Managing care with handheld technology
New software allows clinicians to use a PDA for more than looking up drug information.
Primary-care nurse practitioners and physician assistants are aware that managing patient care successfully requires both breadth and depth of clinical knowledge. The challenge of meeting patient expectations while implementing evidenced-based practice guidelines in a timely manner is inherent in each patient encounter. Certainly some encounters are more challenging than others. Skilled providers recognize the availability and accessibility of resources that support quality patient management, whether those resources are of the human variety (i.e., collaborators, colleagues, or referrals) or the nonhuman variety (i.e., handbooks, textbooks, or computer software programs).
Reference information commonly used by providers in the clinical setting for decades can now be easily accessed using handheld technology—specifically personal digital assistants (PDAs). If you are a clinician who has several guidebooks, a few algorithms, and a prescribing handbook in your lab coat pocket, you may be surprised to learn that your favorite clinical references are now available as handheld technology software bundles. If you bought a PDA many years ago and never really used it as originally planned, now is the time to dust it off and take a second look at what can be done with the handheld software now available.
Without a doubt, the primary reason providers purchase handheld computers is to take advantage of prescribing software. Having the ability to quickly double-check dose, side effects, contraindications, pregnancy categories, and pediatric indications before writing a prescription or recommending OTC medication improves efficiency and quality in the primary-care setting. In addition to providing drug reference information, prescribing software lets the clinician check for drug interactions, which allows invaluable risk/benefit analysis at the point of care. This multicheck functionality offers details regarding drug-drug interactions and enables the prescriber to make accurate clinical decisions.
A number of PDA prescribing resources are available to primary-care clinicians. Two of the top companies that market prescribing resources for PDAs are Lexi-Comp and Epocrates. Discussing the differences between these two companies' products is much like discussing the differences between a Mac and a PC; providers have distinct preferences and loyalties. Clinicians choosing a prescribing resource for the first time should be aware that both companies offer more than one option, both companies' databases have proven reliability,1,2 and both companies offer bundled software packages.
The bundled software available for purchase from Lexi-Comp and Epocrates includes clinical decision-making applications in addition to prescribing resources. Lexi-Complete On-Hand and Epocrates Essentials are two of the most comprehensive options available (Table 1). Software applications bundled together for purchase as a unit are of key importance to providers interested in acquiring clinical decision-making tools in addition to prescribing resources for their PDA.
Before companies like Lexi-Comp and Epocrates began bundling software, many providers looking to use a PDA in the clinical setting were a bit overwhelmed by the task of finding, reviewing, and purchasing clinical references. Now the best diagnostic guides, lab references, symptom assessment tools, dose calculators, and treatment algorithms can be purchased together in one package. Many of these applications are integrated into the prescribing resource database, which means that clinicians using the applications can easily access information as needed.
Even the process of downloading and updating prescribing resources has become easier. Providers who experienced the tedium of downloading handheld applications in the past will appreciate how much more streamlined the process is now. For example, software applications from both Lexi-Comp and Epocrates are downloaded from the Internet automatically onto desktop software and then onto a PDA after the handheld is connected. Databases can be downloaded directly onto memory cards or into the internal memory of the PDA. Versions of prescribing resources exist for almost every form of handheld technology using Palm or Pocket PC operating systems. Updating information is as easy as syncing he PDA to the desktop software. Online technical help and tutorials are available to take the new user through these processes.