Hospitalists are discovering that the tiny devices can be a lifeline to an ever-growing body of medical information. by Ingrid Palmer
Published in the December 2003 issue of Today's Hospitalist
Show up for work without your handheld computer at Group Health Permanente in Spokane, Wash., and you're in for a tough time.
"If you don't have your PDA," says Tom Schaaf, MD, clinical director of the hospitalist pro-gram, "you're dead in the water." Information collected on hospitalized patients in the Spokane area is stored in a database that hospitalists can tap into via their PDAs, and every physician's daily input can be easily handed off to the doctor working the next shift.
PDAs—shorthand for personal digital assistants—are so critical to hospitalists at Group Health that everyone is given a device—and expected to use it. The group even keeps spares on hand in case someone leaves a handheld at home.
As the popularity of pint-size computers booms among physicians, hospitalists in particular are discovering that the tiny devices can be not only a timesaver, but a lifeline to an ever-growing body of medical information.
"When you're on the move in the hospital, you can't carry all the data you need with you," Dr. Schaaf says. "There's no other good way to keep track of all the information you need."
Hospitalist Steven T. Liu, MD, for example, pulls out his handheld computer every 15 minutes or so. He regularly looks up information about a diagnoses or medication, inputs billing codes or reviews a medical history.
"We need to have access to a huge amount of information because we're a multispecialty-based field," says Dr. Liu, assistant professor of medicine at Emory University School of medicine and assistant director of Emory-Eastside Hospitalist Group in Atlanta. "We also need to be mobile, and we have to track all of our patients."
While organizations like Group Health are building sophisticated systems that allow physicians to tap into vast databases with their PDAs, most physicians, like Dr. Liu, use palmtops as standalone tools. As a result, hospitalists are typically on their own when it comes to buying software.
In the crowded and fast-changing market for handheld software, you'll find tremendous variation among products for physicians.
Software prices vary. Some programs, like ePocrates Rx and MedCalc, are free. Others, such as the Washington Manual, can be bought for a one-time fee of $60. Still others charge yearly or monthly subscription fees.
Your ability to search the text of handheld textbooks and other products will also vary. While some will allow you to use a search engine to find a specific term with lightning speed, others make you wind your way through a table of contents.
"If you're looking at software, you need to use several different programs to find out what's really useful to you in your job," says Dr. Liu, who worked as an engineer before entering medicine.
To find out what works for physicians using PDAs, we talked to four hospitalists who are well-versed with handheld software. Here's a look at the five major categories of PDA software for physicians they identified—drug information, medical reference, medical calculators, billing and coding software and patient care tracking programs—and some of the ways the wired set is using them.
Drug information applications for PDAs come in two basic flavors: programs that give you information on drugs, and applications that actually let you print out a prescription or send it directly to the patient's pharmacy.
One thing is clear: In part because the industry giants all offer some version of their software free of charge, this category of medical software for PDAs is hugely popular among physicians.
"Eighty percent of the time I use my Palm for drug reference," explains hospitalist Philip H. Goodman, MD, professor of medicine and biomedical engineering and director of the division of medical informatics and brain computation lab at the University of Nevada School of Medicine in Reno. He highly recommends ePocrates Rx, which he uses primarily for drug interaction information. "It is the single most useful application for handhelds," he says.
Here is a look at the three best-known programs in this category:
• EPocrates Rx. Epocrates, which provides a comprehensive drug list, is probably the single most used software on doctors' PDAs today.
"This program is a wonderful marriage between the physician, the PDA and a reference book," says Dr. Liu. "You can't carry around a textbook as a hospitalist, but you need to be able to look up information from anywhere. Now, we instantly have a 10-pound textbook shrunk into this PDA."
Epocrates Rx supplies dosing information including off-label uses and data about side effects. It can also search for interactions on more than 20 drug combinations.
Users can download a copy of ePocrates free of charge on the Web. The software includes a 30-day trial version of ePocrates Rx Pro, which contains additional features and costs $60 a year.
EPocrates products are available for Palm and Pocket PC devices.
• IScribe. Owned by AdvancePCS, the IScribe formulary reference tool provides information on more than 3,000 drug formularies. It also has information on more than 6,000 drugs and medical supplies.
A separate IScribe electronic prescribing tool goes one step farther and allows you to write prescriptions and print them in your office or send them electronically to a pharmacy. The electronic prescribing tool, however, is available only to physi¬cians who work with certain health care organizations. More information about who is eligible is online.
Both products are free and work only on Palm devices.
• MobilePDR. The handheld version of the Physicians' Desk Reference offers information including indications and contraindications, warnings and precautions, adult and pediatric dosing, and adverse reactions. Like the print product, the PDA version does not contain off-label indications or cost information.
The product is free for qualified physicians, nurses and other health care professionals. Available for Palm and Pocket PC devices.
Hospitalists interviewed for this article say that because they are always on the run, medical reference software is a particularly useful PDA tool. As Dr. Liu notes, "We a very busy breed."
Some popular medical references include the following:
• Griffith's 5-Minute Clinical Consult 2003. This handheld version of the well-known book provides comprehensive information about a wide range of diseases. Most topics are updated to reflect newly released drugs, ICD-9 coding changes and new research. The title costs $64.95 and is available for Palm and Pocket PC devices.
"This program gives more details for background in a treatment," Dr. Goodman says, "but it is not as helpful for on-the-fly decisions" as other products.
The title costs $69.95 and is available for Palm and Pocket PC devices.
• The Sanford Guide to Antimicrobial Therapy 2003. This software includes all the information in the original version, but is easier to navigate because of its navigation tools. "This is basically a pint-size handbook that shows different approaches to treating infections," says Dr. Goodman.
The title costs $25 and is available for both Palm and Pocket PC devices.
The title costs $59.95 and is available for Palm and Pocket PC devices.
"If a patient comes in and I need to calculate some obscure formula, programs like MedCalc and MedRules are perfect," says Dr. Liu. "They have the actual formulas built into them, and they give you information as well as algorithms."
If a patient has pneumonia, for example, Dr. Liu can enter the person's age and other variables. The software will help him determine if the patient is high-risk and needs to stay in the hospital. "It can help you make decisions that are on the cutting edge of medicine," he says.
The physicians interviewed for this article pointed to two popular medical calculators:
MedCalc. This free decision-support tool offers 76 formulas with refer¬ences and clinical-use tips. Units available in SI and regular units. Available in Spanish and French versions. Available only for Palm devices.
MedRules. This free application offers clinical prediction rules taken from the medical literature. Available only for Palm devices.
Billing and coding
The hospitalists interviewed for this story agree that billing is one area where doctors can use their PDAs to boost their bottom line.
"It's been shown that when you capture charges electronically at the point of encounter, you are more accurate and less likely to lose charges," says Dr. Liu, who is the CEO and founder of Ingenious Med in Atlanta, a company that sells several billing and coding applications. "With PDAs, you also minimize denials."
Coding is another area that is notorious for driving physicians crazy, according to Dr. Liu. "If we bill too high, it's considered fraud," he says. "But if we bill too low, the government says that's fraud, too, and we can be slapped with a big fine. These coding tools put the rules out there to help doctors be in compliance with coding."
Jose Gude, MD, a hospitalist at the Virginia Mason Medical Center in Seattle, explains that his group uses Palm handhelds mainly for billing and patient sign-out sheets.
"We enter the patient data and billing codes/diagnosis as we go during rounds," he says. "Our database [HanDBase; www.ddhsoftware.com] interfaces seamlessly with Microsoft Access, which keeps and sorts data from all 10 hospitalists in our group."
"The information is then filtered and sorted, and a billing sheet gets automatically e-mailed to our billing people every time a hot sync occurs for each user," he explains. "And a sign-out sheet is printed for the covering night hospitalist with patient data, to-do lists, etc."
As is the case with Dr. Gude's practice, billing and coding software is one area where a growing number of products can be used as part of a group and networked. Here are some of the more popular programs:
• Ingenious Med Bills.This charge-capture application helps doctors determine specific codes for illnesses. Error-detection algorithms help minimize commonly rejected billing oversights and omissions. The device, which can be used in groups, costs $299 per user. Available for Palm devices only.
• Ingenious Med MasterCoder . This software helps guide you through the steps to document evaluation and management codes. Its goal is to improve reim¬bursements with minimal documentation. The title costs $299 and is available for Palm devices only.
• ModeMD Hospital. Provides electronic charge capture at point-of-care. A network version can deliver data directly to your billing office. The prod¬uct costs $299; network version costs an extra $59 per month.
• PatientKeeper ChargeKeeper. Helps automate the charge-capture process at the point of encounter. Works with billing systems to expedite billing. Available for Pocket PC or Palm OS. Contact for pricing information.
These programs help you track what's going on with your patients, from admission to discharge, and cover labs, tests, medications given, etc. Hospitalists interviewed for this story say this is one area where you will want to do your homework, because the features of these products vary significantly.
Some applications, for example, track patients back to their doctor's offices. The discharge process is improved by printing out prescriptions and a summary of why the patient was in the hospital and what he needs to do after going home.
Some popular programs include the following:
• MercuryMD. Dr. Schaaf's hospitalist group in Spokane uses this company's MData software to integrate data from a variety of sources. It extracts patient data from the hospitals data systems, such as labs, medications and dictation.
A handheld "gateway" application allows physicians to tap into the system via their PDAs. "We can get instant updates on patients," he says. "MercuryMD has tripled the usefulness of our systems."
Available for Palm and Pocket PC devices. Contact for pricing information.
• PatientKeeper Clinical Application Suite. This software gives immediate access to a full range of information, including patient lists, lab results, medication profiles, problem lists, microbiology and radiology reports, allergy profiles and clinical notes such as consultation and daily progress of patients. Available for Palm and Pocket PC devices. Contact for pricing information.
Ingrid Palmer is a freelance writer specializing in health care and technology. She is based in Glendale, Ohio.