HIPPA and PDA use in the workplace

SE How would HIPPA laws affect personal patient information stored in PDAs? Personal patient information such as name, date of birth, and medical/patient number would violate patient confidentiality, especially if the PDA device was lost or stolen. The use of password or encryption software with hand-held devices would need to be incorporated just like it is for desktop computers used in clinics and hospitals. Other institutional policies regarding hand-held devices would need to be incorporated. Nurses, physicians and pharmacists may need to have PDA's supplied to them by their employer instead of using their own hand-held device, especially if HIPPA rules apply and they are using it to access and enter clinical information for patients receiving care.

Medical dictionary software - Any suggestions?

SE Has anyone tried a medical dictionary software for their PDA that they really like and would recommend as a must have? Hardin Library currently does not have any free medical dictionary PDA downloads. I am looking for something that provides
a searchable glossary of medical terms including general medical terminology, medical devices, and medical abbreviations.

I found one freeware dictionary with the following specifications but have not downloaded anything onto my PDA:
Author = Free-Medical-Dictionary.com
OS = Win95, Win98, WinME, WinNT 3.x, WinNT 4.x, Windows2000, WinXP, Windows2003
Date Released October 20, 2004
Filesize = 377 kB
Language = English
Install Support = Install and Uninstall
Requirements Internet Explorer 4.0 or newer

Behaviors towards PDA use by pharmacy students

Siracuse, Mark., Sowell, John. and Musselman, Nicholas. Behavioral Intentions and Attitudes Towards the use of Personal Digital Assistants (PDAs) by Pharmacy Students Paper presented at the annual meeting of the American Association of Colleges of Pharmacy, Sheraton San Diego Hotel & Marina, San Diego, California, USA, Jul 05, 2006

SE Safety and efficacy seems to be primary reason why most students at the University of Iowa use their PDA's. A paper conducted out of the Creighton University College of Pharmacy, Omaha,NE, and presented last year at the American Association of Colleges of Pharmacy cites the prevelance of PDA use by pharmacy students. The paper referenced above mentions that out of 376 doctor of pharmacy students a majority of them, 81%, used it to look up drug information at least weekly and 43% used it for other schoolwork at least weekly. As stated in the article the implications are that: "Pharmacists and pharmacy students will increasingly find themselves needing to utilize hand held technology in their patient care activities. PDA usefulness, PDA ease of use and attitudes towards PDA use have the most influence on PDA use behavior."

This article would be an interesting read if it is published. Right now it has been submitted to the American Journal of Pharmaceutical Education in June 2007 and is under review.

Physician use of PDA's

SE An article, “Use and Perceived Benefits of Handheld PDA Clinical Reference Applications”, from the AMIA 2005 Symposium Proceedings – page 1099 by Jeffrey Rothschild MD, MPH et. al. studied a two week period of use of PDA’s in patient care. For 2 weeks in February 2005, 3567 physicians were asked to use Epocrates (Rx Pro, ID and DX) and complete a survey assessing their PDA experience and practice patterns. Discounted incentives for products were offered for participating in the study.

1501 participants completed the study and reported using Epocrates for at least half of all patient interactions. In conclusion physicians thought they improved patient overall care, optimized treatments, and improved patient health. They especially liked the public health warnings, FDA drug alerts, and patient safety information. Furthermore the physicians also believed that technology will improve productivity, reduce medical error and improve patient outcomes.

If the use of PDA’s by physicians continues to grow in clinical practice settings, as reflected in this article, we may see PDA’s as a requirement in more pharmacy coursework. Discounted hand held devices for students would make PDA’s an affordable asset to learning and I, for one, would support their enhanced incorporation into the classroom. SE

iSpy iPhone

SE An article, “Is Your iPhone More Like ISpy?” from www.internetnews.com dated November 20, 2007 mentions that Apple may be secretly tracking user activity. For example when stock quotes or weather forecasts are requested via the iPhone the phone identification number, International Mobile Equipment Identity (IMEI), gets sent to Apple. Another possibility is that the usage number, Universally Unique Identifiers, (UUID) is tracked without relaying personal information. How much information is being gathered and what is being done with this information is still unknown.
This practice does not directly affect drug information database use after the program has been downloaded onto the iPhone. What this may mean for some people is that they decide not to buy the iPhone technology and use another hand held device for their drug information searches. SE

PDA PK Calculator

SE Dr. Ronald Herman, PhD, Director – Iowa Drug Information Network and Assistant Professor at the University of Iowa has designed a well thought out user friendly PDA tools to calculate CrCl and pharmacokinetic (pk) dosing. Essential is the initial input of weight, age, height, SrCr, sex, hydration status and race. From there one can choose dosing information, and prospective or retrospective pk calculations. Medications within the pk program include Amikacin, Gentimycin, Tobramycin, and Vancomycin. One of the best features about these tools is that one can quickly and accurately calculate the CrCl-GFR estimations and the pk information for a patient while staffing clinical rounds. Another key feature is that this software is available as a freeware program.
This program will be extremely useful in the future thanks to Dr. Herman. –End- SE

Drug Interactions

SE I have on many occasions been asked about drug interactions from patients at the community pharmacy where I work. As a student pharmacist intern I formulate an answer and then present it to the pharmacist in charge before proceeding with the patient. Many times the questions are not that in depth and require no additional resources.
A few times we have had questions involving multiple drugs that require evaluating a patient’s complete medication profile. At these times I like to use the CP Onhand or Thompson’s Clinical Xpert Drug Interaction tools. If the question does not involve any OTC or alternative meds I will usually use CP Onhand because it has more complete explanations. If, on the other hand, the patients question involves alternative or OTC meds I will use the Clinical Xpert interaction resource. While I look up the information on my PDA the pharmacist is looking at a paper version of the LexiComp handbook.
In all cases we have derived the same drug interaction results from both resources.
-End- SE

Student Pharmacists and PDA’s on rotation

SE Recently a pharmacy professor/preceptor told me about her experience with student pharmacists who bring their PDA’s on rotations. As the student arrived and started to unpack their personal belongings into the locker the preceptor and her staff would make special note if the student had a PDA. To them the presence of a PDA loaded with drug information resources symbolized a student who was willing to learn, who was not a know it all and who was serious about their profession. This is not to say that students who do not have a PDA device did not have these qualities too. I found our conversation quite interesting. I had never thought about the perceptions other professionals may have regarding student pharmacists with PDA’s. –End- SE

PDA’s - Just for the fun of it….

SE I’ve written several posts about the use of my PDA for searching drug information databases and diagnostic tool use. But let’s face it, I enjoy my PDA for other reasons too.
My PDA serves as a repository for my vacation photos and friends and family contact information. An additional 2 GB card allows ample room for a few games as well as music and video clips. Last but not least I can look at emails and search the web using my PDA. Overall I would say that I use my PDA on a daily basis not just for medication information research but also just for the fun of it. – End – SE

Considerations for Mac Users

PH: I just wanted to point out to anyone who may view this blog who is a Macintosh user and who is considering getting a Treo Smartphone that there are some issues with some of the Drug Information softwares for Mac users. I will just point out a few examples. There are several softwares that simply cannot be downloaded onto a Mac successfully. Many of them download as an .exe file that Macs are unable to do anything with. Examples of some of the softwares for which this is a problem include Clinical Xpert, ACP's Pier and MosbyRx. Also, there is at least one software, and one that I would dearly like to load onto my smartphone, that can download to a Mac fine, but then cannot be synched to a Treo Smartphone. This software is CP Onhand. Our instructor looked into it further and discovered by calling the company that produces it that this is indeed the case. However, they suggested that their next update would correct the problem. That update was supposed to occur in November, I have not yet attempted to load it this month, if I find out that it now works I will post a comment to this blog. Many of the other softwares do work fine, but I wanted to point out that there are some issues for Mac users to consider.

Diagnosaurus

SE Just like the Medical Eponyms PDA and Palm (Windows and Mac) software program I learned about the Diagnosaurus two and a half years ago in pharmacy school at the University of Iowa.

Strait from the website http://books.mcgraw-hill.com/medical/diagnosaurus/index.html McGraw-Hill's Diagnosaurus 2.0 is a FREE medical PDA software used by students, physicians, and health professionals. It has 1000+ differential diagnosis to help you make informed decisions. Diagnosaurus 2.0 is derived from McGraw-Hill's most trusted CURRENT Consult Medicine 2007.

By using the pull down menu or by keypad search you can search by organ system or just review the list of disease. This program is helpful if you need to consider what other symptoms may be associated with the specific disease state and you can also view DDx or differential diagnosis's.

The font size is adjustable to allow for easier viewing.

Only 0.8 to 1.1 Mb of memory is required for storage.

This database, like Medical Eponyms will be helpful during rotations and on the spot searches especially in retail pharmacy. -End- SE

Medical Eponyms

SE Directly from the website http://www.seguemd.com/eponyms/ the dMedical Eponyms™ is a Pocket PC program that contains a list of over 1,500 common and obscure medical eponyms (e.g., Rovsing's sign, Virchow's node) with descriptions. It is based on Andrew Yee's (http://www.eponyms.net) medical eponym database.

It is available in palm and pocket PC software and was released May 7, 2005 by the by Segue Corporation.

I learned about this resource two and one half years ago during pharmacy practice lab and orientation for pharmacy school at University of Iowa. When I acquired my PDA I placed the medical terminology database on my PDA. Not until recently have I used the program. It comes in handy while reading an article or reviewing patient case notes.

A quick alphabet tab takes you to the disease state descriptions quickly or one can choose to do a search using the keypad. Also one can search using the category setting then scroll down to the area in question, ie: ANAT, DERM, ORTHO, PATH, etc. Disease states from each specifically selected category will then be displayed.

This is a small database taking little memory and could become very handy to have in a pinch. -End- SE

Inforetreiver/InfoPOEMS

SE We reviewed Inforetreiver in our PDA class in early November 2007. Designed mainly for PDA's Inforetreiver features practice guidelines, article review along with LOE-Level Of Evidence ratings, calculators, and 5 min. clinical consults. These features would be extremely helpful at bedside and practice setting consultations where one needs to make reference to evidence based medicine but doesn't have the desktop computer, laptop and remote Internet access. -End- SE

MPR - Monthly Prescribing Reference

SE Recently our PDA class reviewed MPR - Monthly Prescribing Reference. I've downloaded this free resource onto my PDA and enjoy using it for OTC monographs, full monograph view and searching for drugs by disease/illness via the Sections tab. Another useful feature are the prescribing notes which quickly reviews pharmacology facts.

There is supposed to be a way one can compare drug monographs side by side but that can not be located on the PDA version. It's available on the web version.

CE credits are also available and will come in handy after licensure. -End- SE

Do employers provide electronic drug information resources?

SE Of the fifteen retail student pharmacists I've talked to, all have one online drug information database provided to them at their work site via their employers. Usually the software program is Clinical Pharmacology Onhand or E-Facts and Comparison. Although the resource is provided by employers, few students and their co-workers have the time to log onto their work site computer network and look up information. Besides time constraints often times the computers are being used to process prescriptions.
It is not a common practice for employers to provide training or reimbursement for handheld electronic devices and software for their pharmacists. This leaves the pharmacist to use paper versions or online drug resources when they may prefer to use a handheld device. -End- SE

Electronic vs Hard Copy drug info. resources

SE After speaking with a pharmacist that I work with I understand that PDA drug information resources are a highly underused commodity in the retail pharmacy setting. This pharmacist, let's call him Jack, went to school at the University of Iowa and graduated in 2001. He would prefer to use a PDA, not a Smart Phone, at work but finds them unaffordable and he has some experience with using them. If Jack were to own a PDA he would prefer to have Clinical Pharmacology Onhand software. A text copy of Drug Facts and Comparrisons is available at the work place but Jack finds this to be a difficult resource to use because it takes to long to find the information in print and it's usually incomplete. -End- SE

Comments on Paper Rating Drug Information Sources.

PH: I wanted to comment on the paper by Clauson et al. that we read for a quiz in our PDA class. The paper was published in the March 8, 2007 edition of BMC Medical Informatics and Decision Making. I invite anyone else who has read the paper to post comments.

The paper rates 7 products, including: ePocrates, Clinical Pharmacology and Lexi-Comp among others. It rated Clinical Pharmacology (CP) the highest but had three other products ranked closely to CP on its top tier of products. They rated the products on the basis of ease of use, thoroughness and scope.

I found the study had a lot of potential for bias, primarily because of the funding of the study by the company that sells CP. The authors don't describe why they chose to weight the topics that were analyzed the way they did, or how they developed the list of drug related questions used to compare the products. It would certainly be conceivable that questions would be chosen in a way that they knew would favor the CP product, or that topics such as pregnancy and lactation were weighted to a lesser degree so that it would favor CP which performed less favorably in this category than some of the other products.

I will not go so far as to say that the authors did anything that blatant to favor one product, but the association of the report with the company that markets the leading product certainly has to raise some suspicions. I would also like to point out that even if the study was done with all intentions of being unbiased that the method of weighting different topics and how the questions are developed might have a huge impact on the outcome. I would not be surprised if two completely independent lists of questions would be chosen that there would be a difference in the outcome. I think it is very hard to do this comparison in an extremely meaningful way because the authors choices in what is important in a product are subjective and can vary depending on who is performing the analysis.

Future Concerns and Desires for PDAs and Drug Information Technology

PH: When I interviewed two pharmacists that specialize in the field of Drug Information, I asked them what directions they see PDA technology or Electronic Drug Information access going in the future. One pharmacist had concerns about PDA technology. He felt that most companies are starting to focus most of their efforts on developing smart phones as products and that traditional PDAs will become harder and harder to find. He likes keeping his cell phone and PDA as independent and seperate devices and is concerned that he will not be able to do so in the future.

The second pharmacist did not comment on PDAs but said that he would like to see increased reimbursement for those that provide Drug Information service online or electronically. He thinks that it is currently very easy for people to access information about drugs online for free. He admitted that this is a very biased view based on his profession and that most people would view the free access as a good thing. I agree with him on this point but also feel that having so much free information out there makes online drug information acquistion a dangerous task. It becomes very difficult for those seeking information to seperate the good information from the bad information. Services that provide information for a fee and can guarantee that it will be quality information would be a good thing for those that are willing to pay. I think that in general most people will focus on sites that are free in the short-term however.

Dynamed

TL: Recently, while working on a project for a class, I needed to find some information about a condition (risk factors, causes, treatment, etc). In our PDA class recently there was a presentation about Dynamed. The database looked to be pretty easy to navigate and pretty complete in the information available, so I decided to give it a try.
I was amazed at how quickly I was able to get to the information I needed. I am definitely going to use that resource again as well as download it to my PDA!

What drug information references do some pharmacists use? Part 2

TL: I also spoke to a pharmacist I work with, who is in her first year of practice. I asked her about her favorite drug information resources. She really likes Lexicomp because it is quick and easy for her to navigate through to get to information she is seeking. She really likes the pill indentification feature and has needed to refer to it a few times since she began working. I asked if she had used clinical pharmacology much and she was not familiar with that resource. She said that she tends not to use print drug information resources because the electronic information is updated more frequently.
I also talked with her about PDAs. She does not use one at work since she has easy access to a computer. She did use her PDA frequently while on rotations and found the free epocrates software sufficient for what she needed.