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

1. 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

2. 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.

3. 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

4. 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

5. 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.

6. Not always assessed by software Usefulness = Relevance x Validity Work Can be reduced by computers 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.

7. Web, InfoRetriever CogniQ, BMJ, FPIN InfoRetriever, Journal Watch Best Evidence Unbound, Skyscape Usefulness CogniQ, Skyscape Computers to Drill for the Best Information Cochrane Clinical Evidence Clinical Inquiries POEMs Reviews/Textbooks Medline

9. Choosing EBM Sources 1. 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

10. 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

11. So, Which Handheld Should I Buy?

16. Pocket PC Models Dell Axim X30 Dell Axim X50 HP IPaq 2215 HP IPaq hx4715 Casio EG800 Premium Asus MyPal A716

18. Website for PDA Comparisons • http://www.healthsystem.virginia.edu/internet/library/services/computing/pda/

20. Interactive PDA Choosers • http://www.davespda.com/resources/recommend/index.htm • http://www6.activebuyersguide.com/abg/nav/StartGuide.cfm?CatID=12&PID=0X6X98X149243Xdac52&RefID=0

22. 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.

23. 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.

24. 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.

25. 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.

27. Presenting The Top 10….

28. #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.

29. #9 An Immunization Schedule • Shots 2005-vaccination recommendations with information on all vaccines and catch-up schedules (available at www.immunizationed.org).

30. Shots 2005 for Palm

31. Shots 2005 for Pocket PC

32. #8 Medical Calculators • MedCalc for Palm (www.palmgear.com) • Archimedes for Pocket PC (www.skyscape.com) • ABG Pro (www.stacworks.com)

33. 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.

34. MedCalc on Your PDA Main Menu Calculating FENA

35. Medical Calculator for the Pocket PC • Archimedes-free calculator that has all the same calculations as MedCalc.

36. Archimedes on your Pocket PC

37. ABG Pro

38. #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)

39. 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.

40. MedRules on your PDA Bishop’s Score Main Menu

41. Handheld Computer Smoking Intervention Tool (HCSIT)

42. Fine’s Rule for Pneumonia

43. #6 OB Wheels • PregCalc Pro (www.medicaltoolbox.com). • PregTrak (www.stacworks.com). • Due Date Calc (www.handango.com).

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

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

46. DueDateCalc

47. #5 Daily Updates from the Web • AvantGo (www.avantgo.com)

48. 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