I magine evaluating a patient in your office for alopecia who is taking eight medications and you are unsure which, if any, of these medications might be causing the hair loss. Or, imagine you’re performing a hospital consultation and that the patient you’re seeing has a suspected drug eruption, is on 12 drugs, and once again you aren’t sure which, if any, of these medications might be involved. Wouldn’t it be nice to have instantaneous access to various databases that could immediately give you the information you need at the point-of-care? With today’s handheld computers and the right software programs, it’s easily possible to accomplish this. Among physicians, residents, interns and medical students, handheld computers, or personal digital assistants (PDAs) continue to grow in popularity as point-of-care reference tools. Their adoption by dermatologists is no exception to this phenomenon. In a survey completed by Deloitte Research during 2001, 29% of U.S. physicians were using handheld computers. They also predicted that by 2005, almost half of all U.S. physicians will be using handheld computers. Next to their uses for personal and professional scheduling, physicians’ most common use of handheld computers was for accessing prescription drug reference databases — almost 70% of physicians owning PDAs used them for this purpose. The rise in popularity of PDAs among healthcare professionals can be traced to Palm Computing’s introduction of the Palm Pilot Organizer in 1996. Subsequent improvements in PDA design, ease of use, capabilities, battery life, processor speed, memory and lower costs have contributed to their popularity growth. An explosion in medical knowledge and the need for rapid access to a vast medical information knowledge base have also contributed as drivers of this growth trend. Dermatology-Specific Benefits Handheld computers can be used by dermatologists for content reference as well as transactional purposes.1 Having had the opportunity to begin using a handheld computer in my practice 3 years ago for electronic prescribing,2 I have observed the development of new handheld computer software programs that can serve as powerful tools for improving a dermatologist’s efficiency, productivity, decision-making ability and patient care. This article focuses on the use of handheld content reference tools for dermatologists. I’ll examine seven potentially useful handheld software programs with dermatology-specific content. In addition, I’ll also review two free, popular handheld drug reference programs. Medical PDA reference programs covered in this article include those for coding & documentation, disease & treatment, drug information, guidelines and medical literature. Coding and Documentation Instantaneous access to coding and documentation information is essential to dermatologists. To date, DermPilot is the only dermatology-specific PDA coding and documentation software program available. DermPilot. DermPilot (Inga Ellzey Practice Group, Casselberry, FL) is a dermatology-specific coding and fee calculation program available for Palm Operating System (OS) PDAs. Based on the popular HanDBase (DDH Software, Lake Worth, FL) database program, DermPilot is a freestanding database application, which means users don’t need to own or install a separate version of HanDBase. Databases included in DermPilot include Correct Coding Initiative, CPT codes, evaluation/management rules, ICD-9 codes, J-codes, locality information, modifiers, V-codes and a localities database, containing geographic conversion factors used to calculate Medicare fees. An additional analgesics database is also included. DermPilot requires 850 KB of available memory on your PDA. If you want to also install the Correct Coding Initiative feature, you need 1050 KB of memory. As of October 1, 2002, DermPilot version 8.3 became available. DermPilot is installed from a CD-ROM. After ordering, it can also be delivered by e-mail. There are no HotSync conduits installed with the program. The program, without updates, is currently priced at $69. An annual subscription, which included updates, is available for $239. The image below shows the DermPilot 8.2 CPT codes database. The diagnosis codes and their descriptions are shown arranged by code number. Records can be navigated by using arrows on the screen, the scroll button or by searching. Tapping on a code or description displays a screen containing the full text of each field for the selected record. Existing records may be edited and new records may be added. Searching can be done with case sensitive and beginning term limitations. In addition, searching can be done with filters limited to fields, by upper and lower limits and with the “not” modifier. A useful feature of the program is its ability to calculate Medicare fees, however, malpractice, practice expense and work conversion factors, supplied with the program, must be entered for a specific location. DermPilot enables a dermatologist to carry around virtually all the information needed to code for patient care and procedures. Disease & Treatment Reference Programs PDAs have also become popular as references for disease and treatment information. Although popular medical textbooks have been formatted for use on PDAs, some dermatologic texts and databases are just beginning to appear as electronic references for PDAs. Three programs, Derm DRUGs/Rx Therapy, eMedicine Dermatology eBook and Treatment of Skin Disease are potentially useful to dermatologists. Here’s a more detailed description of each program. Derm DRUGs/Rx Therapy. Derm DRUGs/Rx Therapy for Palm OS Handhelds (American Academy of Dermatology, Schaumburg, IL) is a Palm OS version of the Derm/Rx and drug reaction databases, which appear on the American Academy of Dermatology (AAD) Derminfodisc CD-ROM. This PDA software program requires 5 MB of free memory and is only compatible with PDAs running Palm OS 4.0 or higher. It is compatible with expansion cards. Derm DRUGs/Rx Therapy is available to AAD members for $149. The non-member price is $298. Derm DRUGs/Rx Therapy consists of a database of about 1,000 dermatologic diseases, arranged alphabetically. Disease synonyms appear immediately after the disease name. Detailed information on the treatment of each disease is also listed. Treatments are categorized for each disease into topical, systemic and physical. Each treatment is preceded by a letter code, which rates the therapy into one of five categories based on literature evidence. Also included are comments about the disease, literature references, last date updated and reviewers. For 2003, Derm DRUGs/Rx Therapy has added a new drug reaction database, Derm DRUGs (Dermatology Reference User's Guide). This new database includes classification, indications, action, pregnancy category, comments, contraindications, precautions, adverse effects, interactions, dosage, availability and information source. A user’s comments can be added to both databases. Below, you can see the Derm DRUGs/Rx Therapy display for larva migrans. Below larva migrans is cutaneous larva migrans, a synonymous disease name. The database listing for systemic therapy is shown. Small letters appearing before each treatment represent rating categories. An explanation of the rating categories can be accessed from the program menu. Other sections headings can be accessed by tapping on the arrow preceding the heading category, which subsequently displays a drop-down menu offering a choice of sections. Text can be highlighted, copied and pasted by using the program’s menu. Tapping on the Back button causes the program to return to the Rx Browse screen. When using this program, you can switch to the Rx Search screen from the Rx Browse screen and vice-versa. The new drug database operates similarly to the Rx Therapy database. Derm DRUGs/Rx Therapy can serve as a useful point-of-care treatment and drug reference database for dermatologists. eMedicine Dermatology eBook. eMedicine Derma- tology PDA eBook (eMedicine, St. Petersburg, FL) is a comprehensive, multi-authored electronic textbook, also available for viewing as a Web-based text on eMedicine’s web site (www.emedicine.com). The eMedicine Dermatology Web-based text has been converted into a graphics-free, compressed format, which is viewable with Mobipocket Reader (Mobipocket.com, Paris, France), a proprietary reader program available for Palm OS, Pocket PC and other platforms. The complete eMedicine Dermatology PDA eBook is more than 4 MB in size, but may be downloaded and installed to a PDA in smaller sections. The eBook is also compatible with expansion cards on Palm OS and Pocket PC devices. Priced at $49, a subscription includes unlimited updates for 1 year. The image (below) of this program illustrates the chapter on nodular localized cutaneous amyloidosis from the eMedicine Dermatology PDA eBook. The eBook is arranged so that the user can look up diseases by the table of contents or alphabetically. Hyperlinks to various sections in the chapter are indicated by underlined words. Chapter sections include synonyms, introduction, clinical, differential, workup, treatment, follow-up and miscellaneous. Images and references, present in the online version, do not appear in the eBook. Pages are navigated by tapping on the screen or by using up and down keys on the PDA. The page number is indicated in the upper right corner. The thin red bar at the bottom of the screen indicates the current position in the eBook. Searching of eBooks with Mobipocket Reader can be done using case matching and whole word limits. Containing comprehensive information on diseases and their treatments, the eMedicine Dermatology PDA eBook is an excellent electronic point of care reference for dermatologists. Treatment of Skin Disease. Treatment of Skin Disease for PDAs (Mosby, Philadelphia, PA) is a software version of the textbook by the same name, edited by Lebwohl, Heymann, Berth-Jones and Coulson. The textbook is a well-organized, multi-authored compendium of disease and treatment information for 213 different dermatologic diseases. Mirroring the textbook’s organization and layout, the software, available for both Palm OS and PocketPC platforms, contains color images, key points, management strategy, specific indications, and evidence-based first-, second- and third-line therapies. Therapies are assigned letters (A-E), which indicate the amount of published evidence supporting the classification. The software program also contains a drug index, covering 34 different systemic medications commonly used in dermatology. Drug information includes pre-therapy investigation, dosages, contraindications, monitoring, interactions and side effects. Annotated references, which appear in the textbook, are not present in the PDA program. The program uses a proprietary eReader program. For Palm OS devices, two content files are supplied, one with images, the other without. The file with images consumes considerable more memory than the one without images. This option is not available for Pocket PC devices. The product packaging claims compatibility with Palm expansion cards. The PDA version of Treatment of Skin Disease is priced at $79. As you can see in the image below, disease and drugs are arranged alphabetically. The image shows first-line treatments and evidence levels for bullous pemphigoid. Letters in parentheses next to treatments correspond to evidence levels. The evidence key is accessed by tapping the arrow following First line treatment or by tapping the arrow in the upper right-hand corner of the screen. The drop-down menu that appears allows the user to navigate to other sections (key points, management strategy, specific investigations, treatments, photograph and author) for each disease. The arrows at the top of the screen are used for forward and backward navigation. The home icon takes the user back to the eReader library and the AZ icon navigates to the Table of Contents. A search mechanism is lacking from the program and would be a valuable addition in future versions. Despite this one limitation, this program is a superb, portable, evidence-based reference for common dermatologic diseases and treatment information. Drug Information Among physicians who use PDAs, drug reference databases are the most frequently used medical reference programs. A 2001 survey by the American College of Physicians–American Society of Internal Medicine found that more than 80% of respondents used PDAs to access drug information. Numerous drug reference database software programs for PDAs are now available. Because they’re available to physicians at no cost, two programs, ePocrates Rx and mobilePDR, have become popular. Litt’s Drug Eruptions and Interactions for Palm OS, a dermatology-specific program for PDAs, has become a popular PDA program among dermatologists. ePocrates Rx. The name ePocrates has become a household word among physicians using PDAs for reference purposes. ePocrates Rx 6.0 (ePocrates, San Mateo, CA) is a free Palm OS drug reference database, which can be updated through the Internet during synchronization. Brand and generic drugs may be viewed alphabetically or by drug class. For more than 2,700 drugs, ePocrates Rx includes adult and pediatric dosing, contraindications and cautions, drug interactions, adverse reactions, cost and packaging information, and other details, such as metabolism, excretion, safety in pregnancy and lactation, class and mechanism of action. Some off-label indications are included. Personal notes may be added to any drug. A useful, optional feature of ePocrates Rx is the ability to customize the program to provide drug formulary status information. Abbreviations for formulary status appear next to each drug. Alternative choices are given for drugs that are non-formulary or that have no information listed. The program also offers a multiple drug interaction checker and DocAlerts, a messaging and alert feature. During 2002, ePocrates began offering ePocrates Rx Pro 6.0, a subscription version of the program priced at $49.99 per year. In addition to all of the features of the free version, ePocrates Rx Pro also contains qID, an infectious disease drug guide, an alternative medicine database and various medical tables. ePocrates Rx Pro has a color layout scheme, whereas the free version only displays a black and white interface. Here, you can see the display for Accutane (isotretinoin). Formulary status for this drug under Aetna US Healthcare is shown at the top of the screen. Tapping on the bold, underlined text brings up a window explaining the abbreviations and, if available, a hyperlink to alternatives. A pop-up menu in the lower left-hand corner lists available information options. The four icons in the lower right-hand corner of the screen indicate back, home, DocAlerts and MultiCheck. ePocrates Rx is a useful point-of-care drug reference tool that can obviate searching for drug information in books, such as the Physicians’ Desk Reference (PDR). Litt’s Drug Eruptions and Interactions. A particularly useful drug reference program for dermatologists is Dr. Jerome Z. Litt’s Drug Eruptions and Interactions for Palm OS, Second Edition (Parthenon Publishing, New York, NY). This program is a compendium of dermatologic adverse drug reactions, analogous to the printed, diskette, CD-ROM and Web versions of Litt’s Drug Eruption Reference Manual, but lacking detailed references. The program, which sells for $59.95, contains more than 1,500 adverse cutaneous drug reactions for more than 800 prescription and over-the-counter drugs, herbs and supplements. Both frequencies and numbers of adverse reports are also listed. Searching can be done by generic name, trade name, reaction and drug category. In addition, the program offers a multiple drug search. Up to eight generic name drugs can be searched at once for interactions. Additional features include indications, category, trade names, half-life and user-added notes. For example, this image shows what a display listing cutaneous adverse reactions to phenytoin looks like. Trade and generic drug names are cross-referenced, so that when searching for a trade name of phenytoin, the generic designation will be found. Reactions are listed under the headings of skin, hair, nails and other. Reactions are listed alphabetically under each heading. Numbers in parentheses af-ter a reaction correspond to the number of reports of that reaction. This program is particularly useful if treating patients taking a number of medications because of its ability to search for reactions across up to eight drugs at once. Litt’s Drug Eruptions and Interactions is an invaluable aid to dermatologists who regularly encounter patients with potential drug eruptions in the office and hospital settings. mobilePDR. mobilePDR (Thomson Healthcare, Montvale, NJ) is a free drug reference database available for Palm OS and Pocket PC PDAs. Based on the information contained in the printed version of the PDR, mobilePDR contains concise summaries for approximately 1,500 drugs, which include indications, contraindications, warnings & precautions, adult & pediatric dosing, adverse reactions, drug interactions, therapeutic class, black box warnings, packaging, DEA class, pregnancy & nursing information and manufacturer’s name. In many ways, mobilePDR is similar to ePocrates Rx, though there are some differences. mobilePDR is available for Pocket PC, whereas ePocrates Rx is not. Both databases are updated upon synchronization. With mobilePDR, in addition to being able to browse by drug and therapeutic class, you can also browse by indication. For each drug, mobilePDR also lists the corresponding pages in the print version of the PDR. Like ePocrates Rx, users may add notes to individual drugs. Unlike ePocrates Rx, mobilePDR doesn’t include information on costs, mechanism of action, metabolism and excretion. Lastly, mobilePDR, unlike ePocrates Rx, does not offer formulary information. Above, you can see the illustration of the mobilePDR entry for Accutane. The first section that appears is the Black Box Warning. Analogous to ePocrates Rx, a pop-up menu in the lower left-hand corner lists available information options. A button in the lower right-hand corner allows one to enter notes. After returning to the main screen by tapping the Back button, the user can browse or search for different drugs, read the “What’s new” messages or look up drug interactions. Like ePocrates Rx, mobilePDR is a useful, free, point-of-care drug reference database. Guidelines Clinical practice guidelines are becoming increasingly popular as reference tools for medical decision-making. The AAD has developed and published numerous guidelines of care for different skin disorders and procedures. Some of these guidelines are now available in a format that can be read on PDAs. AAD Guidelines of Care. Beginning in 1995, the AAD proactively began developing practice guidelines with the issuance of the first of a set of guidelines designed to promote quality care and assist non-dermatologists in understanding the complexities and scope of dermatologic care. These guidelines have been published in the Journal of the American Academy of Dermatology (JAAD), and appear on the AAD Association’s Web site (www.aadassociation.org). Recently, some of the guidelines were converted into a file format that is readable on PDAs. Although there are 49 guidelines, only 22 have been converted. PDA users must obtain and install a document reader before they are able to view the guidelines on a PDA. Guidelines are downloaded from the Internet as Palm document files. Upon synchronization of the PDA with the computer, the files are placed on the PDA and can be opened with a reader. Suitable free document readers for the Palm OS are CSpotRun, available from PalmGear (www.palmgear.com) and the Palm Reader, available from Palm Digital Media (www.palmdigitalmedia.com). A PocketPC version of the Palm Reader is also available. Here, you can see the AAD Guidelines of Care for laser surgery. The guidelines appear as unformatted text documents, which can be read by scrolling down through the document. Most document readers have search functions, which allow the user to search for specific terms in the document. The AAD Guidelines, now available at the point of care, offer dermatologists useful information in treatment decision-making. Accessing Medical Literature on Your PDA Access to the medical literature is essential for the clinical dermatologist. CogniQ is an example of a program making this information available to physicians on handheld devices. CogniQ. CogniQ (Unbound Medicine, Charlottesville, VA) is a relatively new PDA program, which integrates the Web and handheld devices, delivering personalized content and information to physicians. Available as a 6-month, free trial through the British Medical Journal (www.unboundmedicine.com/ cgi-bin/survey/survey.pl?f=start), CogniQ is available for Palm OS and PocketPC handhelds. Installation creates a conduit on the computer, which synchronizes personalized content with the handheld during synchronization. Personalized content is selected by signing in to the CogniQ Web Library. Currently available information sources include a broad selection of medical journals and summaries of Clinical Evidence, a directory of evidence on the effects of common clinical interventions, published by the BMJ Publishing Group. Additionally, with CogniQ you can perform MEDLINE searches by inputting search terms and retrieving results through the CogniQ Web Library. Unbound Medicine also offers optional CogniQ content sources, including medical textbooks and drug databases. This image shows a journal abstract on CogniQ from the JAAD. Journals available through CogniQ, which are of interest to dermatologists, include the JAAD and the Archives of Dermatology. Updated journal abstracts are automatically retrieved if the user selected the journals. Abstracts can be saved to a user’s Web Library by selecting the More Online checkbox. After synchronization, several options are available. The abstract may be viewed online, the text article may be purchased from the publisher, or Unbound MEDLINE can be used to search for related articles. CogniQ is a valuable handheld application. Indispensable Tools PDAs are quickly becoming almost indispensable to physicians as point-of-care reference tools. Doctors are utilizing PDAs because of the ever-expanding medical knowledge base, which includes both new and changing diseases and drugs. It’s virtually impossible for the human brain to retain every new medical fact. Nor is it realistic to expect physicians to be able to retain and recall the entire body of medical knowledge, which changes on a daily basis. Potential benefits of PDAs used as content tools are improved outcomes, medical error reduction and lowered medical costs. You can derive value from PDAs by using them, not just for their traditional functions as personal organizers, but as useful content sources for various diseases, drugs and other necessary decision-making information.
Information In the Palm of Your Handheld
I magine evaluating a patient in your office for alopecia who is taking eight medications and you are unsure which, if any, of these medications might be causing the hair loss. Or, imagine you’re performing a hospital consultation and that the patient you’re seeing has a suspected drug eruption, is on 12 drugs, and once again you aren’t sure which, if any, of these medications might be involved. Wouldn’t it be nice to have instantaneous access to various databases that could immediately give you the information you need at the point-of-care? With today’s handheld computers and the right software programs, it’s easily possible to accomplish this. Among physicians, residents, interns and medical students, handheld computers, or personal digital assistants (PDAs) continue to grow in popularity as point-of-care reference tools. Their adoption by dermatologists is no exception to this phenomenon. In a survey completed by Deloitte Research during 2001, 29% of U.S. physicians were using handheld computers. They also predicted that by 2005, almost half of all U.S. physicians will be using handheld computers. Next to their uses for personal and professional scheduling, physicians’ most common use of handheld computers was for accessing prescription drug reference databases — almost 70% of physicians owning PDAs used them for this purpose. The rise in popularity of PDAs among healthcare professionals can be traced to Palm Computing’s introduction of the Palm Pilot Organizer in 1996. Subsequent improvements in PDA design, ease of use, capabilities, battery life, processor speed, memory and lower costs have contributed to their popularity growth. An explosion in medical knowledge and the need for rapid access to a vast medical information knowledge base have also contributed as drivers of this growth trend. Dermatology-Specific Benefits Handheld computers can be used by dermatologists for content reference as well as transactional purposes.1 Having had the opportunity to begin using a handheld computer in my practice 3 years ago for electronic prescribing,2 I have observed the development of new handheld computer software programs that can serve as powerful tools for improving a dermatologist’s efficiency, productivity, decision-making ability and patient care. This article focuses on the use of handheld content reference tools for dermatologists. I’ll examine seven potentially useful handheld software programs with dermatology-specific content. In addition, I’ll also review two free, popular handheld drug reference programs. Medical PDA reference programs covered in this article include those for coding & documentation, disease & treatment, drug information, guidelines and medical literature. Coding and Documentation Instantaneous access to coding and documentation information is essential to dermatologists. To date, DermPilot is the only dermatology-specific PDA coding and documentation software program available. DermPilot. DermPilot (Inga Ellzey Practice Group, Casselberry, FL) is a dermatology-specific coding and fee calculation program available for Palm Operating System (OS) PDAs. Based on the popular HanDBase (DDH Software, Lake Worth, FL) database program, DermPilot is a freestanding database application, which means users don’t need to own or install a separate version of HanDBase. Databases included in DermPilot include Correct Coding Initiative, CPT codes, evaluation/management rules, ICD-9 codes, J-codes, locality information, modifiers, V-codes and a localities database, containing geographic conversion factors used to calculate Medicare fees. An additional analgesics database is also included. DermPilot requires 850 KB of available memory on your PDA. If you want to also install the Correct Coding Initiative feature, you need 1050 KB of memory. As of October 1, 2002, DermPilot version 8.3 became available. DermPilot is installed from a CD-ROM. After ordering, it can also be delivered by e-mail. There are no HotSync conduits installed with the program. The program, without updates, is currently priced at $69. An annual subscription, which included updates, is available for $239. The image below shows the DermPilot 8.2 CPT codes database. The diagnosis codes and their descriptions are shown arranged by code number. Records can be navigated by using arrows on the screen, the scroll button or by searching. Tapping on a code or description displays a screen containing the full text of each field for the selected record. Existing records may be edited and new records may be added. Searching can be done with case sensitive and beginning term limitations. In addition, searching can be done with filters limited to fields, by upper and lower limits and with the “not” modifier. A useful feature of the program is its ability to calculate Medicare fees, however, malpractice, practice expense and work conversion factors, supplied with the program, must be entered for a specific location. DermPilot enables a dermatologist to carry around virtually all the information needed to code for patient care and procedures. Disease & Treatment Reference Programs PDAs have also become popular as references for disease and treatment information. Although popular medical textbooks have been formatted for use on PDAs, some dermatologic texts and databases are just beginning to appear as electronic references for PDAs. Three programs, Derm DRUGs/Rx Therapy, eMedicine Dermatology eBook and Treatment of Skin Disease are potentially useful to dermatologists. Here’s a more detailed description of each program. Derm DRUGs/Rx Therapy. Derm DRUGs/Rx Therapy for Palm OS Handhelds (American Academy of Dermatology, Schaumburg, IL) is a Palm OS version of the Derm/Rx and drug reaction databases, which appear on the American Academy of Dermatology (AAD) Derminfodisc CD-ROM. This PDA software program requires 5 MB of free memory and is only compatible with PDAs running Palm OS 4.0 or higher. It is compatible with expansion cards. Derm DRUGs/Rx Therapy is available to AAD members for $149. The non-member price is $298. Derm DRUGs/Rx Therapy consists of a database of about 1,000 dermatologic diseases, arranged alphabetically. Disease synonyms appear immediately after the disease name. Detailed information on the treatment of each disease is also listed. Treatments are categorized for each disease into topical, systemic and physical. Each treatment is preceded by a letter code, which rates the therapy into one of five categories based on literature evidence. Also included are comments about the disease, literature references, last date updated and reviewers. For 2003, Derm DRUGs/Rx Therapy has added a new drug reaction database, Derm DRUGs (Dermatology Reference User's Guide). This new database includes classification, indications, action, pregnancy category, comments, contraindications, precautions, adverse effects, interactions, dosage, availability and information source. A user’s comments can be added to both databases. Below, you can see the Derm DRUGs/Rx Therapy display for larva migrans. Below larva migrans is cutaneous larva migrans, a synonymous disease name. The database listing for systemic therapy is shown. Small letters appearing before each treatment represent rating categories. An explanation of the rating categories can be accessed from the program menu. Other sections headings can be accessed by tapping on the arrow preceding the heading category, which subsequently displays a drop-down menu offering a choice of sections. Text can be highlighted, copied and pasted by using the program’s menu. Tapping on the Back button causes the program to return to the Rx Browse screen. When using this program, you can switch to the Rx Search screen from the Rx Browse screen and vice-versa. The new drug database operates similarly to the Rx Therapy database. Derm DRUGs/Rx Therapy can serve as a useful point-of-care treatment and drug reference database for dermatologists. eMedicine Dermatology eBook. eMedicine Derma- tology PDA eBook (eMedicine, St. Petersburg, FL) is a comprehensive, multi-authored electronic textbook, also available for viewing as a Web-based text on eMedicine’s web site (www.emedicine.com). The eMedicine Dermatology Web-based text has been converted into a graphics-free, compressed format, which is viewable with Mobipocket Reader (Mobipocket.com, Paris, France), a proprietary reader program available for Palm OS, Pocket PC and other platforms. The complete eMedicine Dermatology PDA eBook is more than 4 MB in size, but may be downloaded and installed to a PDA in smaller sections. The eBook is also compatible with expansion cards on Palm OS and Pocket PC devices. Priced at $49, a subscription includes unlimited updates for 1 year. The image (below) of this program illustrates the chapter on nodular localized cutaneous amyloidosis from the eMedicine Dermatology PDA eBook. The eBook is arranged so that the user can look up diseases by the table of contents or alphabetically. Hyperlinks to various sections in the chapter are indicated by underlined words. Chapter sections include synonyms, introduction, clinical, differential, workup, treatment, follow-up and miscellaneous. Images and references, present in the online version, do not appear in the eBook. Pages are navigated by tapping on the screen or by using up and down keys on the PDA. The page number is indicated in the upper right corner. The thin red bar at the bottom of the screen indicates the current position in the eBook. Searching of eBooks with Mobipocket Reader can be done using case matching and whole word limits. Containing comprehensive information on diseases and their treatments, the eMedicine Dermatology PDA eBook is an excellent electronic point of care reference for dermatologists. Treatment of Skin Disease. Treatment of Skin Disease for PDAs (Mosby, Philadelphia, PA) is a software version of the textbook by the same name, edited by Lebwohl, Heymann, Berth-Jones and Coulson. The textbook is a well-organized, multi-authored compendium of disease and treatment information for 213 different dermatologic diseases. Mirroring the textbook’s organization and layout, the software, available for both Palm OS and PocketPC platforms, contains color images, key points, management strategy, specific indications, and evidence-based first-, second- and third-line therapies. Therapies are assigned letters (A-E), which indicate the amount of published evidence supporting the classification. The software program also contains a drug index, covering 34 different systemic medications commonly used in dermatology. Drug information includes pre-therapy investigation, dosages, contraindications, monitoring, interactions and side effects. Annotated references, which appear in the textbook, are not present in the PDA program. The program uses a proprietary eReader program. For Palm OS devices, two content files are supplied, one with images, the other without. The file with images consumes considerable more memory than the one without images. This option is not available for Pocket PC devices. The product packaging claims compatibility with Palm expansion cards. The PDA version of Treatment of Skin Disease is priced at $79. As you can see in the image below, disease and drugs are arranged alphabetically. The image shows first-line treatments and evidence levels for bullous pemphigoid. Letters in parentheses next to treatments correspond to evidence levels. The evidence key is accessed by tapping the arrow following First line treatment or by tapping the arrow in the upper right-hand corner of the screen. The drop-down menu that appears allows the user to navigate to other sections (key points, management strategy, specific investigations, treatments, photograph and author) for each disease. The arrows at the top of the screen are used for forward and backward navigation. The home icon takes the user back to the eReader library and the AZ icon navigates to the Table of Contents. A search mechanism is lacking from the program and would be a valuable addition in future versions. Despite this one limitation, this program is a superb, portable, evidence-based reference for common dermatologic diseases and treatment information. Drug Information Among physicians who use PDAs, drug reference databases are the most frequently used medical reference programs. A 2001 survey by the American College of Physicians–American Society of Internal Medicine found that more than 80% of respondents used PDAs to access drug information. Numerous drug reference database software programs for PDAs are now available. Because they’re available to physicians at no cost, two programs, ePocrates Rx and mobilePDR, have become popular. Litt’s Drug Eruptions and Interactions for Palm OS, a dermatology-specific program for PDAs, has become a popular PDA program among dermatologists. ePocrates Rx. The name ePocrates has become a household word among physicians using PDAs for reference purposes. ePocrates Rx 6.0 (ePocrates, San Mateo, CA) is a free Palm OS drug reference database, which can be updated through the Internet during synchronization. Brand and generic drugs may be viewed alphabetically or by drug class. For more than 2,700 drugs, ePocrates Rx includes adult and pediatric dosing, contraindications and cautions, drug interactions, adverse reactions, cost and packaging information, and other details, such as metabolism, excretion, safety in pregnancy and lactation, class and mechanism of action. Some off-label indications are included. Personal notes may be added to any drug. A useful, optional feature of ePocrates Rx is the ability to customize the program to provide drug formulary status information. Abbreviations for formulary status appear next to each drug. Alternative choices are given for drugs that are non-formulary or that have no information listed. The program also offers a multiple drug interaction checker and DocAlerts, a messaging and alert feature. During 2002, ePocrates began offering ePocrates Rx Pro 6.0, a subscription version of the program priced at $49.99 per year. In addition to all of the features of the free version, ePocrates Rx Pro also contains qID, an infectious disease drug guide, an alternative medicine database and various medical tables. ePocrates Rx Pro has a color layout scheme, whereas the free version only displays a black and white interface. Here, you can see the display for Accutane (isotretinoin). Formulary status for this drug under Aetna US Healthcare is shown at the top of the screen. Tapping on the bold, underlined text brings up a window explaining the abbreviations and, if available, a hyperlink to alternatives. A pop-up menu in the lower left-hand corner lists available information options. The four icons in the lower right-hand corner of the screen indicate back, home, DocAlerts and MultiCheck. ePocrates Rx is a useful point-of-care drug reference tool that can obviate searching for drug information in books, such as the Physicians’ Desk Reference (PDR). Litt’s Drug Eruptions and Interactions. A particularly useful drug reference program for dermatologists is Dr. Jerome Z. Litt’s Drug Eruptions and Interactions for Palm OS, Second Edition (Parthenon Publishing, New York, NY). This program is a compendium of dermatologic adverse drug reactions, analogous to the printed, diskette, CD-ROM and Web versions of Litt’s Drug Eruption Reference Manual, but lacking detailed references. The program, which sells for $59.95, contains more than 1,500 adverse cutaneous drug reactions for more than 800 prescription and over-the-counter drugs, herbs and supplements. Both frequencies and numbers of adverse reports are also listed. Searching can be done by generic name, trade name, reaction and drug category. In addition, the program offers a multiple drug search. Up to eight generic name drugs can be searched at once for interactions. Additional features include indications, category, trade names, half-life and user-added notes. For example, this image shows what a display listing cutaneous adverse reactions to phenytoin looks like. Trade and generic drug names are cross-referenced, so that when searching for a trade name of phenytoin, the generic designation will be found. Reactions are listed under the headings of skin, hair, nails and other. Reactions are listed alphabetically under each heading. Numbers in parentheses af-ter a reaction correspond to the number of reports of that reaction. This program is particularly useful if treating patients taking a number of medications because of its ability to search for reactions across up to eight drugs at once. Litt’s Drug Eruptions and Interactions is an invaluable aid to dermatologists who regularly encounter patients with potential drug eruptions in the office and hospital settings. mobilePDR. mobilePDR (Thomson Healthcare, Montvale, NJ) is a free drug reference database available for Palm OS and Pocket PC PDAs. Based on the information contained in the printed version of the PDR, mobilePDR contains concise summaries for approximately 1,500 drugs, which include indications, contraindications, warnings & precautions, adult & pediatric dosing, adverse reactions, drug interactions, therapeutic class, black box warnings, packaging, DEA class, pregnancy & nursing information and manufacturer’s name. In many ways, mobilePDR is similar to ePocrates Rx, though there are some differences. mobilePDR is available for Pocket PC, whereas ePocrates Rx is not. Both databases are updated upon synchronization. With mobilePDR, in addition to being able to browse by drug and therapeutic class, you can also browse by indication. For each drug, mobilePDR also lists the corresponding pages in the print version of the PDR. Like ePocrates Rx, users may add notes to individual drugs. Unlike ePocrates Rx, mobilePDR doesn’t include information on costs, mechanism of action, metabolism and excretion. Lastly, mobilePDR, unlike ePocrates Rx, does not offer formulary information. Above, you can see the illustration of the mobilePDR entry for Accutane. The first section that appears is the Black Box Warning. Analogous to ePocrates Rx, a pop-up menu in the lower left-hand corner lists available information options. A button in the lower right-hand corner allows one to enter notes. After returning to the main screen by tapping the Back button, the user can browse or search for different drugs, read the “What’s new” messages or look up drug interactions. Like ePocrates Rx, mobilePDR is a useful, free, point-of-care drug reference database. Guidelines Clinical practice guidelines are becoming increasingly popular as reference tools for medical decision-making. The AAD has developed and published numerous guidelines of care for different skin disorders and procedures. Some of these guidelines are now available in a format that can be read on PDAs. AAD Guidelines of Care. Beginning in 1995, the AAD proactively began developing practice guidelines with the issuance of the first of a set of guidelines designed to promote quality care and assist non-dermatologists in understanding the complexities and scope of dermatologic care. These guidelines have been published in the Journal of the American Academy of Dermatology (JAAD), and appear on the AAD Association’s Web site (www.aadassociation.org). Recently, some of the guidelines were converted into a file format that is readable on PDAs. Although there are 49 guidelines, only 22 have been converted. PDA users must obtain and install a document reader before they are able to view the guidelines on a PDA. Guidelines are downloaded from the Internet as Palm document files. Upon synchronization of the PDA with the computer, the files are placed on the PDA and can be opened with a reader. Suitable free document readers for the Palm OS are CSpotRun, available from PalmGear (www.palmgear.com) and the Palm Reader, available from Palm Digital Media (www.palmdigitalmedia.com). A PocketPC version of the Palm Reader is also available. Here, you can see the AAD Guidelines of Care for laser surgery. The guidelines appear as unformatted text documents, which can be read by scrolling down through the document. Most document readers have search functions, which allow the user to search for specific terms in the document. The AAD Guidelines, now available at the point of care, offer dermatologists useful information in treatment decision-making. Accessing Medical Literature on Your PDA Access to the medical literature is essential for the clinical dermatologist. CogniQ is an example of a program making this information available to physicians on handheld devices. CogniQ. CogniQ (Unbound Medicine, Charlottesville, VA) is a relatively new PDA program, which integrates the Web and handheld devices, delivering personalized content and information to physicians. Available as a 6-month, free trial through the British Medical Journal (www.unboundmedicine.com/ cgi-bin/survey/survey.pl?f=start), CogniQ is available for Palm OS and PocketPC handhelds. Installation creates a conduit on the computer, which synchronizes personalized content with the handheld during synchronization. Personalized content is selected by signing in to the CogniQ Web Library. Currently available information sources include a broad selection of medical journals and summaries of Clinical Evidence, a directory of evidence on the effects of common clinical interventions, published by the BMJ Publishing Group. Additionally, with CogniQ you can perform MEDLINE searches by inputting search terms and retrieving results through the CogniQ Web Library. Unbound Medicine also offers optional CogniQ content sources, including medical textbooks and drug databases. This image shows a journal abstract on CogniQ from the JAAD. Journals available through CogniQ, which are of interest to dermatologists, include the JAAD and the Archives of Dermatology. Updated journal abstracts are automatically retrieved if the user selected the journals. Abstracts can be saved to a user’s Web Library by selecting the More Online checkbox. After synchronization, several options are available. The abstract may be viewed online, the text article may be purchased from the publisher, or Unbound MEDLINE can be used to search for related articles. CogniQ is a valuable handheld application. Indispensable Tools PDAs are quickly becoming almost indispensable to physicians as point-of-care reference tools. Doctors are utilizing PDAs because of the ever-expanding medical knowledge base, which includes both new and changing diseases and drugs. It’s virtually impossible for the human brain to retain every new medical fact. Nor is it realistic to expect physicians to be able to retain and recall the entire body of medical knowledge, which changes on a daily basis. Potential benefits of PDAs used as content tools are improved outcomes, medical error reduction and lowered medical costs. You can derive value from PDAs by using them, not just for their traditional functions as personal organizers, but as useful content sources for various diseases, drugs and other necessary decision-making information.
I magine evaluating a patient in your office for alopecia who is taking eight medications and you are unsure which, if any, of these medications might be causing the hair loss. Or, imagine you’re performing a hospital consultation and that the patient you’re seeing has a suspected drug eruption, is on 12 drugs, and once again you aren’t sure which, if any, of these medications might be involved. Wouldn’t it be nice to have instantaneous access to various databases that could immediately give you the information you need at the point-of-care? With today’s handheld computers and the right software programs, it’s easily possible to accomplish this. Among physicians, residents, interns and medical students, handheld computers, or personal digital assistants (PDAs) continue to grow in popularity as point-of-care reference tools. Their adoption by dermatologists is no exception to this phenomenon. In a survey completed by Deloitte Research during 2001, 29% of U.S. physicians were using handheld computers. They also predicted that by 2005, almost half of all U.S. physicians will be using handheld computers. Next to their uses for personal and professional scheduling, physicians’ most common use of handheld computers was for accessing prescription drug reference databases — almost 70% of physicians owning PDAs used them for this purpose. The rise in popularity of PDAs among healthcare professionals can be traced to Palm Computing’s introduction of the Palm Pilot Organizer in 1996. Subsequent improvements in PDA design, ease of use, capabilities, battery life, processor speed, memory and lower costs have contributed to their popularity growth. An explosion in medical knowledge and the need for rapid access to a vast medical information knowledge base have also contributed as drivers of this growth trend. Dermatology-Specific Benefits Handheld computers can be used by dermatologists for content reference as well as transactional purposes.1 Having had the opportunity to begin using a handheld computer in my practice 3 years ago for electronic prescribing,2 I have observed the development of new handheld computer software programs that can serve as powerful tools for improving a dermatologist’s efficiency, productivity, decision-making ability and patient care. This article focuses on the use of handheld content reference tools for dermatologists. I’ll examine seven potentially useful handheld software programs with dermatology-specific content. In addition, I’ll also review two free, popular handheld drug reference programs. Medical PDA reference programs covered in this article include those for coding & documentation, disease & treatment, drug information, guidelines and medical literature. Coding and Documentation Instantaneous access to coding and documentation information is essential to dermatologists. To date, DermPilot is the only dermatology-specific PDA coding and documentation software program available. DermPilot. DermPilot (Inga Ellzey Practice Group, Casselberry, FL) is a dermatology-specific coding and fee calculation program available for Palm Operating System (OS) PDAs. Based on the popular HanDBase (DDH Software, Lake Worth, FL) database program, DermPilot is a freestanding database application, which means users don’t need to own or install a separate version of HanDBase. Databases included in DermPilot include Correct Coding Initiative, CPT codes, evaluation/management rules, ICD-9 codes, J-codes, locality information, modifiers, V-codes and a localities database, containing geographic conversion factors used to calculate Medicare fees. An additional analgesics database is also included. DermPilot requires 850 KB of available memory on your PDA. If you want to also install the Correct Coding Initiative feature, you need 1050 KB of memory. As of October 1, 2002, DermPilot version 8.3 became available. DermPilot is installed from a CD-ROM. After ordering, it can also be delivered by e-mail. There are no HotSync conduits installed with the program. The program, without updates, is currently priced at $69. An annual subscription, which included updates, is available for $239. The image below shows the DermPilot 8.2 CPT codes database. The diagnosis codes and their descriptions are shown arranged by code number. Records can be navigated by using arrows on the screen, the scroll button or by searching. Tapping on a code or description displays a screen containing the full text of each field for the selected record. Existing records may be edited and new records may be added. Searching can be done with case sensitive and beginning term limitations. In addition, searching can be done with filters limited to fields, by upper and lower limits and with the “not” modifier. A useful feature of the program is its ability to calculate Medicare fees, however, malpractice, practice expense and work conversion factors, supplied with the program, must be entered for a specific location. DermPilot enables a dermatologist to carry around virtually all the information needed to code for patient care and procedures. Disease & Treatment Reference Programs PDAs have also become popular as references for disease and treatment information. Although popular medical textbooks have been formatted for use on PDAs, some dermatologic texts and databases are just beginning to appear as electronic references for PDAs. Three programs, Derm DRUGs/Rx Therapy, eMedicine Dermatology eBook and Treatment of Skin Disease are potentially useful to dermatologists. Here’s a more detailed description of each program. Derm DRUGs/Rx Therapy. Derm DRUGs/Rx Therapy for Palm OS Handhelds (American Academy of Dermatology, Schaumburg, IL) is a Palm OS version of the Derm/Rx and drug reaction databases, which appear on the American Academy of Dermatology (AAD) Derminfodisc CD-ROM. This PDA software program requires 5 MB of free memory and is only compatible with PDAs running Palm OS 4.0 or higher. It is compatible with expansion cards. Derm DRUGs/Rx Therapy is available to AAD members for $149. The non-member price is $298. Derm DRUGs/Rx Therapy consists of a database of about 1,000 dermatologic diseases, arranged alphabetically. Disease synonyms appear immediately after the disease name. Detailed information on the treatment of each disease is also listed. Treatments are categorized for each disease into topical, systemic and physical. Each treatment is preceded by a letter code, which rates the therapy into one of five categories based on literature evidence. Also included are comments about the disease, literature references, last date updated and reviewers. For 2003, Derm DRUGs/Rx Therapy has added a new drug reaction database, Derm DRUGs (Dermatology Reference User's Guide). This new database includes classification, indications, action, pregnancy category, comments, contraindications, precautions, adverse effects, interactions, dosage, availability and information source. A user’s comments can be added to both databases. Below, you can see the Derm DRUGs/Rx Therapy display for larva migrans. Below larva migrans is cutaneous larva migrans, a synonymous disease name. The database listing for systemic therapy is shown. Small letters appearing before each treatment represent rating categories. An explanation of the rating categories can be accessed from the program menu. Other sections headings can be accessed by tapping on the arrow preceding the heading category, which subsequently displays a drop-down menu offering a choice of sections. Text can be highlighted, copied and pasted by using the program’s menu. Tapping on the Back button causes the program to return to the Rx Browse screen. When using this program, you can switch to the Rx Search screen from the Rx Browse screen and vice-versa. The new drug database operates similarly to the Rx Therapy database. Derm DRUGs/Rx Therapy can serve as a useful point-of-care treatment and drug reference database for dermatologists. eMedicine Dermatology eBook. eMedicine Derma- tology PDA eBook (eMedicine, St. Petersburg, FL) is a comprehensive, multi-authored electronic textbook, also available for viewing as a Web-based text on eMedicine’s web site (www.emedicine.com). The eMedicine Dermatology Web-based text has been converted into a graphics-free, compressed format, which is viewable with Mobipocket Reader (Mobipocket.com, Paris, France), a proprietary reader program available for Palm OS, Pocket PC and other platforms. The complete eMedicine Dermatology PDA eBook is more than 4 MB in size, but may be downloaded and installed to a PDA in smaller sections. The eBook is also compatible with expansion cards on Palm OS and Pocket PC devices. Priced at $49, a subscription includes unlimited updates for 1 year. The image (below) of this program illustrates the chapter on nodular localized cutaneous amyloidosis from the eMedicine Dermatology PDA eBook. The eBook is arranged so that the user can look up diseases by the table of contents or alphabetically. Hyperlinks to various sections in the chapter are indicated by underlined words. Chapter sections include synonyms, introduction, clinical, differential, workup, treatment, follow-up and miscellaneous. Images and references, present in the online version, do not appear in the eBook. Pages are navigated by tapping on the screen or by using up and down keys on the PDA. The page number is indicated in the upper right corner. The thin red bar at the bottom of the screen indicates the current position in the eBook. Searching of eBooks with Mobipocket Reader can be done using case matching and whole word limits. Containing comprehensive information on diseases and their treatments, the eMedicine Dermatology PDA eBook is an excellent electronic point of care reference for dermatologists. Treatment of Skin Disease. Treatment of Skin Disease for PDAs (Mosby, Philadelphia, PA) is a software version of the textbook by the same name, edited by Lebwohl, Heymann, Berth-Jones and Coulson. The textbook is a well-organized, multi-authored compendium of disease and treatment information for 213 different dermatologic diseases. Mirroring the textbook’s organization and layout, the software, available for both Palm OS and PocketPC platforms, contains color images, key points, management strategy, specific indications, and evidence-based first-, second- and third-line therapies. Therapies are assigned letters (A-E), which indicate the amount of published evidence supporting the classification. The software program also contains a drug index, covering 34 different systemic medications commonly used in dermatology. Drug information includes pre-therapy investigation, dosages, contraindications, monitoring, interactions and side effects. Annotated references, which appear in the textbook, are not present in the PDA program. The program uses a proprietary eReader program. For Palm OS devices, two content files are supplied, one with images, the other without. The file with images consumes considerable more memory than the one without images. This option is not available for Pocket PC devices. The product packaging claims compatibility with Palm expansion cards. The PDA version of Treatment of Skin Disease is priced at $79. As you can see in the image below, disease and drugs are arranged alphabetically. The image shows first-line treatments and evidence levels for bullous pemphigoid. Letters in parentheses next to treatments correspond to evidence levels. The evidence key is accessed by tapping the arrow following First line treatment or by tapping the arrow in the upper right-hand corner of the screen. The drop-down menu that appears allows the user to navigate to other sections (key points, management strategy, specific investigations, treatments, photograph and author) for each disease. The arrows at the top of the screen are used for forward and backward navigation. The home icon takes the user back to the eReader library and the AZ icon navigates to the Table of Contents. A search mechanism is lacking from the program and would be a valuable addition in future versions. Despite this one limitation, this program is a superb, portable, evidence-based reference for common dermatologic diseases and treatment information. Drug Information Among physicians who use PDAs, drug reference databases are the most frequently used medical reference programs. A 2001 survey by the American College of Physicians–American Society of Internal Medicine found that more than 80% of respondents used PDAs to access drug information. Numerous drug reference database software programs for PDAs are now available. Because they’re available to physicians at no cost, two programs, ePocrates Rx and mobilePDR, have become popular. Litt’s Drug Eruptions and Interactions for Palm OS, a dermatology-specific program for PDAs, has become a popular PDA program among dermatologists. ePocrates Rx. The name ePocrates has become a household word among physicians using PDAs for reference purposes. ePocrates Rx 6.0 (ePocrates, San Mateo, CA) is a free Palm OS drug reference database, which can be updated through the Internet during synchronization. Brand and generic drugs may be viewed alphabetically or by drug class. For more than 2,700 drugs, ePocrates Rx includes adult and pediatric dosing, contraindications and cautions, drug interactions, adverse reactions, cost and packaging information, and other details, such as metabolism, excretion, safety in pregnancy and lactation, class and mechanism of action. Some off-label indications are included. Personal notes may be added to any drug. A useful, optional feature of ePocrates Rx is the ability to customize the program to provide drug formulary status information. Abbreviations for formulary status appear next to each drug. Alternative choices are given for drugs that are non-formulary or that have no information listed. The program also offers a multiple drug interaction checker and DocAlerts, a messaging and alert feature. During 2002, ePocrates began offering ePocrates Rx Pro 6.0, a subscription version of the program priced at $49.99 per year. In addition to all of the features of the free version, ePocrates Rx Pro also contains qID, an infectious disease drug guide, an alternative medicine database and various medical tables. ePocrates Rx Pro has a color layout scheme, whereas the free version only displays a black and white interface. Here, you can see the display for Accutane (isotretinoin). Formulary status for this drug under Aetna US Healthcare is shown at the top of the screen. Tapping on the bold, underlined text brings up a window explaining the abbreviations and, if available, a hyperlink to alternatives. A pop-up menu in the lower left-hand corner lists available information options. The four icons in the lower right-hand corner of the screen indicate back, home, DocAlerts and MultiCheck. ePocrates Rx is a useful point-of-care drug reference tool that can obviate searching for drug information in books, such as the Physicians’ Desk Reference (PDR). Litt’s Drug Eruptions and Interactions. A particularly useful drug reference program for dermatologists is Dr. Jerome Z. Litt’s Drug Eruptions and Interactions for Palm OS, Second Edition (Parthenon Publishing, New York, NY). This program is a compendium of dermatologic adverse drug reactions, analogous to the printed, diskette, CD-ROM and Web versions of Litt’s Drug Eruption Reference Manual, but lacking detailed references. The program, which sells for $59.95, contains more than 1,500 adverse cutaneous drug reactions for more than 800 prescription and over-the-counter drugs, herbs and supplements. Both frequencies and numbers of adverse reports are also listed. Searching can be done by generic name, trade name, reaction and drug category. In addition, the program offers a multiple drug search. Up to eight generic name drugs can be searched at once for interactions. Additional features include indications, category, trade names, half-life and user-added notes. For example, this image shows what a display listing cutaneous adverse reactions to phenytoin looks like. Trade and generic drug names are cross-referenced, so that when searching for a trade name of phenytoin, the generic designation will be found. Reactions are listed under the headings of skin, hair, nails and other. Reactions are listed alphabetically under each heading. Numbers in parentheses af-ter a reaction correspond to the number of reports of that reaction. This program is particularly useful if treating patients taking a number of medications because of its ability to search for reactions across up to eight drugs at once. Litt’s Drug Eruptions and Interactions is an invaluable aid to dermatologists who regularly encounter patients with potential drug eruptions in the office and hospital settings. mobilePDR. mobilePDR (Thomson Healthcare, Montvale, NJ) is a free drug reference database available for Palm OS and Pocket PC PDAs. Based on the information contained in the printed version of the PDR, mobilePDR contains concise summaries for approximately 1,500 drugs, which include indications, contraindications, warnings & precautions, adult & pediatric dosing, adverse reactions, drug interactions, therapeutic class, black box warnings, packaging, DEA class, pregnancy & nursing information and manufacturer’s name. In many ways, mobilePDR is similar to ePocrates Rx, though there are some differences. mobilePDR is available for Pocket PC, whereas ePocrates Rx is not. Both databases are updated upon synchronization. With mobilePDR, in addition to being able to browse by drug and therapeutic class, you can also browse by indication. For each drug, mobilePDR also lists the corresponding pages in the print version of the PDR. Like ePocrates Rx, users may add notes to individual drugs. Unlike ePocrates Rx, mobilePDR doesn’t include information on costs, mechanism of action, metabolism and excretion. Lastly, mobilePDR, unlike ePocrates Rx, does not offer formulary information. Above, you can see the illustration of the mobilePDR entry for Accutane. The first section that appears is the Black Box Warning. Analogous to ePocrates Rx, a pop-up menu in the lower left-hand corner lists available information options. A button in the lower right-hand corner allows one to enter notes. After returning to the main screen by tapping the Back button, the user can browse or search for different drugs, read the “What’s new” messages or look up drug interactions. Like ePocrates Rx, mobilePDR is a useful, free, point-of-care drug reference database. Guidelines Clinical practice guidelines are becoming increasingly popular as reference tools for medical decision-making. The AAD has developed and published numerous guidelines of care for different skin disorders and procedures. Some of these guidelines are now available in a format that can be read on PDAs. AAD Guidelines of Care. Beginning in 1995, the AAD proactively began developing practice guidelines with the issuance of the first of a set of guidelines designed to promote quality care and assist non-dermatologists in understanding the complexities and scope of dermatologic care. These guidelines have been published in the Journal of the American Academy of Dermatology (JAAD), and appear on the AAD Association’s Web site (www.aadassociation.org). Recently, some of the guidelines were converted into a file format that is readable on PDAs. Although there are 49 guidelines, only 22 have been converted. PDA users must obtain and install a document reader before they are able to view the guidelines on a PDA. Guidelines are downloaded from the Internet as Palm document files. Upon synchronization of the PDA with the computer, the files are placed on the PDA and can be opened with a reader. Suitable free document readers for the Palm OS are CSpotRun, available from PalmGear (www.palmgear.com) and the Palm Reader, available from Palm Digital Media (www.palmdigitalmedia.com). A PocketPC version of the Palm Reader is also available. Here, you can see the AAD Guidelines of Care for laser surgery. The guidelines appear as unformatted text documents, which can be read by scrolling down through the document. Most document readers have search functions, which allow the user to search for specific terms in the document. The AAD Guidelines, now available at the point of care, offer dermatologists useful information in treatment decision-making. Accessing Medical Literature on Your PDA Access to the medical literature is essential for the clinical dermatologist. CogniQ is an example of a program making this information available to physicians on handheld devices. CogniQ. CogniQ (Unbound Medicine, Charlottesville, VA) is a relatively new PDA program, which integrates the Web and handheld devices, delivering personalized content and information to physicians. Available as a 6-month, free trial through the British Medical Journal (www.unboundmedicine.com/ cgi-bin/survey/survey.pl?f=start), CogniQ is available for Palm OS and PocketPC handhelds. Installation creates a conduit on the computer, which synchronizes personalized content with the handheld during synchronization. Personalized content is selected by signing in to the CogniQ Web Library. Currently available information sources include a broad selection of medical journals and summaries of Clinical Evidence, a directory of evidence on the effects of common clinical interventions, published by the BMJ Publishing Group. Additionally, with CogniQ you can perform MEDLINE searches by inputting search terms and retrieving results through the CogniQ Web Library. Unbound Medicine also offers optional CogniQ content sources, including medical textbooks and drug databases. This image shows a journal abstract on CogniQ from the JAAD. Journals available through CogniQ, which are of interest to dermatologists, include the JAAD and the Archives of Dermatology. Updated journal abstracts are automatically retrieved if the user selected the journals. Abstracts can be saved to a user’s Web Library by selecting the More Online checkbox. After synchronization, several options are available. The abstract may be viewed online, the text article may be purchased from the publisher, or Unbound MEDLINE can be used to search for related articles. CogniQ is a valuable handheld application. Indispensable Tools PDAs are quickly becoming almost indispensable to physicians as point-of-care reference tools. Doctors are utilizing PDAs because of the ever-expanding medical knowledge base, which includes both new and changing diseases and drugs. It’s virtually impossible for the human brain to retain every new medical fact. Nor is it realistic to expect physicians to be able to retain and recall the entire body of medical knowledge, which changes on a daily basis. Potential benefits of PDAs used as content tools are improved outcomes, medical error reduction and lowered medical costs. You can derive value from PDAs by using them, not just for their traditional functions as personal organizers, but as useful content sources for various diseases, drugs and other necessary decision-making information.
