print

PDAs in Family Medicine Practice

pda

The Department of Family Medicine at the University of Rochester embraced the PalmOS-based Personal Digital Asistants (PDAs) in June 2000. Every resident gets a free PDA and is required to use a PalmOS-based handheld computer.

Introduction to PDAs

A PDA is a simplified computer that can be held comfortably in the palm of your hand. What it lacks in raw processing power is made up by accessibility. The PDA can be slipped into a pocket, dropped into a purse, or even clipped to a belt.

PDAs perform basic organizer functions. They can also store reference books, calculate complex medical results, track patients and procedures, and even create prescriptions that are automatically sent to a pharmacy.

There are two incompatible branches of PDA operating systems. The PalmOS-based system is very small, easy to use, includes a lot of software, and at the entry level is relatively inexpensive (as low as $150).

The other PDA operating system, PocketPC, is based on a variant of the Microsoft Windows. Its memory and processor requirements are large, so it requires a fast processor and relatively large amounts of memory. That means higher cost: $300 to $900 or more. Advantages include its resemblence to your desktop computer. Windows-based programs such as Microsoft Word and Excel allow easier migration of documents from the desktop to the PDA and back. But current PocketPC machines require multiple steps for simple tasks and have limited software options.

PDAs in Medicine

PalmOS-based PDAs go way beyond the organizer concept. Below is a list of some uses we have found for the Department's PDAs.

Address Book—Built-in Program

  • Resident, fellow, faculty, and staff phone and pager numbers
  • Pharmacy numbers, including 24-hour and home delivery services
  • Local hospital and laboratory numbers with departmental numbers
  • Useful web addresses
  • Names/numbers/specialties for referrals

Date Book/Calendar—Built-in Program

  • The Palm is much easier to carry than a large paper-based date book. The PDA can also remind you of important dates and meetings with an alarm.

Expense Program—Built-in Program

  • Keep track of various expenses

Email—Built-in Program

  • PalmOS-based PDAs allow you to read and write email from the PDA. If you pay a monthly fee, you can have always-on wireless access to email. For the rest of us, we can send and receive email anytime we attach to our home computer.

Memo Pad—Built-in Program

  • Allows the quick writing of memos.

To-Do List—Built-in Program

  • A to-do list on your PDA includes optional sound reminders.

Calculators

  • Built-in simple calculator
  • Medical-oriented calculators calculate such things as FEN, reticulocyte index, BMI, and corrected Ca++ (see MedCalc and MedMath)
  • Arterial Blood Gas calculator (see ABG Pro)

Medical Rules Database

  • MedRules maintains a list of diagnoses and provides guidelines for reaching the correct diagnosis. It even calculates the probability score of a correct diagnosis, based on signs and symptoms entered.

Pharmaceutical Databases

  • Epocrates: The original drug guide for the PalmOS, and probably one of the most important reasons to own a PDA. Updated every few days are drug name, dosing, side effects, pregnancy category, drug interactions, and cost estimate.
  • Pocket Pharmacopoeia: This popular shirt-pocket drug reference is available free.

Pregnancy Wheel

  • PregCalc Pro: Goes way beyond the plastic pregnancy wheel. It calculates Expected Date of Delivery (EDD). It tells you how many weeks gestation, what pertinent labs to get, expected weight gain, and can even track individual patient data. A must-have for doing OB.

Growth Curve

Microsoft Word and Excel Viewer for PalmOS PDAs

Image Viewer

Billing

Andre S. Chen of STATcoder sells a number of programs that deal with billing. Some of his offerings include:

  • STAT E&M coder
  • STAT ICD-9 coder
  • STAT CPT 2000

Andrew Schechtman, M.D., a family doctor, created a simple ICD-9 and CPT-4 coding tool for the PalmOS. The database requires the full version of iSilo (www.iSilo.com). CodeMeister is basically a database with many hot links and is available for free download at www.meistermed.com.

Web Browsing on PDAs

Database Programs

The Family Medicine Program uses HanDBase as our in-house database program. Another popular offering is JFile. A more targeted database program is Pendragon Forms, which allows the creation of in-house customized databases as well as the sharing of other databases. Our database programs allow residents to:

  • Track surgical procedures
  • Track inpatients
  • Track OB patients
  • Distribute office-wide schedules
  • Access medical and office-related lists/databases, including office-wide schedules, lists of medical translators, developmental milestones lists, recommended immunizations, residency administration chain of command and contact information, antibiotic efficacy info, ICD-9 coding information, and more

Prescription Writing

This is a new application. While in a room with a patient, you can write multiple prescriptions. It can keep track of dosages, amounts, refills, and more. Prescriptions are transmitted either wirelessly to the patient's pharmacy, or to a computer with an IR port. The prescription arrives almost instantly at the pharmacy in an entirely readable form. There is a monthly fee.

Medical Textbooks

Simplified versions of popular medical textbooks are available for PDAs, with new enries every month (see the partial list below). In the future, even more (and unabridged) texts will be available for PDAs. For more choices, visit www.handheldmed.com. Note: These texts generally require 1 MB or more of memory.

Text Documents on PDAs

Because of the Palm's limited memory, new file formats for text files called DOC files have been developed. Popular programs include iSilo and Teal Medical. We use iSilo, which can read DOC files, create modified DOC files from web pages, and allows links similar to web page links. It makes navigating large documents easy, and it allows the display of limited graphics. A few of the text documents we use are listed below. Some of these were created in-house as handouts for lectures given by faculty, fellows, and residents.

  • POEMs—The Journal of Family Practice creates review articles known as Patient-Oriented Evidence that Matters, which are very clinically oriented. Many of these are available for PalmOS-based PDAs.
  • Current Medical Therapeutics.
  • OB Dating Criteria—An in-house guide to the accuracy of OB dating.
  • OB Resident Manual—A Palm version of the URMC's OB manual for residents. It is not available yet to the general public.
  • RIPA-tiered drug lists from the predominant HMO in Rochester. New York state has a preferred drug list that we keep up-to-date on our PDAs.
  • Referral List—Outlines specialists we commonly refer to. This is useful for new providers who do not know local specialists.
  • Refugee Immunizations—An in-house document that lists required immunizations for newly arrived refugees, a big part of our clinical practice.
  • Evaluating Febrile Infants—An in-house document created by a resident and based on the Rochester criteria for the appropriate management of febrile children.
  • Medicare Guidelines—An in-house document that helps users meet Medicare billing criteria.
  • Books/novels—Available (often free) for viewing on the Palm at www.memoware.com.

Patient Tracking Software

Laboratory Values Database

LyteMeister: This iSilo document lists most normal values for common laboratory tests.

Available PalmOS-based PDAs

3Com created the original Palm and the operating system that powers the Palm (PalmOS). 3Com now licenses their PalmOS operating system to other companies. This means that any software written for the Palm can also run on other devices. For medical use, we recommend having at least 16 MB of memory. Palms do not have hard drives, so every program on your Palm must be capable of residing in memory. The more memory you have, the more programs you can have. Below are links to companies that sell PalmOS-based PDAs:

Use at the Department

The Family Medicine Program uses the PalmOS-based PDA platform. This site only lists software for PalmOS-based PDAs. The main factors involved in the decision were:

  • Availability of software
  • Ease of use
  • Cost

Paying for Palms

Faculty pays for PDAs out of Continuing Medical Education (CME) money. For residents, the cost of PDAs comes from resident CME money and from various departmental funds.

PDA-Related Websites