PDAs Transform Health Care

Personal digital assistants (PDAs) are helping pharmacists provide better health care. The mobile technology allows them in real time to document interventions, check for adverse drug reactions, and provide up-to-date information on patients. As these handheld devices become increasingly necessary aids in health care, Epocrates Inc and bioM?rieux Inc are providing clinicians with the software applications for their PDAs.

Cofounded by Richard Fiedotin, MD, and Jeffrey Tangney, executive vice president of sales and marketing, Epocrates was born from a class project the 2 were doing while getting their master?s of business administration degrees at Stanford University. The company, which launched its first mobile device in 1999, now offers 6 mobile device programs and 2 online programs.

?Having the opportunity to have it [drug information] on your desktop or PDA is very beneficial. Mobile technology is the way clinicians work. It helps provide better patient care throughout the whole system,? said Michelle Snyder, vice president of marketing.

Epocrates products are designed by practicing physicians to deliver the most clinically useful and relevant information that health care professionals need at the point of care. Currently, 500,000 clinicians use the Epocrates suite of products, which includes >30,000 community and hospital pharmacists. Snyder believes the products are ?so widely adopted because [they are] easy to use and intuitive.? Clinicians can simply click the tutorial icon on the device or visit the company Web site for a demonstration on how to use the programs.

Snyder said the 2 most useful mobile products for pharmacists are Epocrates Rx and Epocrates Essential. Epocrates Rx, the company?s first product launched in 1999, can be downloaded free on the Epocrates Web site. Epocrates Rx features drug monographs, health plan formularies, a drug-interaction checker, and calculators. Epocrates Essential has a cost, however. The product features the same components of Epocrates Rx with the addition of an infectious-disease treatment guide, alternative (herbal) medicines, an intravenous (IV) compatibility checker, disease monographs and symptom assessment, and diagnostic and laboratory tests.

The features most interesting to pharmacists are the formulary and IV compatibility features, according to Snyder. The company works with 120 health plans and hosts their formulary information. ?Community pharmacists can look up a health plan and see what is covered. They can also see alternative medication covered by the plan if the copay is too high for a patient. Plus, it allows for a pharmacist on the phone with a physician to be on the same page,? explained Snyder. As for the IV compatibility feature, pharmacists can check interactions between drugs and IV medications. ?It can provide pharmacists with concise information on what to prescribe,? she said.

The company?s other mobile device products include the most recently introduced Epocrates Essentials Deluxe, which combines all of Epocrates? premium drug, disease, and diagnostic information into a single suite; Epocrates Coder; Epocrates Medical Dictionary; and Epocrates Rx Pro. All of these products are available for a cost.

The company?s online applications include the free Epocrates Online and the Epocrates Online Premium. Epocrates Online features information on >3300 brand and generic drugs, health plan and hospital insurance formularies, MultiCheck multiple drug?interaction checker, full-color pill images, and patient education handouts in English and Spanish. The premium product, which includes the same components as Epocrates Online, also boasts a pill identifier, >400 alternative-medicine monographs including interaction with drugs, and clinical tables and guidelines.

The MultiCheck feature allows pharmacists to plug in up to 30 different drugs and receive an immediate report on any interactions.

Snyder said that the alternative-medicine feature is especially helpful to community pharmacists because it gives a report on drug interactions that may interfere with prescription medicines a patient may be taking. The pill identifier feature indicates the color, shape, and whether the medication is scored or not.

Thus far, the company has received positive feedback on its suite of products. ?We continue to receive e-mails from users on a regular basis about how Epocrates changed the way they practiced medicine,? said Snyder. As a result, the company started the Epocrates Advocate, a volunteer program ?to help enthusiastic users educate others about the benefits of mobile technology.? The volunteers, who include >1000 health care professionals across all occupations and specialties, are provided with presentations, first alerts on company developments, and alerts about speaking and writing opportunities.

Still relatively new, bioM?rieux?s Stellara was rolled out in phases. The first 3 phases were introduced in December 2004, and the final phase was launched in March 2005.

As for the reason for launching Stellara, Kevin Rivers, PharmD, marketing manager for clinical solutions, said, ?It?s a second-generation product for us, and we wanted to go to a Web-enabled platform. The objective was to reduce medical errors and adverse drug reactions. We wanted to provide these automation tools to pharmacy groups to more effectively identify patients at risk and intervene before there was a problem.?

Stellara is powered by Expert System Platform Technology from TheraDoc Inc. The Stellara software systems? ?tage 1, 2, 3, and 4?integrate individual electronic patient records with coded clinical data and focused medical informatics that represent an onboard clinical decision-support database. Dr. Rivers described the software as an ?intelligent patient-therapy management system.?

The ?tage 1 software system features the Antibiotic Assistant, an integrated infectious-disease knowledge base that uses the clinician?s own antibiograms and antibiotic formulary; the Dosing Assistant for timely antibiotic intervention using the institution?s formulary in concert with the Antibiotic Assistant; and handheld software downloaded from a user-specific Web site.

?tage 2 offers real-time access to VITEK ID/AST results and an optional wireless PDA application. The system features desktop and PDA application with secured access from any Web browser, 4 automated microbial alerts, and availability of data to desktop office software applications through exportation or cutting and pasting.

?tage 3 integrates VITEK ID/AST results with patient antibiotic therapies. It offers an optional PDA application and incorporates the patient?s entire medication profile. In addition, the system features 25 preprogrammed alerts plus antibiotic intervention recommendations with decision logic and reference and individualized patient rosters.

?tage 4 integrates VITEK ID/AST and incorporates full laboratory results for evaluation of patient status. The system also features 90 preprogrammed alerts, an optional wireless PDA application, and comprehensive intervention documentation.

Dr. Rivers said 95% of their subscribers choose ?tage 4. In terms of functionality, they choose ?tage 4 ?because it builds on everything the other models have and has a lot of prebuilt functionality and a full laboratory picture of what is going on with the patient.?

He said Stellara has ?increased the number of interventions where pharmacists can intervene in the improvement of patient care. As for how pharmacists are trained to use Stellara, Dr. Rivers explained that the ?application is fairly intuitive through Web access and on-site training.?

PDAs are becoming so critical to patient care because they give the clinicians mobility so they are not glued to a particular location in the hospital. The clinicians do not have to do double entry at a separate workstation, according to Dr. Rivers. Because PDAs allow clinicians to see everything in real time, they have the most current data during rounds.

?If a facility has a wireless infrastructure, it?s going to be widely accepted. Pharmacists either want a wireless capability on a laptop or a PDA,? he explained.

Whereas both companies do not have plans to add new models to their products now, they do plan to add new features and functionalities to their product lines.