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Are PDAs the Way?
Abstract & Commentary
Synopsis: PDAs may soon become indispensable to ID physicians.
Source: Miller SM, et al. Personal digital assistant infectious diseases applications for health care professionals. Clin Infect Dis. 2003;36:1018-1029.
From the section of clinical pharmacology comes an analysis and insight into some of the computer applications in infectious diseases. This is an important growth area because of the increasing need, if not demand, for immediate information about a huge and expanding volume of information needed for optimal care of patients with infection and the queries others have about emerging infections. Miller and associates reviewed 4 computer programs related to infectious diseases that are available for hand-held devices, otherwise known as personal digital assistants (PDAs).
Their review includes ePocrates ID by ePocrates, the ABX guide by Johns Hopkins, the 2002 Guide to Antimicrobial therapy by Sanford, and the Infectious Diseases and Antimicrobial Notes (IDAN) from the University of Montreal Medical School.
All the programs have useful information and can be used to supplement one’s memory or gain recent, and often timely, information about antibiotics—such as interactions with other drugs, dosing with renal failure, adverse effects, and even cost of the antimicrobial. All are available for the Palm OS operating system, and now 3 are available in a Microsoft Pocket PC format as well. Only the ABX system is free at this point, but the others are available for less than $50 per year.
All of the programs contain basic information about antimicrobial dosing, although the ABX program did not have pediatric recommendations at the time it was reviewed. The information about clinical pharmacology varied, with ePocrates ID having the most about mechanism of action, metabolism, and use in lactation. IDAN does not carry updated cost figures or adverse reaction information, but the others do. All but the IDAN program provide some literature references, with the most being available with ABX.
These PDA programs also include decision support, with the ePocrates, ABX, and IDAN versions being interactive. With the ePocrates ID program, for example, categories of infection are entered, only to find queries for more detail such as whether a foreign body is present or whether the infection is postoperative or not. It also asks for culture results if available and gives more specific answers based on those results. The program has in excess of 300 infections that can be investigated—more than any other. ABX has the same capabilities, but Sanford simply displays tabular information from its paper edition. ABX, ePocrates ID, and IDAN all have the ability to go back to drug information with a few clicks, but Sanford does not.
Miller et al also ran some searches for recommendations for therapy of febrile neutropenia, candidemia, uncomplicated cystitis, and community-acquired pneumonia. Only the IDAN program had recommendations for febrile neutropenia. The others had information about most of the rest, but their recommendations varied.
Comment by Alan D. Tice, MD, FACP
The future is here in regard to computer applications in infectious diseases. You can now reach into your pocket and pull out a device, which can tell you as much, if not more than you want to know, about antimicrobials and even many infections. You can stay ahead of your colleagues in regard to the latest information and preserve your reputation as having the best memory around if you can look at it surreptitiously.
The need for mastery of data management is probably greater in infectious diseases than any other specialty, and the technology is beginning to catch up with the needs. The programs described above allow access not only to basic drug information but also useful guidelines, evidence-based medicine, and advice regarding clinical problems. If an ID specialist can learn to use the latest technology and afford the cost of a PDA program or 2, they can maintain a leadership role. If they do not adapt, it is possible for others to learn as fast and for consults to dwindle. The clinical experience with infectious diseases, however, cannot be replaced but must be supplemented with technology.
The opportunities are increasing in regard to computer applications. Not only are PDAs now practical, as evidenced by a phenomenal growth in the use of ePocrates, but they are being adapted to meet special needs. It is possible to hook up a PDA with the ability to call in prescriptions, to tell you the antibiotics on the formulary, and to force you to write more legibly. They can also be used to review recent guidelines and to record your patient visits and billing information, as well as download the day’s latest medical news about SARS, which you can quietly check during Grand Rounds.
Although ePocrates seems to be the volume leader, the programs from ABX, Sanford, and IDNA all have their advantages, as well. In addition, there is Theradoc, a program hosted for free through the Merckmedicus web site. It is out of the University of Utah and provides a useful decision-support program.
The future is here in terms of practical applications with PDAs, and there is more coming. The Tablet PC developed by a number of hardware vendors and Microsoft’s help will bring even more resources to the bedside with units the size and nearly the weight of a clipboard. They have all the capability of a laptop of a year or 2 ago plus the ability to allow you to scribble your notes—and possibly even translate them into text. The new ones usually have wireless connections incorporated so can be used anywhere there is Internet access—such as some Starbucks outlets and many medical libraries, although many hospitals are afraid to introduce them because of HIPAA regulations. How many new applications there will be over the next few years only time will tell, but it is worthwhile keeping up to date.
Dr. Tice is Infections Limited, PS Tacoma, WA; Infectious Disease Consultant, John A Burns School of Medicine, University of Hawaii, Honolulu, HI Section Editor, Managed Care