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

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Core Knowledge

Schiff AJHP 2002

(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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OUR COMMODITY

Any contentAny deviceAny networkAny time

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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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Epocrates Epocrates Rx Epocrates Essentials

iPhone BlackBerry Palm WebOS Android Windows Mobile

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Clinical Pharmacology

Website

iPhone BlackBerry Windows Mobile 6 Android

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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

Pure PDAs…

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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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Android

Open OS Google Many hardware

manufacturers T-Mobile, Verizon,

Sprint >50K 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)

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Mobile OS Comparison

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Features Comparison

http://cell-phones.toptenreviews.com/smartphones/

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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Accessories

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ADDITIONAL TOPICS

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Patient Education

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Google Translate (34 languages)

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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

Questions

Brent I. Fox, PharmD, PhDAssistant ProfessorDepartment of Pharmacy Care SystemsAuburn University Harrison School of Pharmacy