Handhelds in healthcare: benefits of content at the point of care

Jackie CahoonNHS Partnership Development Manager

Who am I? What am I doing here?

New position

Somewhere between business development and market research

Ovid resources now available to all NHS staff in UK

Increasing need for integration with NHS KM/information initiatives

Responsible for communications with all NHS stakeholders:– Librarians

– IM&T staff

– Clinical managers

– Clinical effectiveness

– Education

Presentation outline

Introduction to mobile technologies in healthcare

Applications currently available

Content applications

Case study: Ovid@ Hand

The future

Why mobile?

1. Healthcare professions highly mobile -

Clinician sees one patient every 7-9 mins, with 2 mins travel between*

For every 10 patients seen, 1-5 questions arise requiring information*

Ely, Osheroff Analysis of questions asked by family doctors regarding patient care BMJ 1999 319: 358-361

Why mobile?

2. Medicine and healthcare are information intensive -

Patient notes and test results

Personal notes and records

Evidence and guidance to support treatment and management decisions

PDA popularity in the US

Doctors using PDAs doubled 99-01

ACP American Soc. Of Internal Medicine survey 2001:

47% of members using PDAs

67% (expected) by end of 2002

ePocarates qRx been used by 200,000 physicians since 1999

ePocrates second product (qID) took 9 weeks to achieve same user levels as qRx which took 9 months

Operating systems

US – 79% PALM OS

– 12% Pocket PC

Europe– 43% PALM OS

– 28% PocketPC

PocketPC richer colour, more memory, more powerful

PALM OS used by innovative Sony, Handspring

The advantages of handhelds in healthcare

Price

Size

Time

Real point-of-care utility

Potential for revolution with EPR

Presentation outline

Introduction to mobile technologies in healthcare

Applications currently available

Content applications

Case study: Ovid@ Hand

The future

Popular applications in healthcare

1. Medical calculators

2. Patient management tools

– E.g. patient tracking, booking

– Most EPR vendors have PDA initiatives

3. Electronic prescription management

- messaging to pharmacy

Popular applications in healthcare

4. Content reference

Majority of tools content related

Point-of-care availability

Quicker than print look-up

Review content especially PDA friendly

ePocrates most popular single resource (still free!)

Calculators – an example

Palm MedCalc - more than 64 formulas e.g.

Alveolo-arterial O2 gradient

Anion gap

Bayes theorem

Body mass index

Corrected calcium ( albumine et proteins )

Corrected QT Corrected sodium ( glucose, proteins and lipids )

Patient management

e.g. Patient Keeper Personal

admission diagnoses

patient histories

daily progress notes, and lab results

set alarms for reminders

use pop-up lists, check-boxes, and multiple-choice for data entry

beam patient information to others using a Palm OS-based device with an infrared port

Some trial sites in the UK

Cambridge University – student access to course materials, clinical ‘nuglets’

Surrey Ambulance Trust– Realtime patient tracking and advice system

Salford Royal Hospitals– PDA diaries

Chelsea & Westminster– trialing tablets

Queen’s hospital, Burton on Trent– PDAs is use as part of Electronic Prescribing pilot

Presentation outline

Introduction to mobile technologies in healthcare

Applications currently available

Content applications

Case study: Ovid@ Hand

The future

Content applications

Healthcare content marketplace big

Old and new players, and lots of amateurs

PDA ideal for quick reference information

e.g. drug handbooks, treatment guidelines

Content providers struggling with current limitations

Handheldmed.com’s top sellers

The value of content at the point of care

Sackett’s evidence cart experiment– 16 questions answered in time it took to visit library

– Availability of evidence sources affected their use

IOM’s report To Err is Human 2000– Medical errors one of the US’s biggest causes of death

– Preventable healthcare errors cost the economy $17-$29 billion p.a.

BMJ editorial March, 2001

– Medical errors lead to 3 million extra bed days per year in England and Wales, costing £1bn 2

Content considerations for handheld delivery

Memory limitations

Screen size

PDA and desktop combo?

- appropriate info. chunks pushed to PDA

- bulk content storage on internet servers

- query and review at point-of-care

- management and digest via desktop

Case study – Ovid@ Hand

Why handhelds for Ovid?

web content now available when required/appropriate

integration with clinical workflow

opportunity to work with development partner (Unbound Medicine)

40% of US physicians using PDAs!

Case study – Ovid@ Hand

Features of Ovid@ Hand:

Journal TOCs and abstracts – user sets preferences

A-Z Drug Facts - downloaded to device

Medline question-capture ‘on the go’ (smartsearch technology)

PALM OS now, Windows CE later in 2002

Web-based ‘personal library’ for doc. management and link-up with Ovid Online

Ovid@Hand

Ovid@Hand

Journals tables of contents and abstracts

New content indicated clearly (*)

Submit questions

and conduct searches

Article ordering

Easily and automatically

upload articles

Browse through records

Searches are automatically uploaded to

“MyLibrary” when you hotsync

Click “Search Ovid” to execute your stored search

View abstracts, citations and full

text, or link to related

articles

Question-capture

Select a database

Enter ‘smart search’

Attach references or

notes

How to get Ovid@ Hand

User must be affiliated with institution subscribing to Ovid journals

User registers for Ovid@ Hand

Selects journal titles for PDA access

Downloads software

Follows installation process

Syncs and goes

Presentation outline

Introduction to mobile technologies in healthcare

Applications currently available

Content applications

Case study: Ovid@ Hand

The future

Some bets for the near future

Clinical PDA use in UK will explode in 2 years

Why? -– WLAN

– UK EHR programme

– Broadband LANs

Phone/PDAs likely to dominate European market (but tablets may take over in hospital setting)

Security issues will not hold back this development

Some bets for the near future

Student doctors will be issued with handheld devices as standard

Handwriting and voice recognition will become standard

Publishers and info. providers will customise for mobile world

New content types and intermediary services will appear

More information:

www.pdamd.comwww.handheldmed.com

www.med.virginia.edu/hs-library/pda/home.html

www.mclibrary.duke.edu/respub/pdaformat/

www.ovid.com/products/handwww.med-mobile.org

jcahoon@ovid.com