In my opinion... there are a lot of medical students and physicians out there who really need a Palm Computer. They just don't know it yet. They give excuses like "I carry around so much already, the last thing I need is something else in my lab coat."
The trick is to have a handheld computer replace something they are already carrying. Like a drug reference book. Nearly every student and physician has one. There are simply too many drugs with too many similar names and too many dosage regimes to remember them all.
So instead of memorizing, we carry around a little book, somewhere in the peripheral brain we call a lab coat. We even put tabs or dog-ears on the drugs we use regularly, adding our personal notes about mechanism of action, cost, etc. in the margins.
And this works pretty well until that dreaded day, every year or so, when a new version of the little book comes out. The shiny new little book has all the new drugs, new dosages, new adverse reaction warnings, and in some cases outright recalls.
But the old one has all your notes and quick reference shortcuts. And therein lies the problem, how do you keep your personal drug information and integrate it with the latest little book information. The answer use to be that you copied information by hand from one little book to the next. But now with programs like ePocrates qRx 4.0 this can be done automatically. And not only once a year, but continuously, as soon as the new information is available. Think of it as a continuous infusion of drug information as opposed to the old method of a yearly bolus.
ePocrates qRx 4.0 So, let's talk about the details of ePocrates' new qRx 4.0.
Navigating
When you first open qRx 4.0 it looks identical to qRx 3.0. Which is a good thing, because the interface of qRx has always been very intuitive. There are two ways to get to the drug information: by drug class and by drug name. In drug class mode, you are presented with 19 drug classes, which either describe the action of the drug or the system on which the drug acts. In drug name mode, you are presented with a list of all brand and generic drug names.
In both cases, you scan the list using either the scroll bar, scroll buttons, or graffiti. Then you select the drug of interest from the on screen list. You can set program preferences to start in either mode. I usually start in drug name mode, since I am typically looking up a dosage for a drug I plan to use. But, on occasion I will switch to Drug class mode when I am looking for a drug with a specific action or for a replacement drug for a patient with a drug allergy. The ability to search in either mode is a definite plus.
Drug Information
Once you have found the drug you are looking for, the drug's brand name is displayed with the generic name listed below it. The remainder of the screen is devoted to one of eight categories of information:
- Adult Dosing
- Pediatric Dosing
- Contraindications/Cautions
- Drug Interactions
- Adverse Reactions
- Cost & Packaging Information
- Other Information
- Personal Notes
You can set program preferences to start in any of these 8 categories. You can also switch between these categories using a pop-up menu at the bottom of the page. [Insert screen shot of Drug information page with pop-up menu displayed] Mine is set up to start with Adult Dosing information.
Adult & Pediatric Dosing
While these are two different categories of information displayed on two different screens, the format is identical. Below the generic name are the dosage forms available from various manufacturers, including tablets/capsules/suppositories, liquids/elixirs/suspensions, and IV/IM concentrations.
Then comes the meat of the information, a scrollable list of indications followed by dose, route, and schedule guidelines for each indication. Additional information is sometimes includes such as maximum dose, alternative schedules, or therapeutic/toxic levels. And just think, getting to this information took at most a few graffiti characters and a couple of screen taps. Pretty cool.
Contraindications/Cautions
Lists situations in which the drug should not be given, or in which the drug should only be given with extreme care. Pay attention here because this has the potential of saving your patient's life, and with this type of reference it only takes a few seconds.
Drug Interactions
Lists the classes of drugs with which the current drug will interact. If you want to know what type of interactions occur with a given class of drugs, simply tap on the class name. If you are not sure which drugs are in a given class, just tap on the "^" next to the class name, and a list of drugs in that class will pop-up.
Adverse Reactions Lists the side effects of the current drug, but more importantly divides the list into Serious Reactions (that is, be prepared to take action if this occurs), and Common Reactions (that is, you can let the patient know this may occur so there are no surprise calls at 3 a.m.).
Cost & Packaging Information Lists the manufacturer(s) of the drug, which is great if you need to fill out indigent drug program forms. Also lists the price and packaging information as made available by www.drugstore.com, which is helpful for the not quite indigent patient (aka medical students).
Other Information Kind of a catch all for other useful information such as: Pregnancy Class & Lactation Class (you can even tap on the letter if you have forgotten what these classes mean), Metabolism Location, Excretion Route, DEA Class, Therapeutic Class, and most importantly Mechanism of Action. The addition of Mechanism of Action is actually one of the most important upgrades to this version of qRx at least from a medical student's perspective. It is like a constant refresher of basic science pharmacology in a clinical setting, which is the best way to learn.
Personal Notes This is an area for you to write your own notes on each drug. The next time you access the drug, you know to check your personal notes because a "Notes Icon" appears next to the brand name on every drug information category.
Power Features
These are the program features that can only come from a handheld computer and thus make that little drug book in your pocket seem so much littler.
AutoUpdate Every time you Hotsync your palm computer, you are automatically connected to the ePocrates website. Once connected, the latest drug updates are downloaded and transferred to your PDA. The newest drugs are added seamlessly. Any newly discovered adverse reactions are updated. There is even a service called "Doc Alert" which can be used to highlight any newly revealed Severe Adverse Reactions. The new information is meshed with any existing personal notes you may have. No more recopying personal notes from one little book to another.
MultiCheck This feature check for drug interactions between multiple drugs. Say you have a patient on 8 drugs each in a different class. That would be 28 potential class-to-class interactions (trust me on the math). You could spend all day looking up each class-to-class interaction or you can use MultiCheck. The way it works is by selecting each drug from the drug name list. When you have drugs selected, You simply tap Run and all potential interactions are checked and any known interactions are listed. You can then tap on the list of known interactions to how the drugs interact and what you may have to do about it. Try doing that with your little drug book.
Find Here we are getting into the basic power of computers. The ability to search through large volumes of data for patterns is invaluable. The find feature of a handheld computing drug database allows ePocrates find function is even cooler in that you can search through any of the categories of drug information discussed above. For example, if you have a patient complaining of nausea with most of their medications, you can tell them that nausea is a very common side effect or you could tell them that there are over 1100 medications that are known to cause nausea (actually there are 1146, found by searching nausea under adverse reactions). You decide which sounds better.
Another example, you diagnose someone with meningitis. What can you use to treat it? There are 14 drugs with indications that include meningitis. Once you've found the drug you want to use, simply tap on its name and you are immediately brought to the drug information screen.
Areas for Improvement
Overall I'm pretty happy with qRx 4.0, but there is always room for improvement.
Categories With the increasing cost consciousness of medicine, and thus the increasing prevalence of formulary lists, it would be nice if you could include drugs in multiple categories which would represent multiple formularies. Also the method of categorizing drugs is tedious, requiring multiple taps to change each drug's category individually. There ought to be a way to do this via a list like the categorization of applications on the launcher screen. This has the potential of being a very powerful tool, I know the people at ePocrates can work out these few kinks.
Patient Drug Lists This is more an integration issue than an area for improvement for qRx. Wouldn't it be cool if a drug program like qRx could be integrated with a patient tracking program, and maybe even with a disease reference like 5MCC. Yes, I've said this in the past, but now seeing how much more useful the drug programs have become, it pains me even more to see the missed opportunities of not integrating. I would hope that someone at ePocrates is listening.
Well, that's it for this month.
/GregEJ