TOPICS

COLUMNS

LISTINGS

2001 LISTINGS

HELP

PARTNER LINKS

TECHNOLOGY

Hand tools: Many uses for handhelds

For these physicians -- and maybe for you -- a handheld computer is a great way to track medications, look up practice guidelines -- and play chess.

By Tyler Chin, amednews staff. July 30, 2001.

Many physicians use handheld devices primarily as personal electronic organizers, and for keeping track of schedules, addresses, expenses and to-do lists. But other doctors use the devices professionally and for fun.

To get a snapshot of what work- and nonwork-related software programs are available to physicians, AMNews assembled a group of tech-savvy practicing physicians who use handhelds. We interviewed them separately about what programs they use, how they use them and where they acquired them. Many of the programs are free. Others generally cost $20 to $50, though some are available for free, either for short trial periods or if you become a beta tester for the company that sells them.

The physician panel
Handheld resources

Before reading what the physician panel said, readers might want some background to put their comments in context. For example, some doctors use software based on HanDBase, a relational database application manufactured by DDH Software Inc., Lake Worth, Fla.

"HanDBase is kind of like having a spreadsheet on your Palm Pilot that you can use to track information," said Michael Owens, MD, a gastroenterology fellow at the University of Washington in Seattle. The spreadsheet is more like Microsoft Access than Microsoft Excel, he said, "because with Access you can take the spreadsheet and turn it into a form that you can click on and enter your data, making it really easy for data entry. HanDBase is similar to that."

Several Web sites offer numerous HanDBase databases for coding, billing and other medical applications. Doctors can download ready-made applications from several sites. Or if they know how to create and use spreadsheets, they can write their own HandDBase applications, Dr. Owens said.

Some physicians also use AvantGo, a free program that lets you download sites onto a handheld. For example, if you install AvantGo on your handheld and PC, you can set it up so you could read the front page of The New York Times or American Medical News on your handheld.

In addition, physicians also use document readers, including Quickoffice and Quicksheet from Dallas-based Cutting Edge Software Inc.; WordSmith from Blue Nomad, Redwood City, Calif.; and Documents To Go from DataViz Inc., Trumbull, Conn. These programs let doctors read and edit Microsoft Word, Excel and other files on their handhelds. Another program -- iSilo from DC & Co. -- lets users compress and transfer Web pages to the devices.

Some doctors also subscribe to wireless Internet services from OmniSky Corp., San Francisco, and Santa Clara, Calif.-based Palm Inc.'s Palm Net, both of which charge $40 to $45 monthly for unlimited Internet access.

All but one of the physicians interviewed use Palm devices. The exception uses a TRGpro and HandEra 330 from Des Moines, Iowa-based HandEra Inc. HandEra devices run on the Palm operating system and accommodate CompactFlash cards that let users boost memory up to 1 gigabyte.

Professional applications

James H. States, MD, an adolescent medicine specialist in Spokane, Wash., uses a 128-megabyte CompactFlash card that has a large number of medical textbooks, including Lexi-Comp's LexiDrugs, the 5 Minute Pediatric Consult, Griffth's 5 Minute Clinical Consult 2000, the American Psychiatric Assn.'s practice guidelines, DSM-IV Revised Text, the Physician's Drug Handbook, the Advanced Cardiac Life Support Pocket Survival Guide, and the Merck Manual.

Dr. States also customized and integrated 15 HanDBase applications, including patient demographics, patient charting and coding. He also uses a drug reference guide from ePocrates Inc.; cardiac risk and coding programs from Austin Physician Productivity LLC, Austin, Texas; and medical calculators called MedMath and STAT GrowthCharts, which are available from several sites.

Bernd Wollschlaeger, MD, a family physician in North Miami Beach, Fla., uses a Palm VIIx primarily to capture data in the exam room.

"I have a template I developed in which I enter the information and when the visit is over, I just hot sync it over to my computer, and then cut and paste the information into my medical records system," he said.

Dr. Wollschlaeger also uses ePocrates' drug reference database, logonhealth from LogonHealth Corp, Morris Plains, N.J., to transmit wireless prescriptions to pharmacies and a program from iScribe Inc., Redwood City, Calif., to write and print prescriptions.

Mark Alan Snyder, MD, a Cincinnati orthopedic surgeon, has used a Palm IIIx in the past two years to collect pre- and post-surgery outcomes data for every patient needing a total joint replacement. Dr. Snyder, one of 22 doctors in an orthopedic group, records data using templates that he developed using commercial software from Pendragon Software Corp., Libertyville, Ill. Those data are then transferred to a PC and database for easy access and research.

Orin M. Goldblum, MD, a Pittsburgh dermatologist, uses the drug reference, scheduling and wireless prescribing applications that are part of ePhysician Practice from ePhysician Inc., Mountain View, Calif.

He also uses a drug reference database from ePocrates, Documents To Go, iSilo and D.E.R.M. (Drug Eruption Reference Manual), a specialized dermatology database developed by Jerome Z. Litt, MD, a dermatologist in Cleveland.

Steven Randolph White, MD, a Chicago pulmonologist, uses a Palm IIIe "for three things," he said. "[Personal] scheduling and the calendar is very useful for me. I learned how to do the handwriting so I use it to take notes at lectures [when I'm at a medical conference]. And ... I use ePocrates when I'm seeing patients to look up drugs quickly."

Michael Owens, MD, a gastroenterologist in Seattle, uses HanDBase to track basic, elementary patient information -- the patient's symptoms, their main diagnostic tests, procedures, etc.

"I also use it at the hospital so when I get a call about a patient ... I jot down stuff over the phone: who the patient is, what his medical record number is, what his concerns are, his vital signs and things like that." He can then make a to-do list so he'll know what to follow up on after he sees a patient.

"I also use it professionally for drug information ... [and] for all my contacts, including numbers for everyone at all the different hospitals I go to," Dr. Owens said.

"With AvantGo, you can actually customize your own channel for anything you want [on the Internet]," he said. "I use it to get the table of contents from the big gastroenterology journals."

Another channel, Mydocsonline, is "a repository on the Web for anything you want to put in it ... key articles, key protocols, papers and [bibliographies]. Every time I hot sync, all those document are transferred to my Palm."

Personal or fun applications

Aside from professional uses, most of the physicians on the panel also found applications for personal use.

"I can check flight arrival and departure times, buy books on Amazon.com or Barnes and Noble.com, and do e-mailing when I'm out of town," Dr. Wollschlaeger said. He checks weather reports when he's out of town and gets news and directions from MapQuest.com Inc. "I just ordered [movie] tickets online."

Dr. Goldblum said he uses OmniSky "all the time when I'm traveling to send and respond to e-mail and browse the Web." But he admits that browsing the Web with a handheld is "a little bit on the slow side."

Dr. Owens uses it for things like balancing his checkbook and reading the newspaper from the town where he went to undergraduate school. "I have some information about Palm Pilot updates in another channel. I have some tips for Seattle restaurants and upcoming cultural events, a channel for movie times," he said.

Meanwhile, Dr. States likes ChessGenius, a game he plays alone or with young patients; Parens Lite calculator; Batmon battery monitor; third-party personal information management software called Action Names and DateBK4 that enhance the preinstalled personal organizer applications; Quickoffice; Quicksheet; and Documents To Go.

Handheld advantages

Dr. Snyder recognizes the added benefits of integrating handheld use into his practice; he now has all the data he always wanted but found difficult to retrieve when the information was on paper.

"We also have the ability to capture every patient in a very prospective manner," he said. "Only one out of four practices collect outcomes data on average in orthopedics. The objection they have to doing it is time and expense, but this allows us to do it at a fraction of the cost of multiple research personnel, software or expensive computers."

Use of the device also boosts patient confidence, he said. "Patients frequently will comment that they're reassured you're ... actually recording the data."

Dr. States estimates that he spent about $1,000 to buy his device, software, CompactFlash card and a keyboard. That cost has been "absolutely" worth it in terms of overhead, productivity and convenience, he said. "The average secretary costs you $2,500 a month. I have a secretary who works for six people and she only does scheduling and billing [for me]. She costs me $500 a month. ... I don't pay full-time benefits or full-time retirement."

He also has found accessing different drug databases very convenient. "EPocrates has less information, but it's in a nice compact format" and is updated monthly, he said. "LexiDrugs has more mechanistic information but it's not updated as often. ... These two are complementary. And anybody who is doing really serious pharmacology needs more than one drug database."

Dr. Wollschlaeger loves it that he can access the Internet wireless on his Palm, letting him work and do anything whenever he wants. "By having the core function of the PDA to capture patient data at the point of service plus having connectivity to the Internet through a Palm device, I can transmit data immediately to a pharmacy, which is a tremendous relief for me because I don't have to write a prescription, give the patient paper with the prescription written on it and the patient doesn't have to wait at the pharmacy," he said. "I'm literally enhancing my efficacy and the way I work in my practice."

Dr. Goldblum likes ePhysician's system because it integrates the prescribing and drug reference applications so that he can flip back and forth between each, meaning that he does not have to exit one program to go into another.

ADDITIONAL INFORMATION:

The physician panel

Orin M. Goldblum, MD

45 years old
Dermatologist
Pittsburgh

Michael Owens, MD

30 years old
Gastroenterology fellow, University of Washington, Seattle

Mark Alan Snyder, MD

48 years old
Orthopedic surgeon
Cincinnati

James H. States, MD

55 years old
Adolescent medicine specialist
Spokane, Wash.
Co-founder of MobileTree Inc., which sells handhelds and offers consulting and training services.

Bernd Wollschlaeger, MD

43 years old
Family physician
North Miami Beach, Fla.

Steven Randolph White, MD

45 years old
Pulmonologist University of Chicago Hospitals & Health System

Handheld resources

Physicians interviewed for this story download and learn about software applications for handhelds from these Web sites, most of which offer software for Palm and Pocket PC devices:

Handheldmed Inc.
(http://www.handheldmed.com/)

Healthy PalmPilot, PDA Verticals Corp.
(http://www.healthypalmpilot.com/)

PalmGear.com
(http://www.palmgear.com/)

pdaMD.com
(http://www.pdamd.com/)

ZDNet
(http://www.zdnet.com/)

DDH Software Inc.
(http://www.ddhsoftware.com/)

Skyscape.com Inc.
(http://www.skyscape.com/)

Statcoder.com from Austin Physician Productivity LLC
(http://www.statcoder.com/)

ePhysician Inc.
(http://www.ephysician.com/)

ePocrates Inc.
(http://www.epocrates.com/)

iScribe Inc.
(http://www.iscribe.com/)

iSilo.com from DC & Co.
(http://www.isilo.com/)