2. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Top 10 Applications for your PDA: Practicing Information Mastery at the Point of Care Scott M. Strayer, MD, MPH Department of Family Medicine University of Virginia

3. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Learning Objectives What is Information Mastery and how to practice it at the point-of-care. Choosing the right Personal Digital Assistant for your practice. How to turn your Personal Digital Assistant into a Medical Digital Assistant. The top 10 applications for your Medical Digital Assistant for practicing Information Mastery at the point-of-care.

4. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care How do we learn? Adults learn by solving problems Our “problems” = clinical questions CME can highlight advances and make us aware of our deficits Answering clinical questions in the context of a real case at the point of care is how we learn

5. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Clinical questions They’re common: Average 1 question for every other patient They’re important –Only 1 in 3 questions pursued –Found “answer” 80% of time –Guess at 70-80% of information needs! –Journals only used to answer 2 of 1101 questions in busy practice –Books, colleagues used most often Ely JE. Analysis of questions asked by family doctors regarding patient care. BMJ 1999;319:358-61

6. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Clinical Questions Internal Medicine Residents –2 for every 3 patients –29% pursued –textbook (31%); journals (21%); attendings (17%) Patient expectation, fear of malpractice associated with seeking answer Lack of time (60%), forgot (29%). Am J Med 2000;109:218-33.

7. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Information Mastery and Computers Slawson DC, Shaughnessy AF, Bennett JH. Becoming a Medical Information Master:Feeling Good About Not Knowing Everything. The Journal of Family Practice 1994;38:505-13. Can be reduced by computers Usefulness = Relevance x Validity Work Not always assessed by software

8. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Computers to Drill for the Best Information Web, InfoRetriever InfoRetriever, Journal Watch Best Evidence CogniQ, BMJ, FPIN Unbound, Skyscape Usefulness CogniQ, Skyscape Medline Reviews/Textbooks POEMs Clinical Evidence Clinical Inquiries Cochrane

9. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

10. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Choosing EBM Sources 1. How is the information filtered? –Patient- vs disease- oriented? –Specialty-specific? –Comprehensive? Which journals? –Does it matter (it should change my practice) or is it simply news? 2. Is the information valid? –Is level or strength of evidence labeled? –Beware “Trojan Horse”! –How often updated? –Evidence or expert opinion

11. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Two Tools Needed to Master Information A method of being alerted to new information (foraging) A tool for finding the information again when you need it. (hunting) Without both: –You don’t know that new info. is available –You can’t find it when you do

12. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care So, Which Handheld Should I Buy?

13. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

14. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

15. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

16. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

17. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Pocket PC Models Dell Axim X30Dell Axim X50HP IPaq 2215HP IPaq hx4715 Casio EG800 Premium Asus MyPal A716

18. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

19. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Website for PDA Comparisons http://www.healthsystem.virginia.edu/int ernet/library/services/computing/pda/http://www.healthsystem.virginia.edu/int ernet/library/services/computing/pda/

20. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

21. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Interactive PDA Choosers http://www.davespda.com/resources/rec ommend/index.htmhttp://www.davespda.com/resources/rec ommend/index.htm http://www6.activebuyersguide.com/abg /nav/StartGuide.cfm?CatID=12&PID=0X 6X98X149243Xdac52&RefID=0 http://www6.activebuyersguide.com/abg /nav/StartGuide.cfm?CatID=12&PID=0X 6X98X149243Xdac52&RefID=0

22. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

23. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Websites for Handheld Programs www.pdamd.com- great reviews, for physicians specifically www.palmgear.com-shareware, freeware and commercial programs. www.handango.com-shareware, freeware, and commercial programs.

24. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Websites for Programs www.handbase.com-programs that run on the database program “HanDBase” (many of them are free) www.handheldmed.com-physician reviews for Palm Pilots and Windows CE handhelds Pbrain.hypermart.net-many useful programs.

25. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care More Web Sites Medical Piloteer Ring healthypalmpilot.hypermart.net/webring www.pocketpc.com Many useful and convenient links for medical programs on the Palm Pilot.

26. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care How to Download and Install Handheld Software See http://www.pdamd.com/vertical/tutorials/ guides/installpalm.xml (for Palm OS) http://www.pdamd.com/vertical/tutorials/ guides/installpalm.xml http://www.pdamd.com/vertical/tutorials/ guides/installce.xml (for PocketPC)http://www.pdamd.com/vertical/tutorials/ guides/installce.xml These are the best tutorials I have seen yet.

27. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

28. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Presenting The Top 10….

29. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #10 Your Favorite Textbook on your Handheld TextBooks: http://www.skyscape.com; www.unboundmedicine.comhttp://www.skyscape.com www.unboundmedicine.com Merck Manual and 5 Minute Clinical consult on Palm or Pocket PC handhelds. Also available: Harrison’s, Neofax, PDR, Emergency Medicine (Cline), Surgical Pearls, DeGowin and DeGowin’s Diagnostic Examination, Obstetrical Pearls, Gynecological Pearls, Red Book, 5 Minute Pediatric Consult.

30. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #9 An Immunization Schedule Shots 2005-vaccination recommendations with information on all vaccines and catch-up schedules (available at www.immunizationed.org).

31. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Shots 2005 for Palm

32. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Shots 2005 for Pocket PC

33. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #8 Medical Calculators MedCalc for Palm (www.palmgear.com)www.palmgear.com Archimedes for Pocket PC (www.skyscape.com)www.skyscape.com ABG Pro (www.stacworks.com)www.stacworks.com

34. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care MedCalc MedCalc-formulas for creatinine clearance, fractional excretion of sodium, IV fluid rates, number needed to treat, post-test probabilities, predicted peak flow, pregnancy calculator.

35. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care MedCalc on Your PDA Main MenuCalculating FENA

36. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Medical Calculator for the Pocket PC Archimedes-free calculator that has all the same calculations as MedCalc.

37. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Archimedes on your Pocket PC

38. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care ABG Pro

39. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #7 Information Mastery Calculators MedRules (http://pbrain.hypermart.net).http://pbrain.hypermart.net Handheld Computer Smoking Intervention Tool (www.smokefree.gov/hp-hcsit.html).www.smokefree.gov/hp-hcsit.html Fine’s Rule for Pneumonia (www.ahrq.gov)www.ahrq.gov

40. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care MedRules Medrules-Gail breast cancer risk, bishop’s score, Goldman’s score, APACHE II scores, Sinusitis predictor, UTI predictor, Appendicitis score, Pharyngitis evaluation, Ottawa rules, and many more.

41. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care MedRules on your PDA Main Menu Bishop’s Score

42. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Handheld Computer Smoking Intervention Tool (HCSIT)

43. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Fine’s Rule for Pneumonia

44. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #6 OB Wheels PregCalc Pro (www.medicaltoolbox.com).www.medicaltoolbox.com PregTrak (www.stacworks.com).www.stacworks.com Due Date Calc (www.handango.com).www.handango.com

45. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care OB Tools PregCalc Pro-allows you to enter LMP, EDD or U/S data to calculate EGA, EDC, etc. Allows you to save patients.

46. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care PregPro -Set LMP -Set EDD -Confirm U/S dating -Lab reminder -Saves patients

47. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care DueDateCalc

48. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #5 Daily Updates from the Web AvantGo (www.avantgo.com)www.avantgo.com

49. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care AvantGo Mobile Internet Free! - http://www.avantgo.comhttp://www.avantgo.com Web-based (content written in HTML) Users subscribe to “channels” (specially-formatted Web sites) –Commercial –Private Automatically updated with each HotSync

50. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

51. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

52. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

53. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care A Student's Guide to the Medical Literature, PDA Version URL: http://denison.uchsc.edu/SG/PDA.html Author: Katherine McLucas, University of Colorado Health Sciences Center medical student Operating System: Palm OS, PocketPC, WinCEA Student's Guide to the Medical Literature, PDA Version A how-to guide developed for medical students on appraising the medical literature. Covers how to frame research questions, develop search strategies, appraise the results, and implement findings into clinical practice. Free AvantGo account required.

54. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Duke University Medical Center Library Evidence-Based Medicine File URL: http://www.mclibrary.duke.edu/respub/pdafo rmat/ Author: Connie Schardt, MLS, AHIP Operating System: Palm OS, Pocket PC, WinCEDuke University Medical Center Library Evidence-Based Medicine File Free PDA file of evidence-based medicine resources. Contains information on EBM terminology, how to construct a well-built clinical question, and how to evaluate various types of journal articles. A reference guide on searching Ovid MEDLINE is also included. Free AvantGo account required.

55. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

56. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

57. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care AvantGo

58. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #4 Your Favorite Websites at the Point-of-Care iSilo (www.isilo.com)

59. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Using Your Favorite Websites at the Point of Care iSilo-allows you to add web pages to your Palm Pilot. I.e. can add JFP Poems index (www.infopoems.com) or Iowa Family Practice Handbook (www.vh.org/providers/clinref/fphandbo ok/fpcontents.html) Get browser at www.isilo.com Follow instructions on using iSilo web.

60. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Cochrane Abstracts on iSilo

61. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

62. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care CDC Travel on Your Palm

63. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Creating iSilo content for your handheld computer (link)link

64. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #3 Database Program HanDBase (www.handbase.com).www.handbase.com

65. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care CME Tracker on HanDBase

66. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Entering a Procedure in HanDBase

67. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #2 A Good IM Reference InfoRetriever (www.infopoems.com)www.infopoems.com Unbound Medicine and Clinical Evidence from BMJ (www.unboundmedicine.com)www.unboundmedicine.com

68. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care InfoRetriever 2005 Windows 95/98/NT/ME/2000/XP, PocketPC, Palm and Web Bayesian diagnostic test / H&P calculator (2000+) Basic drug info by class and cost for 1200 drugs Key evidence-based treatment guidelines Cochrane Database of Systematic Reviews: over 1750+ abstracts 200+ clinical prediction rules www.InfoPOEMs.com 2200+ short research synopses (400 added per year) 5 Minute Clinical Consult

69. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care InfoRetriever to help with treatment decisions A 46 y/o male, smoker –PMH significant for hypertension treated with HCTZ. Most recent BP = 138/86. –FH: Both parents have HTN over age 70, no h/o CAD. –Lipids: Chol = 197; HDL = 41; LDL = 141. Questions: –What is his risk of an AMI or sudden cardiac death in the next 10 years? –How much will lowering the SBP below 130 reduce the risk? –How much will stopping smoking affect his risk?

70. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care InfoRetriever

71. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care InfoRetriever

72. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care InfoRetriever

73. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Should his SBP be lowered to <130?

74. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care What if he quit smoking instead?

75. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care A Patient Success Story

76. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Unbound Medicine http://www.unboundmedicine.com CogniQ platform enables installation of popular reference titles with auto- updating capability Has OVID searching capability with web-based management of knowledge

77. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

78. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

79. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

80. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

81. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

82. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

83. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

84. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care #1 A Good Drug Reference ePocrates qRx 6.0 (www.epocrates.com)www.epocrates.com

85. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Writing Prescriptions Epocrates qRX 6.0-comprehensive free drug database. Replaces PDR, Pocket Pharmacopiea. (www.epocrates.com go to “product information” and register ) adult dosing, pediatric dosing, metabolism, pregnancy categories, drug interactions and contraindications. Notes section for your own comments. Hotsync daily with web updates.

86. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care

87. Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH Information Mastery at the Point of Care Contact us: Scott Strayer sstrayer@virginia.edu sstrayer@virginia.edu Website: Center for Information Mastery http://www.healthsystem.virgin ia.edu/internet/familymed/docs /info_mastery.cfm