOncRules. I did spot this page of PDA Downloads with some Oncology e-book referencessuch as 2003 Cancer Chemotherapeutic Agents Guide and Cancer Staging Guide.

Mobility in hospital

In December 2002, Camden-Clark Memorial Hospital enabled physicians to access patient data from PDAs in an effort to make itself more attractive to physicians. The Parkersburg, W.Va.-based not-for-profit hospital doesn't own any affiliated physician practices, so it must compete for physicians and admissions with two other nearby for-profit hospitals.

Camden-Clark deployed the MData Enterprise System mobile software from Durham, N.C.-based MercuryMD Inc. on its wireless local area network, hoping for eventual bottom-line results. "We take every opportunity we can to offer information technology to help physicians practice safely and more efficiently," says CIO Josh Woods. "The mobile software makes us a more physician-friendly hospital."

Camden-Clark didn't push its new mobile software on physicians, but it did encourage doctors to bring in their PDAs and the hospital would give them to access patient data. The software enables the hospital to mobilize about 90% of patient data from its hospital information system from Medical Information Technology Inc., Westwood, Mass. Such data includes lab results, radiology reports, dictation and medication lists.

Within a few months, physicians realized the system helped them practice more efficiently and even finish their work early, Woods says. Now nearly 60% of area physicians use the software while practicing at Camden-Clark, he adds. Additionally, the hospital now has a 65% market share over its closest competitor.

"I can't assign a specific value to this project," he says. "But physicians are excited about the freedom and power they get from the mobile software. They no longer feel tied to carrying a paper chart."

Source: MobileHealthData

MIMS

The more publicised drug references on your PDA are American-centric ones. The drawback is that these formularies may not contain certain drugs not available in the USA and the trade names are often different, leaving you to resort to generic name searches (sometimes not easy, as the little grey cells malfunction - hey that's why we need PDAs)


MIMs is a popular drug reference in the Asia-Pacific region.
The only one available for PDAs (both Palm and PPC) comes from MIMs Australia.

I sure hope Medimedia who publish MIMs, produces regional flavours for the other Asia-Pacific countries in the future, but at least it is a good start.


It comes with a main program which allows you to to search for drugs by Name, Therapeutic Class, Actions & Indication




What I like about it is that it allows you to also search by Company - in case you remember only the Company but forget the product. I think the other Drug references don't allow you to do this.
For each entry there is information on...
- Usage
- Contraindications
- Precautions
- Adverse reactions
- Interactions
- Formulation (Dose | Pack)


MIMS Pda edition also comes with an Interaction checking module which works much like ePocrates' Multicheck.

MIMs costs Aussie 165.00 to subscribe. This works out to be US$ 120 per year so this is almost twice as costly as the other PDA drug references.

Overall impression: good comprehensive PDA drug reference. Could be cheaper.

BabyCheck v2.2

BabyCheck has been updated to v 2.2

This freebie allows you to track your baby's development.

Update Description:
- Added: Brazilian verion
- Added: Sexe in the Birth Information screen
- Added: BMI calculation in the mensurations detail screen
- Added: BMI graph according the child sexe
- Added: BMI in the measurements Memo exportation


(ok I know the English could be better but I think it's still a terrific effort. Freeware)

The Intern's Palmomental Reflex

Spotted in the NEJM:

To the Editor: The contemporary palmomental reflex can no longer be viewed as primitive. Usually elicited by a probing question from a staff physician, it is a reflexive action observed in medical students and house officers. The reflex involves a quick movement to expose a personal digital assistant (Palm Pilot) or similar device, followed by repetitive stabs with the stylus on the device screen. The "palmo" component of the reflex seems to be necessary to start the "mental" component required to answer the question. The reflex has replaced the "um" and "ah" of indecision or thought and has almost eliminated the "I don't know" response.


G.L. Crelinsten, M.D.
McGill University
Montreal, QC H3H 1V4, Canada
gcrelinsten@qc.aibn.com

New Palm products for UK docs

Raj Mann brought the following to my attention:

1) The BNF is FINALLY available for PalmOS via an SD card, however one big
disadvantage is the £125 price tag for a 1 year licence. The full information is hidden away in a dusty corner of the BNF website, here is the url: http://www.pharmpress.com/shop/pdf/BNFPDAweb.pdf

I agree with Raj that there should be some subsidy for "impoverished junior docs" - perhaps some Pharma sponsorship scheme? I can't help but think the cost could be much less if the BNF had also released a version which does not come with an SD card. I personally would hate having to swop cards each time I want to access a drug reference.

2) MedHand Int. have released Dr. Companion, a suite of medical programs aimed specifically at either Swedish or UK medics (I think other countries are in development). This really is a palm fanatics wet dream. It contains virtually everything that a UK medic could wish for. Again supplied on an SD card, but thoughtfully with 128Mb free space left on the card. This product is very expensive, with a small discount for NHS staff (Hopefully tax deductable?). Having said that, it really is all that a UK doctor could wish for in terms of palm reference tools.

Thanks once again for the heads-up, Raj. If anyone has other non-US (for a change!) medical PDA products to highlight, please let me know.

Drug Interaction revisited

Have you wondered how reliable your PDA's drug interaction checker is? I was fortuitous enough to pick up the interaction between Cabamazepine and Lamotrigine sometime back. That interaction was picked up by Skyscape's iFacts.
Recently I had a patient who was given high dose Methotrexate requiring folinic acid (leucoverin) rescue, and who also developed Pneumocystis carinii pneumonia and required Cotrimoxazole at the same time. One would have thought that leucoverin would interfere with cotrimoxazole. I whipped out my T3 and checked ePocrates' Multicheck and lo & behold, the answer was "No significant interactions found or known". Unfortunately iFacts doesn't even list leucoverin or folinic acid in the list of drugs.
MIMS Interact did pick it up:
"The generic trimethoprim (of Bactrim) has a mutually antagonistic effect with the generic folinic acid"
I also checked Lexidrugs and it states:
"May decrease efficacy of cotrimoxazole against PCP"

I'm not saying there's any formulary for the Palm which is outstanding and better than the rest. They each have their limitations. My stand is never rely on any single formulary. I suggest load up your PDA with at least 2, if not three!

Dx + Rx

Daniel B. Hier recaps the ePocrates products/modules in this PdaMD Review: ePocrates Rx and ePocrates Rx Pro, ePocrates Dx, ePocrates ID, and Tables. If you haven't joined the ePocrates bandwagon, this would be a good overview of the ePocrates Clinical Suite.

My main criticism of ePcrates is after all this time, they still can't store their databases in SD. Putting all the neat stuff is going to take more than 2MB of precious Ram.

However, I agree fully with Daniel's bottom line:
"The seamless integration of the 5MCC with ePocrates Rx is an impressive achievement for ePocrates. This integration creates synergy between two very good PDA products and makes the ePocrates Clinical Suite a powerful clinical tool. Rich diagnostic and therapeutic information is now combined in a single clinical tool that is concise, up to date, and easy to use. ePocrates is beginning to tip their hand. They are moving out of the pure drug monograph distribution business into the knowledge management business. They are providing clinicians with the knowledge they need in order to manage and treat their patients effectively. The ePocrates Clinical Suite for the Palm OS is a significant step in this new direction"

New releases from Meistermed
Meistermed has come out with:

- NCDMeister
A guide to National Coverage Determinations (NCD) helping providers avoid denial of payment for lab tests
- ICDMeister
The Fastest and Easiest ICD-9 Coding Tool for PDA
- PAPMeister
Containing everything you need to know about:
Current screening recommendations for cervical cancer
HPV DNA testing
Liquid-based cytology
Management of abnormal Pap smears
Diagnosis and treatment of cervical cancer
- CPTMeister
A Coding Reference Based on the Physicians' Current Procedural Terminology (CPT™) Codes Developed by the
American Medical Association

More Free Guidelines for your PDA



Mobile Medica has a list of Free Guidelines from the American Academy of Ophthalmology, American Heart Association, American College of Physicians, American College of Chest Physicians, American Urological Association, The Society for Cardiac Angiography and Interventions specially formatted for your PDA.

Registration is free and you only need to provide a valid email address. The website says to use the Apprisor viewer for the documents which you can download from Mobile Medica , but in actual fact the documents are also iSilo compatible so if you are already a registered iSilo user, you don't have to install an extra viewer. The iSilo Medical Depot also lists the same free downloads from Mobile Medica.

What are you waiting for? :)

DiagnosisPro for PalmOS

No, unfortunately a PalmOS version of this program is still not out but I am told a version for this excellent program may be released in the next quarter. 'm holding my breath.
In the meantime, when you order a Windows version of DiagnosisPro, you get a free PocketPC version.

Paediatric Vade-Mecum - Palmtop Edition


Hodder Arnold has released, in Palm Doc format, a complete revision of the successful pocketbook, A Paediatric Vade-Mecum.

This book provides the junior doctor and trainee grade paediatrician with invaluable information on the diagnosis and management of illness in children, and with practical evidence-based advice for the safe and effective management of the sick child.

The best part is the book is available for free and can be downloaded here. The file size is 4.7MB so you are better off storing it in your SD or MS card. The book does not include the Formulary. Still, it's a worthy addition to the aspiring Paediatrician's library.


Thanks to tt32003 for the tip, posted in KVPUG's Doctor's Shack

Clinical Evidence for PDA

The BMJ Publishing Group, a leading medical publisher, has teamed up with Unbound Medicine to combine Clinical Evidence with Unbound Medicine's award-winning CogniQ™ platform.

Clinical Evidence is an essential tool for any health professional wanting to base their clinical decisions on the best available evidence. It sums up the current state of knowledge, ignorance, and uncertainty about the prevention and treatment of hundreds of clinical conditions in a straightforward question and answer format, identifying what works and what doesn't.
The printed edition is regularly distributed to almost one million users worldwide. With CogniQ, Clinical Evidence can now be delivered direct to the point of need, enabling physicians, nurses and other healthcare professionals to access evidence-based answers on the go.
Clinical Evidence for PDA is available for trial and purchase at the Clinical Evidence website and the Unbound Medicine store. An annual subscription includes the concise version of Clinical Evidence on the handheld, monthly content updates delivered via CogniQ's Auto-Updates feature, a personal Web Library, and access to Clinical Evidence full text and Unbound MEDLINE on the Web.

CareTools Adds Reference App

Seattle-based CareTools has added a drug reference application to the electronic prescribing function of its PocketChart PDA software. The vendor has integrated content and tools from mobilePDR reference software into the electronic prescribing application of its hand-held medical records system.

The mobilePDR application, from Montvale, N.J.-based Thomson Medical Economics, offers physicians self-updating medication lists and real-time drug interaction checking tools accessible on PDAs. In combining the technologies, the vendors sought to create electronic prescribing software that enables physicians to write prescriptions, check them against real-time reference data and transmit them from their PDAs.

Source: MobileHealthData

New tool for Community Acquired Pneumonia

The Agency for Healthcare Research and Quality today announced its first clinical decision-support tool for personal digital assistants (PDAs) that is designed to help clinicians deliver evidence-based medicine at the point of care. AHRQ's new Pneumonia Severity Index Calculator (which is available for download from the AHRQ Web site at http://pda.ahrq.gov), is an interactive application for Palm Pilots and other PDAs to help doctors quickly and easily determine whether patients with community-acquired pneumonia should be treated at home or in a hospital.

"This new Pneumonia Severity Index Calculator is an example of how technology can support and facilitate the delivery of evidence-based medicine," said AHRQ Director Carolyn M. Clancy, M.D. "AHRQ is striving to make decision support tools such as this available to clinicians."

Community-acquired pneumonia contracted outside of a hospital or nursing home environment affects approximately 4 million Americans and costs approximately $10 billion to treat each year. Nearly all of those costs -- 92 percent -- are spent on treating patients who are hospitalized for care.

Developed by MDpda Design, Inc., the Pneumonia Severity Index Calculator is based on a clinical algorithm produced in 1997 by the AHRQ-funded multidisciplinary research team called the Pneumonia Patient Outcomes Research Team or PORT. The Pneumonia PORT developed and tested the Pneumonia Severity Index clinical algorithm to aid clinicians in treatment decisions for patients with community-acquired pneumonia.

This algorithm has been validated in a broad, randomized controlled trial and was shown to be safe, cost-effective, and to improve satisfaction by enabling patients to be treated at home rather than the hospital when appropriate. There is a sizable number of low-risk patients who could be treated safely on an outpatient basis, but these patients must be accurately identified before such treatment is recommended, according to the AHRQ- sponsored research.

AHRQ PDA applications are available for download at http://pda.ahrq.gov. The AHRQ Pneumonia Severity Index Calculator is available in Palm OS, Pocket PC and HTML formats. Additional AHRQ PDA applications are under development.

Source: USNewswire

PDA Suite Reviews

I find alot of my work depends on using Word and Excel Documents. I use Documents To Go on my Tungsten 3 as this great application came bundled with it. It serves my needs well but Documents To Go is not the only Office Suite for PalmOS. There's also QuickOffice and veterans will remember the venerable Wordsmith which was (and is still) a great Word processor for the Palm

Tanker Bob from PDABuyers' Guide has this great Palm Office Suite roundup which you might be interested to read.

ePocrates Dx

Rod Story has written a review on ePcrates Dx, the new product from ePocrates which integrates ePocrates with 5 Minute Clinical Consult.

"Now imagine the marriage of ePocrates software and 5MCC and you've captured the essence of why pocket computing has become indispensable in clinical medicine. Visualize looking up a diagnosis, quickly accessing clinical pearls, one-clicking your way to your medical therapy of choice, even calculating the weight-based dose, and you have the most useful handheld medical program to date, ePocrates Dx.

A quick tour of ePocrates Dx demonstrates just how well thought out this program is. At first glance you'll notice that ePocrates familiar format has been maintained, with it's quick search Look Up: line, ability to view meds by class, and useful MultiCheck function. Newly placed at the top are the components of the ePocrates Clinical Suite, readily accessed by hot-linked tabs. Just a quick click on the Dx tab takes you to ePocrates 5MCC program, with the same quick search Look Up: line on the bottom of the screen. Once a condition is selected, multi-layered clickable headings are easily accessible at the top of the text or from a pop up menu on the bottom of the screen. These include signs and symptoms, diagnosis (with a thorough differential), and the golden nugget medications. Another quick click on the medication of choice seamlessly links back to ePocrates Rx and the core drug data we've learned to rely on. To complete the package, ePocrates Rx Pro adds the infectious disease portion (also hot-linked) and a new integrated weight-based dosing calculator. "

Read Rod's complete review at PDAMd.com

ePocratesDx integrates with both the free version of ePocrates as well as ePocratesPro. You can purchase annual subscriptions to ePocratesDx using flexible plans based upon the Clinical Suite you choose. Kudos to ePocrates for innovation.