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 Pinnacle Health Ground Rounds 2005 ©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 Pinnacle Health Ground Rounds 2005 Bishop’s Score ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Handheld Computer Smoking Intervention Tool (HCSIT) Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Fine’s Rule for Pneumonia Pinnacle Health Ground Rounds 2005 ©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 Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #5 Daily Updates from the Web • AvantGo (www.avantgo.com) Pinnacle Health Ground Rounds 2005 ©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 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 • 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 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 AvantGo Pinnacle Health Ground Rounds 2005 ©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) Pinnacle Health Ground Rounds 2005 ©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. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Cochrane Abstracts on iSilo 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 CDC Travel on Your Palm Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care • Creating iSilo content for your handheld computer (link) Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #3 Database Program • HanDBase (www.handbase.com). Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care CME Tracker on HanDBase Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Entering a Procedure in HanDBase Pinnacle Health Ground Rounds 2005 ©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? Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care InfoRetriever Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care InfoRetriever Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care InfoRetriever Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Should his SBP be lowered to <130? Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care What if he quit smoking instead? Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care A Patient Success Story Pinnacle Health Ground Rounds 2005 ©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) Pinnacle Health Ground Rounds 2005 ©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
