Supporting Your Practice with Portable Information Technologies Brent I. Fox, PharmD, PhD Assistant...
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Transcript of Supporting Your Practice with Portable Information Technologies Brent I. Fox, PharmD, PhD Assistant...
Supporting Your Practice with Portable Information Technologies
Brent I. Fox, PharmD, PhDAssistant ProfessorDepartment of Pharmacy Care SystemsAuburn University Harrison School of Pharmacy
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Objectives1. Describe the need for portable information technologies to
support pharmacy practice2. Describe evidence surrounding the use of software to support
pharmacists’ decision-making 3. Describe the selection factors to consider when adopting a
portable information device4. Describe the array of portable information technologies
available for pharmacists5. Identify 3 portable information device accessories for
purchase consideration6. Develop a personal plan for device and software adoption
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Institute of Medicine (IOM) To Err is Human: Building A Safer
Health System (11/99) Crossing the Quality Chasm: A New
Health System for the 21st Century (3/01)
Health Professions Education: A Bridge to Quality (4/03)
Preventing Medication Errors (7/06)
Awareness: The Focus is on Safety
(Leape, 1995)
Systems Failures and Attributed Errors
• 1-7: 78% of errors• Limited information
access• Information should be
available to physicians, nurses, & pharmacists when and how it is needed
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Evidence-based Medicine
Sackett et al. define evidence-based medicine as:
"The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients; EBM de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research." Sackett, D.L. et al. (1996) Evidence based medicine: what it is and what it
isn't. BMJ 312 (7023), 13 January, 71-72.
Why Practice EBM?
1. New types of evidence are now being generated which, when we know and understand them, create frequent, major changes in the way we care for patients.
2. Although we need new information daily, we usually fail to get it.
3. Our up-to-date knowledge and clinical performance deteriorate over time.
4. Traditional CE does not work.5. A different approach has been shown to be
more effective. David Nash, Wisconsin Quality and Safety Forum, 10/08 7
EBM: Challenges
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There were 6000+ new articles published globally in the biomedical literature in 1992.
There are limits to our human memory, and we humans have a limited ability to incorporate information into our decision-making.
We have opinions, but these opinions may be based on conjecture.
David Eddy takes the position that, "The complexity of modern American medicine is exceeding the capacity of the unaided human mind." Evidence-based Health Care program presented at the University of
California, San Diego, June 2002.
Davidoff F, Haynes B, Sackett D, Smith R. Evidence based medicine. BMJ. 1995;310:1085-1086.
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Software Types iPhone only 2010
California Healthcare Foundation. How smartphones are changing health care for consumers and providers. http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf
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Software Types: Medical Reference iPhone only 2010
California Healthcare Foundation. How smartphones are changing health care for consumers and providers. http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf
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Software Considerations: General Updating Download or Web-
based Free/trial version UI/functionality *Features Pricing (multi-year) Linking across
applications Space requirements Memory card support Electronic version of
paper reference? A word about
installation
Data plan costs Drug interaction
checking Severity scale Number
Pharma or other support?
Target users Charts & tables Notes Training and support All apps for all
platforms? Tablets? Nonrenewal = stop?
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Software Considerations: Features Search
Brand/generic Indication, ADR/SE NDC Drug class Other
Patient education Images Pricing Calculators information
Formulary integration IV compatibility International products Storage Administration Dosage forms and
strengths Dosing (special
populations) Other monograph
content desired
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Facts and Comparisons A to Z Drug Facts
Unbound Medicine Silver
Medications and updates
Gold + Drug Interaction Facts
Platinum + Review of Natural
Products
Android BlackBerry Windows Mobile Palm OS
A to Z Drug Facts Skyscape
iFacts
Android BlackBerry iPhone Palm OS Symbian
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mobile Micromedex Revamped Jan 2010 Wireless access via
browser Includes
DrugDex DiseaseDex Emergency
Med DiseaseDex General Med AltMedDex Drug-Reax IV Index IdentiDex Lab Avisor
Complimentary
Data plan required
iPhone BlackBerry
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Lexi-Comp Individual databases
(20+) Packages
Handheld (+ Online) Updates
Palm OS Windows Mobile BlackBerry* iPhone Palm WebOS* Android
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Lexi Complete Suite
1. Lexi-Drugs 2. Lexi-Interact3. Lexi-Natural Products4. Pediatric Lexi-Drugs5. Lexi Poisoning and
Toxicology6. Lexi-Lab and Diagnostic
Procedures7. Lexi-Infectious Diseases8. Lexi-Pharmacogenomics9. Lexi-Calc10. Dental Lexi-Drugs
11. Nursing Lexi-Drugs12. Lexi-PALS 13. Nuclear, Biological, and
Chemical Agent Exposures14. Lexi-Companion Guides15. Perioperative Nursing Lexi-
Drugs16. Lexi-I.V. Compatibility17. Medical Abbreviations18. Griffith’s 5 Minute Clinical
Consult19. Stedman’s Medical Dictionary20. Pharmacotherapy Handbook
(from McGraw Hill)++
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Computer Hardware Array (large to small)
1. Mainframes2. Minicomputers3. Micro-Computers
a. IBM and Clonesb. Applesc. Desktops
1. Towers2. Mini-Towers3. Integrated
4. Notebooks1. Tabletsa. Convertiblesb. COWs
5. Air Panels6. Sub-notebooks7. UMPC8. Palmtop PDAs9. SmartPhones
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Personal Digital Assistants (PDAs)
Shirt Pocket OS Options Screen Size Connectivity Storage Swappable
Batteries Data Entry
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Smartphones
Cellular Carrier Data Plans OS Options Data Input Storage Swappable
Batteries Added
Features
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Palm WebOS (and Palm OS)
Legacy devices (T|X)
WebOS Pre Plus Pixi Plus
Elevation Partners Sprint, Verizon,
AT&T* >2000 apps
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iPhone and iPod Touch Apple Revolutionized
smartphone market Integration with
other Apple products
AT&T 185K apps
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Windows Phone 7* Coming 4th qtr? Completely new Xbox LIVE and
Zune integration Tiles (vs Start) Many hardware
manufacturers AT&T, Sprint,
Verizon, T-Mobile Apps?
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BlackBerry
BlackBerry 6 (3rd qtr)
Trackball Enterprise
integration Data plan AT&T, Sprint,
Verizon, T-Mobile Apps? (>2000)
Types of ConnectionsConnection
TypesFunctional Aspects Applications
Wi-Fi Commonplace wireless broadband Email and Internet @ home and work
Bluetooth Personal radio frequency up to 30’ Wireless device connections
802.15 (WPAN) Broadband for personal devices like PDAs and home entertainment
Based on Bluetooth, higher transfer rates
BPL Uses the existing utility power grid for broadband
Broadband to anyone with electricity
EV-DO Broadband for mobile phones (CDMA)
Email, Internet, clinical uses anywhere
EDGE Broadband for mobile phones (GSM) Email, Internet, clinical uses anywhere
WiMAX High bandwidth over long distances (3 – 30 miles)
Wireless broadband over the “last mile”
UWB (Digital Pulse Wireless)
Digital transmission of voice and data over short distances at high speeds
Huge voice/data transfers, low power, through media
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Selection Criteria
Do you want 1 device or are you OK carrying 2? If 2, get a PDA from eBay or an iPod
Touch If 1, read on….
Status of current cellular contract If you can not get out, select among
your carrier’s devices (next slide) If you can get out, next slide 34
Selection Criteria
If staying with your current provider, start with what you can afford Device Plan (voice and data)
If switching carriers, consider coverage and price
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Selection Criteria: Features
Interaction Touch screen vs Keyboard (Real/Virtual ) vs
Both Wireless
High speed data vs WiFi Camera
Quality Flash
GPS
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Selection Criteria: Features
Bluetooth Apps Music/video Memory Battery life
Form factor = test drive Verizon
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Cost of Ownership
Caveat: 10/28/09
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Innovation in Wireless Products is Accelerating!
Apple iPhone, 3 Skype Phone, Amazon Kindle, Google….
91% of mobile users keep phone within 1 meter reach 24x7
15-25% of mobiles have GPS, 50% within 5 years
Morgan Stanley – Web Trends 2007 – http://www.slideshare.net/misteroo/web2-139178?src=related_normal&rel=5944
California Healthcare Foundation. How smartphones are changing health care for consumers and providers. http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf
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Where are Patients are Tuning In?
California Healthcare Foundation. How smartphones are changing health care for consumers and providers. http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf
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Connecting with Your Patients in the Future
Web 2.0
Health 2.0
PHR
EMR/EHR
National Records
California Healthcare Foundation. How smartphones are changing health care for consumers and providers. http://www.chcf.org/~/media/Files/PDF/H/HowSmartphonesChangingHealthCare.pdf
EHRPharmacy
PBM
Payer
ElectronicMedicalRecord
PersonalHealthRecord
HospitalInformation
System
Managed CareInformation
System
Pharmacy
PhysicianPractice
Patient
HospitalOr IDN
PharmacyManagement
System
Lab
Clinical LabInformation
System
Inpatient EMRClinical Data Repository
Payer EMRMember Clinical SummaryRx Claims History
Patient Lab HistoryBlood Donor RepositoryGenetic Profiles
Imaging
ImageManagement
System
PACS ArchiveDiagnostic Image Repository
Prescription History
PHRClipboardPMR: Current Meds
Ambulatory EMR