Perspective
What's in Your Pocket?
iPhone, iPod, iPAQ. Physicians and medical students weigh in on the devices that assist them during their work day.
Each of us has some type of reminder system we can’t live without. For some, it still may be the calendar that hangs on the wall, the notebook filled with penciled-in lists of things to do, and a dog-eared list of commonly prescribed drugs on health plan formularies.
For a growing number of us, smart phones and handheld computers have become our pocket-sized assistants, reference libraries, and even safety nets. They can give us an electronic nudge when a meeting or appointment is approaching, provide us with access to the latest evidence-based, peer-reviewed clinical information on the spot, and tell us whether two drugs might interact.
We asked recipients of the MMA’s email newsletter, MMA News Now, to tell us about the pocket-sized electronic devices they use and why they find them invaluable in their daily practice. Here’s what a few had to say.
iPod Touch
Katie Pastorius
Third-year medical student, University of Minnesota
I’ve had my iTouch for about six months. The device is identical to the iPhone but doesn’t have the phone capabilities. It can run the same applications, which can be downloaded from the Internet via a wireless connection.
I use the device mostly for accessing my email and Epocrates. And I use it all the time when doing patient care. I can reference Epocrates to look up names of medications that I’m not familiar with and to read about the indications, adverse effects, drug interactions, and pharmacology. The touch screen is easy to use, and the wireless Internet is quick and has a strong signal. The only downside is that it does not save passwords for websites or allow me to download documents.
The iTouch is relatively inexpensive, as you don’t have to subscribe to a monthly service. Plus, it’s an iPod, so I can download podcasts and music to listen to while running or driving.
HP iPAQ X11
David Bucher, M.D.
Family physician, United Family Practice Health Center and United Hospital, St. Paul
The residency program gave me the iPAQ about 10 months ago as a replacement for the Palm I had been using. The iPAQ offers wireless Internet access and the ability to connect to other devices via Bluetooth, which is something I haven’t used before.
So far, I’ve loaded Epocrates and the Sanford Guide onto it, both of which I use routinely at the point of care. I can quickly check for drug interactions, dosages for pediatric patients, and the doses or costs of drugs that are rarely used. It is much faster to do this using the iPAQ than sitting down at a computer in the clinic and going online to find the information.
Although I’ll admit I couldn’t get along without the iPAQ, I am looking at other options like the iPhone.
iPhone
Colin Segovis, M.D./Ph.D. student, Mayo Clinic College of Medicine
Before the iPhone came along, I used to wear something akin to a Batman-style utility belt to carry all of my electronic devices. I had a cell phone, a Palm or Windows Mobile for email and medical apps, and an iPod for music and podcasts.
My cell phone served as my phone, calendar, and address book, but all the data had to be entered manually. The Blackberry was an attractive-but-expensive alternative because it could link with my work email, contact list, and calendar. But neither could provide me with the medical applications I needed.
Until recently, the devices best suited for medicine were Palm or Windows Mobile devices, as they could support a number of medical calculators, drug references such as Epocrates and Micromedex, coding and billing applications, and patient tracking applications, and allow users to create their own collections of medical notes. I’ve used both. However, no single device could meet all of my needs.
The iPhone changed that. Besides serving as my cell phone, my iPhone also serves as my day planner, address book, iPod, and most importantly, my peripheral medical brain. I can route multiple email addresses to my iPhone, including my work account. My work contacts and calendar are also automatically synced with my iPhone over the cellular network.
The iPhone is a convergence device, and what makes it a superb tool for the clinic are the applications available for it, coupled with its unique interface. Once the iTunes Apps Store opened, the number of medical applications for the iPhone and iPod Touch exploded. Epocrates immediately released an iPhone version. Instead of just releasing the same version of their current software, they created a new version that leverages the iPhone’s unique interface. The visual pill identifier that comes with the free version of Epocrates for the iPhone can be a lifesaver. Another medical application that demonstrates many of the best features of the iPhone is Netter’s Anatomy Flashcards. The high-resolution screen of the iPhone, along with the ability to easily zoom in for a detailed view, allows for the high-quality drawings to be rendered as they are found in the printed atlas. ICD-9 Consult (provides access to the latest ICD-9 codes), WebMD (assists with diagnosis), and Eponyms (a database of common and obscure medical terminology) are just a few of the other useful applications that are available.
Evernote (www.evernote.com) has become my favorite application for the iPhone. Evernote allows me to create notes using text, pictures, or voice and then syncs them online so I can access or update them from any device connected to the Internet.
The iPhone and iPod Touch also allow for video podcasting, which wasn’t possible with earlier mobile devices or iPods. Now, image-intensive specialties such as radiology are delivering lectures as video podcasts for the iPhone and iPod Touch.
I expect to see many new applications for the iPhone and iPod Touch in health care. And the best thing of all, the iPhone fits in my pocket.
Palm TX and Sprint Palm Centro
Robert T. Falk, M.D.
Family physician, Quello Clinic, Edina
I have used Palm PDAs for more than eight years. I purchased my most recent one two years ago. Although I have the Washington Manual and 5-Minute Clinical Consult loaded on it, I primarily use it to access Epocrates, which allows me to check drug dosages, contraindications, and side effects in a fraction of the time it would take me to look them up using the Physicians’ Desk Reference. In addition, it provides me with medical calculators that allow me to easily determine FeNa and other formulas.
I also have Epocrates loaded on my Sprint Palm Centro, a smart phone I use on call. However, I prefer the TX because it loads information faster and has a larger screen.
Palm Tungsten E2
Elizabeth Liljeblad, M.D.
Family physician, St. Luke’s Urgent Care in Duluth and Superior, Wisconsin
This is the second Palm I’ve owned during the last eight years. I’ve had it for about a year and use it to access Epocrates daily. It’s handy for looking up drug doses, frequent side effects, contraindications, and drug interactions. On a recent shift, I started a patient on Neurontin (gabapentin) for chronic pain. I looked up the medication to find out how to start it (one tablet on day 1, one b.i.d. on day 2, then one t.i.d.) and the appropriate dosage.
One feature I really like is that I can give patients a ballpark estimate of how much their prescription is going to cost, and I can choose meds based on cost, especially if a patient has no insurance or a high co-pay. Another nice feature Epocrates offers is MedMath. I frequently use it to calculate predicted peak flow values.
In addition to Epocrates, I occasionally use the Palm to refer to 5-Minute Clinical Consult. It helps confirm whether I’m on the right track when making a diagnosis. It also gives basic information about what labs to order, what meds are appropriate, and how to advise a patient regarding the clinical course of a disease. I used it recently when I thought a child in the clinic might have RSV. It gave me a list of symptoms that confirmed that this child’s presentation was consistent with RSV.
Before I had the Palm, I used to refer to the printed Monthly Prescribing Reference and the Physicians’ Desk Reference. For clinical information, I would refer to texts in our office. I still refer to books, but I can find information more quickly with the Palm.
The other thing I have loaded on the Palm is a list of phone numbers for physicians, dentists, pharmacies, and hospitals in the Duluth/Superior area. If I can’t remember which office a particular physician works at, I can search for his or her name and find the phone number that way.
Palm Treo 700P
Jerry R. Hendel, M.D.
Retired family physician, Fergus Falls Medical Group
I retired last year at age 67 after 32 years at Fergus Falls Medical Group. I got my Treo in February of 2007 to replace the cell phone and Palm I had been using. I’ve been using Palms since about 1998, upgrading from a Palm VX to a T3 to an M505 before purchasing the Treo. I was probably the third physician in our 40-physician group to get a Palm. Before I got my first one, I used the Physicians’ Desk Reference a lot. By the time I retired, I seldom used it, as I probably used my Treo to look up drug interactions, side effects, and costs on Epocrates for about every third patient I saw.
In addition to Epocrates, I have the Washington Manual of Medical Therapeutics, Harrison’s Principles of Internal Medicine, and 5-Minute Clinical Consult loaded on it. I was also one of the earliest adopters of UptoDate in our practice, and I started accessing it online using the Treo shortly before I retired.
I am still very dependent on my Palm Treo for my scheduler (DateBk6) and contact list (Address XT). One of the handy features of the Treo is that if I have an appointment with a physician or tickets to the opera, I can use the search function to find the dates for them. I just type in “Dr. Jones” or “Aida,” and it will search for them in the database.
The Treo is my first Palm to offer Internet access. I used the device to access the Internet while in practice, but I seldom use it for that now because of the slow speed, small screen, and availability of faster computers everywhere (I frequently tote my laptop, especially when I travel).