More than 100 medical programs are designed for personal digital assistants. Here's how some key titles stack up.
More than 100 medical programs are designed for personal digital assistants. Here's how some key titles stack up.
Now that the number of software programs specifically designed for physicians' PDAs has reached triple digits, how do you sift the wheat from the chaff?
To see which products offer the biggest bang for the buck, a team of computer-savvy doctors put some of the most potentially useful titles through their paces. These programs are written for PDAs with the Palm or Windows CE operating system, or both. Keep in mind that dual-version software may offer different features and perform differently on different types of machines.
Included in the information we present is the program's cost, if any; the publisher's Web site; and a Web site where you can purchase and download the software if it isn't available from the publisher directly, or if the publisher's price isn't the lowest. In most cases, you can try a working model of a program online, download a trial version, or purchase a full version with a money-back guarantee.
The evaluations that follow the descriptions of each product are unavoidably subjective, because our doctor-reviewerswhose names are noted before each reviewcalled the shots as they saw them. On the next two pages, the reviewers rate 10 aspects of each program. You'll find biographical information on the reviewers within the article "PDAs for Doctors: Put a computer in your pocket and change your life".
In some cases, more than one doctor tested a piece of software. If opinions or insights differed, we included them in the chart and averaged the ratings. All of our evaluators used the programs just as you wouldwith patients present. This field testing offers the truest reflection of how useful a piece of software is to physicians. Waiting 15 seconds for a program to search its database, then having to scroll through a lengthy entry to find the information you want, is no big deal if you're not pressed for time. Having to do all that in the trenches with the clock ticking is quite another matter.
Finally, we invited the programs' publishers to comment on our reviews, and asked for news about future versions of the software. Their responses, if any, follow the reviews.
LexiDrugs is a reference to more than 3,900 medications spanning some 500 therapeutic classifications. It also includes more than 1,250 monographs. Monograph categories include US and Canadian brand name, use, usual dosage, drug interactions, warnings/precautions, contraindications, pregnancy risk factors, dosage forms, therapeutic category, adverse reactions, mechanism of action, overdose/toxicology, administration, restrictions, test interactions, dietary considerations, pharmacodynamics/kinetics, and monitoring parameters.
Previous versions of LexiDrugs were slow. The latest WinCE version, which I tested on an HP Jornada 680 HPC, is fastboth to load and to search. Indeed, it uses smart search, which makes finding information a breeze. When I see patients, I usually leave LexiDrugs open on my PDA. I can find an answer in LexiDrugs faster than it takes me just to locate a drug reference book in my office. The software makes life easy in other ways, too. Headings are linked to specific topics within a given drug entry to minimize scrolling. You can also customize the topic list, so the subjects most important to you appear first. I often need to look up drug contraindications and dosages, so I customized the list to put those topics first. You also can attach your own notes to a given drug entry. Unfortunately, though, if I learn about a wonderful new drug, I can't create an entry for it; I can only attach a note to an entry already in the database. Database updates can periodically be downloaded for a fee. LexiDrugs clearly improves my productivity. It saves me five to 10 minutes in every patient session.
Never having worked with Lexi-Drugs before this evaluation, I tested the Palm version, and it's fabulousreason enough to purchase a PDA with the Palm OS. Previously, my primary source of drug information was the book Drug Facts and Comparisons. Now that I have LexiDrugs, I rarely use DF&C. Still, LexiDrugs omits some useful information. When switching patients from, say, morphine to codeine, how much morphine equals 30 mg of codeine? What's the potency of the estrogen in different birth control pills? LexiDrugs doesn't tell me. DF&C does. Also missing from LexiDrugs: medication costs. The database should have this information; patients ask for it all the time. Despite these quibbles, LexiDrugs is one program I now can't live without.
Apothecarium mates with LexiDrugs (and other Skyscape drug databases, such as PediatricDrugs, GeriatricDrugs, and CardiologyDrugs), so you can use LexiDrugs to look up a drug you'd like to prescribe, then go to Apothecarium to view interactions with drugs the patient is already taking. You can also use Apothecarium separately to check drug interactions. The software flags known interactions and lets you link to a monograph that discusses significance level, mechanism of action, clinical effects, predisposing factors, patient management, and references.
Apothecarium is really cool, but like LexiDrugs, it's a space hog. It barely fits on a Palm PDA with a small amount of nonupgradable memory. To use the program, especially in conjunction with LexiDrugs, you'll need a Palm with 8 MB of memory, or a Handspring Visor Deluxe or TRGpro. Apothecarium would be even larger if it included monographs discussing drug interactions for individual drugs. Instead, the program describes interactions by class. You can search by class name (for example, NSAID), generic name (ibuprofen), or brand name (e.g., Motrin). Tapping on the topic heading NSAID evokes nine monographs on NSAIDs. You can also use a "drug selection" feature to list all the medications a patient is on and view their interactions. When I listed Coumadin, Motrin, Allegra-D, and Serzone, for instance, Apothecarium showed the one significant interactionbetween NSAIDs and anticoagulantsand its level of significance on a scale ranging from "limited" to "serious." To learn details of the interaction, there's a link to the monograph. If you look up a drug in LexiDrugs, and want to check its interactions with other drugs using Apothecarium, you're shifted to the latter automatically (as long as you have Apothecarium loaded, of course). Apothecarium's database, while good, isn't complete. It lists prazosin, for example, but not terazosin or doxazosin. Since the latter two drugs rarely react adversely with other drugs, perhaps that's why they were omitted, but it would have been nice to have this confirmed. Even so, Apothecarium is a great program, worth the price.
ePocrates qRx, version 3.0OS and program size: Palm onlyunder 900K
Publisher's Web Site: www.epocrates.comPrice: free
ePocrates qRx is a searchable drug database with key clinical informationindication-specific dosing, adverse reactions, drug-to-drug interactions, contraindications, and pregnancy and lactation datafor more than 1,600 of the most commonly prescribed drugs. Newly added to this version of the program is pediatric dosing for more than 385 drugs. A team of pharmacists and physicians frequently updates the database to include new drug approvals, indication changes, recalls, and the latest dosing information. Updates are free.
ePocrates qRx offers quick access to nuts-and-bolts information. I use it in the exam room and when I'm precepting residents. Two to three taps on my Palm touchscreen elicits the data I'm after. Smart search makes finding information in ePocrates qRx very fast; it easily outperforms the book Tarascon Pocket Pharmacopoeia, which I no longer use. The software won't let you create a list of favorite drugs, but you can write and attach notes to any drug entry. It takes just a few minutes to learn ePocrates qRx. Updates are vital, free, and easy to download.
ePocrates qRx isn't as well-known as LexiDrugs, but the software is quick and the program is easy to learn. Search for drug information alphabetically by generic or trade name, or by drug class. Adverse reactions are usefully grouped into common and uncommon. ePocrates qRx includes off-label indications for drugs, a feature that's missing from many drug reference books. Legal implications for prescribing a given drug are flagged with an asterisk and discussed. Two shortcomings: The program lacks information on standard quantities for dermatological agents. And if you work in a hospital or in a group that's networked, and the network has a firewall, you may not be able to download updates at work. You can do this at home, however.
ePocrates responds: "With more than 110,000 users65,000 of them physiciansePocrates qRx is extremely well known. In the next version, as part of the packaging/pricing section, we're adding standard quantities for dermatological agents. In addition, we're releasing an infectious disease program that will provide diagnosis-specific antimicrobial recommendations."
2000 PDR, from the publisher of this magazine, is available in different media at different prices. You can buy a CD-ROM for $129.95, then download all (or parts) of the program to your Windows desktop PC and from there to your PDA (Palm OS only). For the same price, you can download the software directly from the Internet (both Palm OS and WinCE), but only at the Franklin site. A module containing the full program that fits into a Handspring Visor with the Palm OS costs $199.95again, only at the Franklin site. You can also buy a Handspring Visor Deluxe and the module in one package for $449.95, but only at the Medical Economics Bookstore site.
This program is the equivalent of more than 2,000 pages of Medical Economics' Physicians' Desk Reference 2000 and PDR for Ophthalmology. It covers more than 3,000 drugs, searchable by brand name, generic name, manufacturer, and product category. The database includes 1,555 monographs focusing on indications, usage, contraindications, adverse reactions, dosage, administration, and more. Once the software is installed on a Windows desktop PC, seven therapeutic categories of dataanti-infectives, antineoplastics/biologicals, cardiovascular/respiratory, endocrinology, gastrointestinal/nutritional/urinary tract, neurology, and topicalscan be downloaded individually to conserve space.
For physicians who routinely use PDR in book form, 2000 PDR is a great piece of softwaretrue to the printed version, but far more user-friendly. The book's color photos of pills aren't in the electronic version, but how often do you need them? Even though links let you jump from one topic to another within an entry, you must do a lot of scrolling to read the extensive texta hassle. The link symbols aren't particularly intuitiveX stands for "contraindications," for instancebut they don't take long to figure out, and getting used to the software itself is relatively easy. A smart search feature speeds information retrieval. One option is to purchase a Handspring Visor and the companion 2000 PDR module. That's what I tested. To run this huge program on any other PDA with the Palm OS, you'll need a memory upgrade. For annual drug updates, you must either purchase the revised CD-ROM or Handspring Visor module, or download the revised program from the Internet.
Medical Economics responds: "A separate, slimmed-down version of PDR for both Palm OS and WinCE devices should be available for Internet downloading in 2001. It will offer briefer entries for 1,200 to 1,500 of the most-often-prescribed drugs, making PDR handier to use at the point of care, and will require less than 2 MB of memory."
Outlines in Clinical Medicine (OCM) provides summaries of more than 750 topics relating to general medicine, internal medicine subspecialties, family practice, pediatrics, geriatrics, ophthalmology, gynecology, obstetrics, psychiatry, and neurology, plus more than 300 board review questions. Each topic contains sections on pathophysiology, signs and symptoms, laboratory evaluation, differential diagnosis, and current therapies.
OCM took 10 to 15 seconds to start up on an HP Jornada 680 HPC; links required another three to four seconds to connect to data. Collectively, that's slow with a patient present. So OCM, the PDA version of a CD-ROM reference for desktop computers, isn't an ideal point-of-care reference. The publisher's own 5-Minute Clinical Consult program offers similar information and is much faster (see review below). OCM is meant primarily as a review tool, and its information isn't evidence-based. OCM data is grouped by organ system or disease name. Tapping on a plus sign near "Gastroenterology," for example, retrieved information on digestive diseases. I could also conduct a smart search of OCM's databasea nice feature. If I used a vague keyword, like "colitis," a box with more specific choices appearedin this case, "Crohn's disease," "ulcerative colitis," and "inflammatory bowel disease"so I could narrow my search. I could also run an advanced search to summon all OCM information on colitis. Residents and practicing physicians might find OCM useful as a refresher on less common disorders, but I wouldn't recommend it for treating patients at the bedside.
5-Minute Clinical Consult 2000 (5MCC), the software version of a standard reference for medical diagnosis and treatment, features more than 1,000 topics arranged alphabetically. In addition, more than 300 clinicians contributed information on 593 expanded topicsbasics, diagnosis, treatment, medication, follow-up, and more. In the latest version, 60 percent of the articles have been updated. 5MCC is offered by two publishersHandheldmed and Skyscape. The content is identical, but the programs' "readers"software that allows you to review and search the book's text and perform other taskshave different features. Handheldmed's is $52.50 at its own Web site. Skyscape's is $64.95 at www.handango.com.
Handheldmed and Skyscape are a study in contrasts. Handheldmed has focused more on building an extensive library of medical books, less on designing a reader that works rewardingly with those books. Skyscape has taken the opposite tack. Its library is far less extensive, but its reader is more feature-rich and enjoyable to use. Handheldmed's reader is text-only. With no graphics, color, or concern for the user's aesthetic experience, it harks back to the pre-Windows days of DOS. Skyscape's reader, on the other hand, is highly graphical, colorful, modern, and Windows-like. This isn't to suggest that Handheldmed's software isn't useful. In fact, some Handheldmed titles are on my PDA. But when I have a choice between using the Handheldmed reader and Skyscape'sas I do with 5MCCI unquestionably prefer the latter. Skyscape's reader for the WinCE version of 5MCC, unlike its grayscale Palm OS version, employs color-coding to ease navigation. And unlike the Palm version, the WinCE version lets you open little windows containing text on the PDA display, so you can keep more kinds of information on screen at once. Each window has a different-colored background to minimize confusion. The text is also color-coded, which makes it easier to locate information. Topic headings are blue. Basic information is red. Other text is black. Skyscape also publishes LexiDrugs (see above) and Outlines in Clinical Medicine (see above); all three programs are cross-linked. Get the skinny on a disorder in 5MCC, switch to OCM for a bit more detail, then zip over to LexiDrugs for appropriate medications. 5MCC also retrieves information more swiftly than OCM, making it more useful as a "bedside buddy" for patient care.
I use Skyscape's 5MCC for the Palm OS. Even though the program is in grayscale rather than color, and the reader isn't as fancy as that of the WinCE version, I love it. Entries are concise but useful. Every other dayespecially on hospital roundsI learn something that helps me, generally with less-common adult medicine problems. Recently, for example, I had a patient with sarcoidosis, which I hadn't seen in a year. I used 5MCC to look it up and learned that I had to watch calcium levels and order a certain blood test that I knew of but had forgotten. 5MCC isn't ideal for medical students; it's a refresher, not a basic text. But for residents and practicing physicians, it's fabulous. The software is speedy. The index is comprehensive. And the references are greatalthough some are out of date. When I looked up anorectal abscess, for instance, 5MCC's most recent article was dated 1984. Another drawback: In the Palm version, once you locate an article, the search feature doesn't work within it, so you must scroll through a lot of text. But these are minor quibbles about an otherwise great program.
Handheldmed responds: "Our reader, as Bailey points out, doesn't use color. In all other respects, however, it matches Skyscape's reader feature for feature. Moreover, our medical reference books are compressed to conserve PDA memory. As a result, our version of 5MCC requires nearly 60 percent less memory than Skyscape's version. This is a key benefit for users of Palm PDAs with limited memory."
PocketClinician LibraryOS and program size: WinCE and Palmvaries by program
Publisher's Web site:www.handheldmed.comPrice: varies by program. Or subscribe to MobilePractice, which includes the entire library, for $179 per year
The PocketClinician Library (PCL) includes 23 titles that you can purchase individually or subscribe to collectivelyas part of a package of products called MobilePracticefor an annual fee. Among the titles are 5-Minute Clinical Consult ($52.50 if purchased separately), Harrison's Principles of Internal Medicine Companion Handbook ($32.50), The Intern Pocket Survival Guide ($14), Physician's Drug Handbook ($75), Gynecological Pearls ($49.95), Obstetrical Pearls ($49.95), The Common Symptom Guide ($75), and The Merck Manual: Centennial Edition (free when you register on Handheldmed's Web site). If your PDA has sufficient memory, keep the whole libraryup to 10,000 pages of informationin your pocket. PCL's reader, downloadable from Handheldmed's Web site, includes a table of contents, index, and search engine, and lets you bookmark and attach notes to any entry.
Most hard-copy versions of books in PCL are small enough to fit in your pocket. They're mainly memory jogs for medical students and residents. Harrison's Principles of Internal Medicine Companion Handbook is especially worthwhile for a new doctor or one in training, but most established physicians will have internalized its information already. 5-Minute Clinical Consult (see above), however, is useful for a veteran doctor in an outpatient setting, although I found it less helpful when seeing inpatients. Unfortunately, the search feature of Handheldmed's reader took 10 to 15 seconds to retrieve information in the Palm version of 5MCCan awkward amount of time to wait with a patient present.
Handheldmed responds: "Narsipur claims our search feature is too slow. If you want our software to perform a word-by-word search of an entire text, that may indeed take several seconds, depending on the text's length. But our software also lets you run a smart search of a book's index. Simply type or write the first few letters of the topic you want, and the entry you seek will appear on screen almost instantly."
PatientKeeper, version 2.2OS and Program size: Palm only 340K
Publisher's Web site:www.patientkeeper.comPrice: $35
PatientKeeper (PK), an inpatient management program, lets you enter patient demographics, admission diagnosis, medical record number, and/or bed number, as well as sort patients by those criteria. Review organ systems and physical exam information for patients, track home and hospital medications, and enter lab and test results. The contents of a previous chart note can be pasted automatically into the current note for easy updating. Using your PDA's infrared transmitter, beam patient information to other doctors with PK on their PDAs, as well as to a printer with an infrared receiver (you'll need special software to do this). You can also beam PK patient information to non-PK users who carry PDAs with the Palm OS.
PK is primarily a database for inpatients. It lets you track lab values, test results, procedures, consults, and more. Several medical schools now use PK, and others are likely to adopt the program. PK is also great for residents, attendings, and rounding physicians who just need a patient's name, phone number, and diagnosis. Every feature is customizable. And you can beam patient data to another doctor who also has PK on his PDA. The software doesn't automatically merge the data, however. Unless the receiving doctor first deletes his file on that patient, PK will show two consecutive files, as if they were for separate patients. Another quibble: You can print PK-generated notes and add them to a patient's chart, but advertising that's inappropriate for a medical record appears at the bottom of each printed page. For PK to be more widely adopted, as it deserves to be, that should be scrapped. At my hospital, we use PK to efficiently track a census of some 50 patients. Software updates are available. PK is a great piece of software, one of two I couldn't live without (ePocrates qRx is the other).
PatientKeeper responds: "The ad at the bottom of each printed page appears only on free trial versions and is removed when the user purchases the software."
Patient Tracker 4.1 OS and program size: WinCE348K, Palmunder 150K
Publisher's Web site: www.handheldmed.comPrice: free
Patient Tracker (PT) is a searchable, sortable inpatient management database, into which you can enter, among other things, labs, medications, and test results. H&P and progress notes are automatically generated, eliminating the need to carry patient information on cards. Palm and WinCE versions of PT are cross-compatible: Users can beam PT information to each other, regardless of which type of PDA they own.
PT serves as a sort of electronic scratch pad on which interns and residents can make notes on inpatients. The WinCE version I tested was not the most recent, and, while a good idea conceptually, it needed work. PT lets you enter information about each patientdemographics, primary physician, room number, hospital ID, vital signs, lab and test results, and notes. You can also create individual problem and drug lists, although that information must be entered manuallya hassle. One neat feature: Vital signs and medications can be imported automatically from a previous chart note into a current note. Limited customizability, though, is a minus. For example, I had problems printing selected informationlike a medication list to put in a patient's chart. And PT wouldn't let me beam patient data to another doctor with a compatible PDA; supposedly, the new version will. Despite its rough spots, I'll probably continue to use PT. Having a list of inpatients with their room numbers is handy, and it's nice to have a record of what a patient's key lab parameters were on preceding days. I'm eager to try the latest version of PT. It has great potential.
Handheldmed responds: "The latest version of PT is highly customizable. A dictation/transcription module for PK, as well as a procedure-logging module, will soon be available."
InfoRetrieverOS and program size: WinCE only8.167MB (The Compaq iPAQ Pocket PC is strongly recommended, because of the speed of its processor. The program will work on other WinCE devices, but it will run slowly)
Publisher's Web site: www.infopoems.comPrice: $149, with site licenses and group discounts available
InfoRetriever (IR) is an evidence-based-medicine database for physicians. It includes more than 1,000 synopses200 to 300 words eachof articles culled from InfoPointer, a daily medical update service. It also contains 850 abstracts from the Cochrane Database of Systematic Reviews, basic prescribing information for over 1,200 drugs, and more than 55 clinical prediction rulessuch as the Ottawa Ankle Rules and the Strep Score. Details on hundreds of diagnostic testsas well as history and physical exam maneuverscan be evoked with a diagnostic calculator. Among other features are summaries of selected evidence-based guidelines in the public domainincluding text summaries, tables, and algorithms.
IR presents useful new or recent medical information for family physicians. If a study shows that a given drug is especially effective, you'll find it in IR. I especially like IR's decision rules. If a patient has pneumonia, for instance, you enter his age, symptoms, and signs; then IR indicatesbased on good evidence and scientific studieswhether the patient should be hospitalized or treated as an outpatient. IR's drug database is less detailed than, say, LexiDrugs' (see above), but it has some information that LexiDrugs doesn't, such as a drug's cost. IR also can add and update formularies for all your health plans and mate that information to its drug entries. This program helps make your care very scientific and up to date.
The guidelines offered in IR are derived from the Cochrane Database of Systematic Reviews, which every doctor should learn how to use. CDSR is a worldwide collaboration of physicians who have assembled a database of important controlled studies of medical treatments. Many current treatment guidelines are based on a consensus of specialists, with no supporting evidence. CDSR offers much of that missing evidence, and IR makes it easy to access electronically at the point of care.
Evidence- based medicine database
You'll find the Web addresses of leading PDA manufacturers and medical software publishers within this article. In addition, the sites listed below offer hardware, software, or both. The software sites are either exclusively medical or include sections devoted to the field.
The hardware sites also may include peripheral devices, such as memory modules and cards, wireless modems, Ethernet adapters, and full-size keyboards, as well as accessories like protective leather cases and even leather portfolios into which PDAs can be inserted.
For PDA hardware and medical software
Medical software only
Additional research was conducted by Senior Associate Editor Suzanne Duke.
. PDAs for Doctors: Colleagues rate the leading software.