Feisal A. Adatia, MD, Ophthalmology Resident and Philippe L. Bedard, MD, Internal Medicine Resident, University of Toronto, Toronto, ON.
According to a 2003 CMA Physician Resource Questionnaire, one-third of Canadian physicians currently use handheld computers in clinical practice, a 73% increase over the last two years.1 Skyscape Inc., a leading provider of handheld medical programs, recently found that more than half of U.S. physicians use handheld computers.2 Surprisingly, physicians’ use of handheld computers far exceeds use by the general public. Jupiter Research forecasts that only 7% of the general U.S. public will own a handheld computer by the year 2008.3 The ability to rapidly access software that can influence decision-making at the point of care is primarily responsible for the growing popularity of handheld computers among physicians.
ePocrates Rx (www.epocrates.com), a widely used free drug database reviewed elsewhere,4 initially was released only on the Palm OS platform. This is likely responsible, in part, for the dominance of the Palm OS over the Pocket PC platform in the medical arena. This article briefly reviews seven free and simple handheld programs that may be useful for the clinician with older patients.
Mathias Tschopp’s MedCalc is a medical calculator for the Palm OS which includes 76 common medical formulas. It is available in both English and French and uses both SI and regular units. It is one of the most popular medical programs available and is frequently updated. Categorized formulas can be accessed through a drop-down menu, and clinical use tips, detailed information on the full formula and bibliographic references also are provided. For example, if one clicks to the top right-hand corner of the application screen and selects “Renal” from the drop-down menu, the creatinine clearance (Cockcroft) formula may be selected. By entering the patient’s age, weight, plasma creatinine and sex, the calculator can estimate the creatinine clearance. By hitting the “i” or detailed information icon on the right, tips on when this formula is valid will be seen, as well as the full formula and its bibliographic reference.
Andrew Yee’s medical eponyms is another popular handheld program with more than 1,460 common and obscure medical eponyms, making it a favourite tool for the curious medical historian and superstar trainee alike. Like MedCalc, it uses a drop-down menu to categorize its database. Although the descriptions of eponyms are brief and there is a paucity of bibliographic references, the database is comprehensive and easy to read.
Kent Willyard’s Medrules allows for the calculation of 40 formulas using evidence-based criteria, such as deep vein thrombosis probability, pre-operative cardiovascular risk, and the electrocardiographic criteria for myocardial infarction with chest pain and pre-existing left bundle branch block. At the top right of the program there are 10 drop-down menus organized by medical subspecialty. Once a category is chosen, a number of relevant calculation options are displayed. By clicking on the desired formula, a screen with tick boxes appears with a calculation button at the bottom left. The top corner provides the reference upon which the calculation is based. However, the inclusion and exclusion criteria of the studies from which the formulas are derived are not listed.
STAT A-Fib Stroke Risk
This program by Andre Chen is based on The Framingham Heart Study (JAMA 2003;290:1049-56). It consists of one screen with tick boxes that could be marked off, allowing for the calculation of a five-year risk of stroke and risk of stroke or death. This calculator is particularly useful when deciding if a patient should be offered long-term anticoagulation therapy instead of antiplatelet therapy. Unfortunately, the criteria of Chen, et al. does not include echocardiographic information such as left ventricular hypertrophy or ejection function. This program is one of many free programs offered by Statcoder.
ODB Limited Use Codes
This is a database of the Ontario Drug Benefit (ODB) Plan pharmaceutical limited use codes put together by Greg Higgins. It features a searchable pharmaceutical list and uses a free reader program known as “List”. Each entry includes the limited use code number and a description of the indication under which patients may be covered by the ODB limited use plan. Greg Higgins also provides free downloadable databases of the OHIP fee schedule and the OMA Fee Schedule for uninsured services.
This program allows users to download current peer-reviewed medical literature abstracts to their handheld computer with each hotsync operation. Users can choose from a variety of subject channels, such as Arthritis, Diabetes and Pain Management, and can obtain abstracts from selected journals on their handhelds. These abstracts can then be bookmarked and linked to the full-text article on the Internet. In addition, news content from Reuters Health can be downloaded to a handheld with JournalToGo.
GAC Clinical Practice
The Ontario Guidelines Advisory Committee reviews clinical practice guidelines (CPG) and publishes a series of CPG summaries. These brief CPG summaries are available in PDF format and can be downloaded to a handheld computer and viewed with a PDF reader, such as the free Adobe Acrobat PDF reader. These brief CPG summaries are given an overall quality rating out of 4, and recommendations are organized according to the strength of the evidence. In addition, the summaries provide the date of initial guideline review and when the guidelines are scheduled for re-appraisal. u
Shelley Martin. More than half of MDs under age 35 now using PDAs. Can Med Assoc J 2003;169:952-a.
Survey: Physicians using handheld computers can provide better care, though intergration with the enterprise is slow. http://www.skyscape.com/company/PressRelease.aspx?id=119.
Jupiter Research reports PDA penetration will only reach 7% of the overall U.S. population by 2008, yet sees opportunity for personal information management (PIM) devices. http://www.internet.com/corporate/releases/04.01.06-newjupresearch.html.
Feisal Adatia and Philippe L. Bedard. “Palm reading”: 2. Handheld software for physicians. Can Med Assoc J 2003;168:727-34.