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PDAs in Family Medicine Practice

Introduction to PDAs and Smartphones

A PDA/Smartphone 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 and calculate complex medical results.

PDAs in Medicine

PDAs and Smartphones go way beyond the organizer concept. Below is a list of some uses we have found for PDAs and Smartphones.

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

  • A PDA or Smartphone 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

  • PDAs and Smartphones 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)
  • 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.

Growth Curve

Microsoft Word and Excel Viewer for 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

HanDBase is one 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.

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 and Smartphones

New file formats for text files called DOC files have been developed. Popular programs include iSilo and Teal Medical. iSilo, 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.

Laboratory Values Database

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

PDA-Related Websites

The Family Medicine Residency has reviewed all rotations and their respective needs for Patient Health Information(PHI) in the provision of patient care. We have determined that there is no justification for residents to enter PHI on any portable devices. All patient information is to be stored on password protected and encrypted systems provided by the Health Center.  All PDAs and Smartphones/Blackberries should be locked with a password and are not to be used to record patient information.