Clinical applications

While the availability of bundled software packages has simplified the process of acquiring handheld clinical applications, the ability to download additional specific software based on individual provider needs is still an important part of using a PDA as a resource to manage patient care. Many providers first use the PDA as a basic prescribing resource and later add other clinical software applications. The process of adding software to handhelds is much easier today, as the memory capability and expandability of even the most basic PDAs have increased considerably in recent years.

What clinical applications do primary-care clinicians find most useful? A simple Web search uncovers thousands of choices. Table 2 lists examples of available PDA software and indicates whether they are available without charge or require payment. The evidence-based applications listed in Table 2 are the ones most used by providers in primary care.3,4 The following summary is meant as a helpful guide to clinical applications for the PDA.

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• Billing and coding: Stat E&M CoderStat ICD-9 Coder 
    — StatCoder provides a number of tools to help with accurate coding and billing in an easy-to-use format. Free trials of the software can be downloaded.
• Cholesterol guidelines: STAT Cholesterol or ATP III Guidelines 
    — Either of these programs allows individualized patient management based on national cholesterol guidelines. Patients can see how changing lifestyle behaviors can decrease risk factors when the application is used with a team approach.
• Continuing education: Prescriber’s LetterMedical Letter 
    — The PDA versions of these unbiased, well-known newsletters are free to subscribers. Included with subscriptions are opportunities for pharmacology continuing education.
• Dermatology reference: DermMeister
    — A dermatology reference with photos available in a handheld format is a rarity. (The fact that this one is free and user-friendly is quite a bonus.)
• Dosage calculations, IV rate calculations: MedMath and MedCalc 
    — These medical calculators allow easy access to countless formulas. The ability to quickly perform common calculations (e.g., dose based on weight, spirometry values, or cardiac output) makes either of these calculators a must-have. These programs are often part of bundled software but can be downloaded separately as freeware.
• Electronic prescribing and/or electronic records: iScribe, RxNT, EMR liteAllscripts 
    — As the trend toward electronic prescribing systems and electronic medical records continues, user-friendly computer applications that incorporate handhelds are more widely available. The software applications listed offer various levels of integrated prescribing systems.
• Emergency response resource: .911
    — The CDC offers free guidance for disasters, epidemics, and outbreaks. Download this free application to the expanded memory of a PDA, and detailed emergency preparedness and disaster information will be readily available if needed.
• Geriatric reference: Geriatrics at Your Fingertips 
    — This reference is the PDA version of the pocket guide from the American Geriatric Society.
• Immunizations: Shots 2008
    — This free application allows quick access to the immunization schedules for pediatric, adolescent, and adult patients; catch-up schedules and high-risk considerations are included. Having the most recent recommendations from the Advisory Committee on Immunization Practices (ACIP) available as a handheld reference is invaluable.
• Infectious disease reference: Johns Hopkins University Antibiotic Guide 
    — Search by diagnosis, pathogen, or antibiotic with this application to review evidence-based treatment guidelines. This is helpful for cross-referencing when a patient has more than one infectious disease diagnosis. The Antibiotic Guide is often bundled with other software, although it can be purchased separately as listed.
• Medical calculators, assessment tools, formulas, flow charts: Stat Growth-BP, BMI, Glasgow Coma Scale, Peak Flow Rate, arterial blood gases, and hundreds of others 
    — Almost any chart, graph, formula, table, or algorithm used in primary care is available for the PDA. Downloading these free applications to the handheld helps eliminate the assortment of notes that were once stuffed into a lab- coat pocket and will limit the need to search through office files or bookshelves to find that long-lost guidebook or reference.
• Mental status tool: MentStat
    — Allows the provider to administer and score the Mini Mental Status Exam
• Pediatric references: Bright FuturesRed Book 
    — The American Academy of Pediatrics has PDA versions of references available.
• Pregnancy calculator: OB Wheel
    — Allows the provider to calculate the estimated day of confinement, gestational age, and Bishop score
• Prescribing resources (with and without clinical software): Epocrates, Lexi-Comp, Clinical Pharmacology, Micromedex, Monthly Prescribing Reference, and Pepid 
    — The drug database from Monthly Prescribing Reference is available to medical professionals as a free download for mobile devices, as well as desktop and laptop computers. The MPR Mobile & Desktop Edition is compatible with Blackberry, Palm, Microsoft Mobile, Microsoft XP, and Microsoft Vista.     
    — Epocrates and Lexi-Comp offer versions of their prescribing software bundled with and without clinical references. Clinical Pharmacology, Micromedex, and Monthly Prescribing Reference have online and PDA versions. Pepid is an excellent clinical decision-making reference that includes prescribing and clinical software and is now available for mobile and wireless devices.
• Provider-specific references: NP ToolboxPA Toolbox 
    — The “Toolbox Series” now includes a bundle of software specific to NP or PA practice. An excellent resource, the Toolbox includes numerous pediatric references.
• Symptom assessment: Diagnosaurus
    — This free application generates lists of differential diagnoses for various signs, symptoms, and diseases and is an excellent tool preceptors can use to spark discussions with students.
• Sexually transmitted disease treatment: CDC Guidelines 2006
    — The CDC provides the most recent evidence-based treatment guidelines for sexually transmitted diseases in a free PDA version.
• Symptom assessment and disease management: 5-Minute Clinical ConsultHarrison’s Manual of Medicine
    — These comprehensive and respected clinical references allow for quick review of symptoms, workup, diagnosis, and treatment. Both are available as part of software bundles or separately as listed.