Top 10 Applications for your PDA: Practicing Information

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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
Pinnacle Health Ground 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.
Pinnacle Health Ground 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
Pinnacle Health Ground 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
Pinnacle Health Ground 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.
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Information Mastery and Computers
Not always assessed by software
Usefulness = Relevance x Validity
Work
Can be reduced by
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.
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Computers to Drill for the Best Information
Web, InfoRetriever
Cochrane
Clinical Evidence
Clinical Inquiries
Reviews/Textbooks
Usefulness
POEMs
CogniQ, BMJ, FPIN
InfoRetriever, Journal
Watch
Best Evidence
Unbound, Skyscape
CogniQ, Skyscape
Medline
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
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
Pinnacle Health Ground 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
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
So, Which Handheld Should I Buy?
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pocket PC Models
Dell Axim X30
Dell Axim X50
Casio EG800
Asus MyPal A716
Pinnacle
Health Ground Rounds 2005
Premium
HP IPaq 2215
HP IPaq hx4715
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Website for PDA Comparisons
• http://www.healthsystem.virginia.edu/int
ernet/library/services/computing/pda/
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Interactive PDA Choosers
• http://www.davespda.com/resources/rec
ommend/index.htm
• http://www6.activebuyersguide.com/abg
/nav/StartGuide.cfm?CatID=12&PID=0X
6X98X149243Xdac52&RefID=0
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground 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.
Pinnacle Health Ground 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.
Pinnacle Health Ground 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.
Pinnacle Health Ground 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.
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Presenting The Top 10….
Pinnacle Health Ground 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.
Pinnacle Health Ground 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).
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Shots 2005 for Palm
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Shots 2005 for Pocket PC
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©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)
Pinnacle Health Ground 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.
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
MedCalc on Your PDA
Main Menu
Pinnacle Health Ground Rounds 2005
Calculating FENA
©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.
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Archimedes on your Pocket PC
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
ABG Pro
Pinnacle Health Ground 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)
Pinnacle Health Ground 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.
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
MedRules on your PDA
Main Menu
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Bishop’s Score
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Handheld Computer Smoking
Intervention Tool (HCSIT)
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Fine’s Rule for Pneumonia
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©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).
Pinnacle Health Ground 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.
Pinnacle Health Ground 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
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
DueDateCalc
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#5 Daily Updates from the Web
• AvantGo (www.avantgo.com)
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©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
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
• A Student's Guide to the Medical
Literature, PDA Version
URL:
http://denison.uchsc.edu/SG/PDA.html
Author: Katherine McLucas, University of
Colorado Health Sciences Center medical
student
Operating System: Palm OS, PocketPC,
WinCE
• A how-to guide developed for medical
students on appraising the medical
literature. Covers how to frame research
questions, develop search strategies,
appraise the results, and implement findings
into clinical practice. Free AvantGo account
required.
Pinnacle
Health Ground 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/pdafo
rmat/
Author: Connie Schardt, MLS, AHIP
Operating 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.
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
AvantGo
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©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)
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©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/fphandboo
k/fpcontents.html)
• Get browser at www.isilo.com
• Follow instructions on using iSilo web.
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Cochrane Abstracts on iSilo
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
CDC Travel on Your Palm
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
• Creating iSilo content for your handheld
computer (link)
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#3 Database Program
• HanDBase (www.handbase.com).
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
CME Tracker on HanDBase
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Entering a Procedure in HanDBase
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©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)
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
InfoRetriever 2005
Windows 95/98/NT/ME/2000/XP, PocketPC, Palm and Web
2200+ short research
synopses (400 added
per year)
5 Minute Clinical
Consult
Cochrane Database
of Systematic Reviews:
over 1750+ abstracts
200+ clinical
prediction
rules
Bayesian
diagnostic
test / H&P
calculator
(2000+)
Basic drug
info by class
and cost for
1200 drugs
Key evidence-based
treatment guidelines
www.InfoPOEMs.com
Pinnacle Health Ground 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?
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
InfoRetriever
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
InfoRetriever
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
InfoRetriever
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Should his SBP be lowered to
<130?
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
What if he quit smoking instead?
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©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
A Patient Success Story
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©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 autoupdating capability
• Has OVID searching capability with
web-based management of knowledge
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground 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)
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©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.
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground 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
Mastery
http://www.healthsystem.virgin
ia.edu/internet/familymed/docs
/info_mastery.cfm
Pinnacle Health Ground Rounds 2005
©2005, Scott M. Strayer, MD, MPH
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