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Hardware, software and wetware : how information technology will help you take better care of patients

Hardware, software and wetware : how information technology will help you take better care of patients. Mark H. Ebell MD, MS Associate Professor, University of Georgia Deputy Editor, American Family Physician

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Hardware, software and wetware : how information technology will help you take better care of patients

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  1. Hardware, software and wetware: how information technology will help you take better care of patients Mark H. Ebell MD, MS Associate Professor, University of Georgia Deputy Editor, American Family Physician Editor in Chief, Essential Evidence, and co-founder, InfoPOEMs, John Wiley & Sons

  2. 4 Numbers

  3. 120 • Median number of patients seen per week by a family physician

  4. 15 • Median minutes per patient encounter

  5. 8 • Average number of decisions made per encounter by a family physician

  6. 3 • Average number of clinical problems addressed per encounter with a family physician

  7. Primary care is hard: 120 patients, 360 problems, and 960 decisions per week • Primary care is important • Primary care is undervalued Is information technology part of the solution?

  8. Not surprisingly, we have a lot of questions! • Adults learn by solving problems • Our “problems” are our point-of-care clinical questions • Research: • 10-15 clinical questions per day • Answer less than half (easy or urgent) • When answered, non-pursued questions would have changed patient care ½ the time • So: questions are common, central to learning, and important for patient care

  9. Attitude • Value your questions • Question authority • Ask and answer at least one hard, non-urgent question per week with the best available evidence

  10. Questions Study • Funded by Physician’s Institute for Excellence in Medicine in Georgia • We want to learn what questions you have, so we can design: • Better educational programs • Better search software • Better journals and references • Please send us your questions! • See packet…

  11. W E T W A R E

  12. Wetware Information Overload • 20,000+ articles /yr in 100 top clinical journals • 30-60 min/week to keep up with literature Solution: focus on only the most useful information

  13. Wetware Most useful information (Shaughnessy and Slawson) • Highly relevant • Highly valid • Low work Usefulness = Relevance x Validity Work

  14. Wetware High validity • Do it yourself or rely on others? • Look for: • Independent: no pharma support • Critical assessment of study quality: not just author’s abstract • Recommendations labeled with strength of evidence: transparency

  15. Wetware High relevance • Common or important problem in your practice • Improved patient oriented outcomes • Would change your practice Patient Oriented Evidence that Matters

  16. Wetware Reduced work • Regular literature surveillance • Structured critical appraisals • Easy access with push (email, newsletter) and pull (Web, PDA) service • Interactive tools (not just static text)

  17. Wetware Two sources needed • Push source: updating service providing most relevant, valid new information • Pull source: answer questions at point of care with best available evidence

  18. Wetware Your current push sources • Drug reps • Colleagues • Journals and medical newspapers • Independent newsletters • Evidence-based updates via email Usefulness = Relevance x Validity Work

  19. Wetware Your current pull sources • Colleagues • Journals • Books (average = 10 years old) • General medical Web sites • Expert-based medical references • Evidence-based independent medical sites Usefulness = Relevance x Validity Work

  20. Wetware Criteria for evaluating new information source • Relevance: clear focus on patient oriented outcomes? • Work: tools, calculators, summaries, bullets, algorithms, tables? • Validity: truly independent, with transparent rating of evidence strength? Usefulness = Relevance x Validity Work

  21. H A R D W A R E

  22. Which is more important to a physician in 2009?

  23. Smartphones: Operating Systems (OS) • OS is as important as who makes phone • Can be confusing: Palm phone running Windows Mobile OS! • Common smartphone operating systems; • iPhone • Google “Android” • Windows Mobile • Blackberry • Palm WebOS

  24. Smartphones: What to Look For Cost • $50- $200 is typical for device • Monthly cost for data access: $30-$50 Network Access • 3G versus 2G (versus 4G?) • Quality of coverage in your area Other • Keyboard on screen or physical? • Extent of medical software available?

  25. Windows Mobile 6.1 • Extensive range of medical software • Many networks • Various keyboard options • Clunky OS • Open software library

  26. Palm WebOS • Several models, cost varies ($49 to $300) • Extensive range of medical software • Physical portrait style keyboard • Almost no medical software

  27. Blackberry • Several models, cost varies ($100-$300) • Limited medical software • Many networks • Physical portrait keyboard or on-screen (Storm)

  28. iPhone • $199 • Good medical software library • Single network (AT&T) but likely to change soon • On-screen keyboard only • 8 – 16 gb memory with best music, video, podcast player

  29. Google Phone:T-Mobile G1 • Verizon (Motorola Droid, above) and T-Mobile (HTC Hero, below) • Limited medical software • Fewer apps overall (10,000 vs 75,000 for iPhone) • Rapidly increasing apps and market share

  30. Netbooks • Brands: Asus, HP, Dell • Compact (1.5-3 lbs) • Cheap: $300 - $500 • Durable • Look for those with 8-10 hour battery life

  31. And one more thing…the iPad

  32. S O F T W A R E

  33. 3 Steps To Becoming a Point of Care EBM Expert • Use secondary sources first • Optimize Medline searches • Load up your smartphone

  34. 1. Use secondary sources first • Find and use a push tool, i.e.: • Journal Watch • ACP Journal Club • InfoPOEMs • American Family Physician “Tips” • BMJ EvidenceUpdates • Is your source: • Independent of industry support? • Evidence-based, with evidence rated? • How is relevance evaluated? POEMs?

  35. 1. Think secondary first • Find and use a pull tool, i.e: • ACP PIER: pier.acponline.org • Clinical Evidence: www.clinicalevidence.com • Cochrane Library: www.cochrane.org • DynaMed: www.dynamicmedical.com • Essential Evidence: www.essentialevidence.com • Is your source: • Evidence-based, with evidence rated? • Include interactive decision support tools? • Available on smartphone as well as Web?

  36. Translating Research Into Practice (TRIP) • From the United Kingdom • Searches dozens of evidence-based sites from around the world at once • Freely available • www.tripdatabase.com

  37. Bandolier • Monthly online and print journal of evidence-based healthcare • Witty, thoughtful essays • Provides non-US perspective • http://www.medicine.ox.ac.uk/bandolier/

  38. National Guidelines Clearinghouse • Any group can submit guidelines, which are presented in a consistent format • Does not require that guidelines be evidence-based (can be consensus or other methodology) • http://www.guidelines.gov

  39. Dynamed • Online and PDA evidence-based reference • By subscription only • Organized by disease/symptom topic • http://www.ebscohost.com/dynamed/

  40. Clinical Evidence • From the British Medical Association • Evidence-based summaries of the evidence for common clinical topics • Free to most US physicians through United Healthcare Foundation • www.clinicalevidence.com

  41. American College of Physicians Physicians Information and Education Resource (PIER+) • Evidence-based online textbook that addresses over 300 common topics • Freely available to members of the ACP • Available by subscription to others • http://pier.acponline.org

  42. Essential Evidence

  43. Essential Evidence • 700 Essential Evidence clinical topics • 3500 POEMs • 3000+ Cochrane reviews • 300+ decision support tools • 3000+ diagnostic calculators • Evidence-based guidelines from NGC • Disclosure – I am the editor-in-chief

  44. Essential Evidence demo • www.essentialevidence.com

  45. 2. Optimize Medline searches • Learn to use PubMed’s “Clinical Queries” feature • Gradually narrow your search • When you find a useful article, select “Related articles”

  46. 3. Load up your smartphone • Prescribing: • ePocrates, Lexicomp, Tarascon Pharmacopeia, Theradoc • Decision support and calculators: • AHRQ EPS, Essential Evidence, Archimedes, MedRules, MediMath • Complete references: • DynaMed, Essential Evidence, UpToDate, PubMed on Tap, Best Evidence

  47. ePocrates • Widely used drug reference for Palm, Blackberry, iPhone, and Pocket PC

  48. Guide for selecting best antibiotic Free and easy to use http://www. theradoc.com/downloads/ Antibiotic Guides: Theradoc

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