Mobile Medical Software makes life easier for healthcare professionals and their patients

MARLBOROUGH, Mass. -Feb/March 2007 Issue

By Edward M. Zabrek, M.D., F.A.C.O.G.

There's a rich and growing field of software solutions for medical professionals available for Windows Mobile. They range from reference texts to programs that can track patient records to software that can improve the practice of medicine. The number of resources is growing rapidly; we can't cover everything that's available, but I will highlight the programs that have impressed me. Also, see the sidebar in this article for yet more Web sites and software to check out in the Windows Mobile healthcare arena.

Medical References

Skyscape: Familiar medical textbooks available in the point-of-care library for all healthcare professionals (http://www.skyscape.com)

Skyscape is a leading provider of interactive, intelligent mobile healthcare solutions. Having a wealth of information on my Pocket PC (and Smartphone) at the point of care improves the quality and efficiency of patient management and helps reduce medical errors. Skyscape provides more than 300 of medicine's most trusted and proven medical references in 35 medical specialties, from more than 30 major medical publishers.

Skyscape's Constellation incorporates pertinent individual titles customized for individual specialties (including Pediatrics, Anesthesia, Cardiology, Alternative Medicine, and others). They contain critical information on drugs, diseases, interactions, lab information, treatment options, and guidelines for each specialty. Skyscape's patented ART (Advanced Reference and Transaction) technology creates solutions that reflect and support the intuitive thought processes of the medical practitioner, and are very easy to use at the point of care. Skyscape aggregates information from a variety of sources, integrates this information, and presents it "in-context" on the Pocket PC, significantly improving the quality and efficiency of medical decision-making.

Skyscape Constellation offers an integrated source for decision support.

A physician can literally keep his entire knowledge base (thousands of pages of medical texts) in his pocket! The truly incredible aspect about these software titles is that no matter how many Skyscape titles you install onto your device, they all act as one cross-referenced text, making the information even more useful and practical.

As an Ob-Gyn, I am very concerned when giving any medications to women of child-bearing age, fearing that with a known or unknown pregnancy, the wrong drug could have devastating effects. An essential reference, Drugs in Pregnancy and Lactation, has been my gold standard textbook for the past 20 years. It details the precise risks from drugs for unborn fetuses and for live-born breast-feeding babies. Having this book available to me on my mobile device via Skyscape has given me a powerful tool to keep my unborn patients safe. I strongly feel that all practicing physicians should be using this text every time they prescribe a medication to women who are at risk for, or who are already pregnant, or who are breast-feeding. I wish that this invaluable text were imbedded in every medical software program offered to every physician in every specialty.

Another great feature of the Skyscape products is that all of the programs load to an external memory card, keeping valuable internal memory free for programs that must be loaded to that space. This feature, and the breadth of the specialty-specific titles, is what distinguish Skyscape from Epocrates. One other cool new feature that has been introduced is "live" program updates. If you have a wireless connection (LAN, Phone Edition, etc.) you can get the very latest textbook information and news alerts from ARTbeat (see my review of ARTbeat at http://www.pocketpcmag.com/_... without having to cradle to your PC via ActiveSync.

Newly added features to the already great Skyscape lineup include Mobile CME's, very complete insurance formularies (with updates), and live updates of software titles on a connected mobile device.

For any physician looking for easy point-of-care specialty-specific references for their Pocket PC, one cannot do any better than Skyscape!

Epocrates: Proprietary, peer reviewed general information, the pioneer of point-of-care healthcare solutions (http://www.epocrates.com)

The Epocrates drug reference has been available for Palm OS devices for a long time. In fact, many physicians bought Palm devices just so that they could use it. Now Epocrates offers their more robust subscription products on the Pocket PC. These include Epocrates Essentials: "All-in-one guide to diseases, drugs and diagnostics." The Epocrates Essentials premium suite includes the Epocrates Rx Pro, which includes IV compatibility and drip rate. There are additional free features and services including DocAlert messaging and MobileCME.

Epocrates Lab covers hundreds of diagnostic tests and panels. It enables doctors to look up information based on the lab test, specimen type, or panel. Information includes the basics of the selected lab, reference ranges, interpretation, appropriate prep/collection method, and commonly associated ICD-9 codes in the cost/billing section. Epocrates Lab allows users to view a comprehensive differential diagnosis for an abnormal value, with suggested follow-up. Users can then click on a possible disease or drug cause and are instantly linked into Epocrates Dx or Epocrates Rx Pro. Diseases and drugs with the linking capability are underlined and highlighted in green, making them easy to locate and click on, quickly giving you the information you need. Epocrates Lab gives detailed information to help evaluate lab results.

Epocrates Dx is a new offering for Pocket PC users, providing access to over 1,200 clinical topics, sourced from Griffith's 5 Minute Clinical Consult. Epocrates Dx is constantly updated and expanded by Epocrates, and can be updated wirelessly via the Internet using a wireless LAN connection, or with a Pocket PC Phone Edition. The reference allows users to view topics alphabetically or by body system, yielding quick searches based on a user's needs. Epocrates Dx allows you to review basic knowledge, differential diagnosis, treatment options, and medication options. Users can jump from Epocrates Dx to Epocrates Rx Pro by selecting a hot-linked medication, and then quickly jump back to Epocrates Dx if additional information is needed.

Epocrates Rx Pro (another part of Epocrates Essentials) has been available for Pocket PC users since April 2003, and it continues to improve on WM devices. Epocrates Rx Pro gives users immediate access to information on virtually any drug or herbal medicine on the market today, allowing users to search by drug or class. It also provides both adult and pediatric dosing schedules, adverse reactions, contraindications and cautions, drug interactions, pregnancy/lactation drug class information, mechanism of action, and estimated cost of the drug (sourced from http://www.Drugstore.com). Epocrates Rx Pro is the premium drug and formulary reference.

Included with Epocrates Rx Pro is Epocrates ID (an infectious disease treatment guide), tables and guidelines, and MedTools (provides timely DocAlert messages chosen by the Epocrates team of medical editors from the FDA, CDC, ISMP and others). These include specialty-specific messages, so that the information sent is relevant for each particular medical practitioner. One of the most useful features in Epocrates Rx Pro is MultiCheck, which checks up to 30 drugs or herbal medicines against each other for potential drug-drug or drug-herbal interactions, all within seconds. Epocrates Rx Pro now also includes an IV compatibility checker. (MedMath, a medical calculator, although included in Epocrates Rx Pro for Palm OS users, is not included in the Pocket PC version.)

Epocrates ID is one of the main differentiators (besides herbals, tables and guidelines), between the premium Epocrates drug and formulary reference (Epocrates Rx Pro) and the free version (Epocrates Rx-see below). The ID section allows users to search for infectious disease treatments by "system" (body), "bug" or "drug" and provides users with empiric and specific therapy. The tables and guidelines section provides a wealth of information ranging from ACLS and PALS protocols to Lipid Lowering Agents and Vaccination Schedules.

Epocrates Rx is a free, long-awaited drug and formulary reference that includes over 3,000 drug monographs (no herbals), MultiCheck drug interaction checker, and DocAlert messages. In the past, this product was only available to Palm OS users.

WM Smartphone users can download a free scaled down version of Epocrates at http://www.get.epocrates.com. While not as complete as the Essentials product, it certainly adds a great tool, and the price can't be beat! Check http://www.Epocrates.com for more information.

Mobile Merck Medicus from Merck (http://www.merckmedicus.com)

Mobile Merck Medicus is one of the newest entrants into the mobile healthcare world, and when it was introduced it instantly became one of my favorite mobile healthcare tools. The product includes medical journals, the complete Merck Manual, and the Pocket Guide to Diagnostic Tests, 4e, and all at no cost to the user. Not only is it free; it includes no advertising or marketing bias. It is supported by educational grants from Merck Pharmaceuticals. This suite of programs is customized for each individual physician user. This is an astounding software solution that keeps me up to date with my latest journals. It's also a great reference! No doc should have a Pocket PC without Mobile Merck Medicus on board.

Mobile Merck Medicus gives access to a wealth of medical information.

Up To Date (http://www.uptodate.com)

If Mobile Merck Medicus gives doctors the latest medical journals, and Skyscape provides them with the most current, up to date text reference information, then what's left? Up to Date! This subscription service allows practitioners to research and obtain the latest peer-reviewed information in a matter of minutes, rather than hours or days as with the typical Medline search. A panel of over 250 physicians review the content obtained from Up to Date quarterly, guaranteeing that the most accurate, current and complete information is available. This product is one of the few healthcare solutions that work on the Smartphone. It has not only become an invaluable tool in my daily practice, I can receive continuing medical education credits for using it!

Thomson Clinical Xpert from Thomson Healthcare (http://www.pdr.net)

This is the best free medical software on the market! Formerly known as Mobile PDR (Physicians Desk Reference), this product includes a PDR and many other options; it's another free software title for the Pocket PC (and Palm OS devices). I commend Thomson Healthcare for bringing the "gold standard" drug reference guide and much more to mobile devices.

Components of Thomson Clinical Expert include:

• Drugs: Search over 4,000 drug trade names.
• Interactions: Check up to 32 medications at one time.
• Toxicology: Screen 200 of the most common poisonings and drug overdoses.
• News and Alerts: Keep up to date with FDA announcements, clinical updates, upcoming drug launches.
• Laboratory test information: Identify and interpret details of over 500 laboratory tests.
• Disease database: Diagnose with the most current treatment information including evidence and recommendation ratings.
• Alternative medicine: Consult information on over 300 of the most popular herbals and dietary supplements.
• Medical Calculators: Convenient calculators cover dosing, conversions and much more.

Electronic health records/charge capture

Allscripts Healthcare Solutions (http://www.allscripts.com) offers an incredible Electronic Medical Record (EMR) and e-prescribing (TouchScript.NET) solution. (See my review at http://www.pocketpcmag.com/_.... ) TouchWorks, the developer of the program, has been a winner of many healthcare industry awards, including the Microsoft Healthcare User Group (MSHUG) annual award. They offer one of the most complete packages in the industry. They've maintained a first-class solution in the face of the "dot com" stock market collapse and the demise of nearly every other eRx company. AHS has been a true survivor and a consistent winner.

Other programs of not include PatientKeeper, NextGen, Cerner Mobile Millennium, StatCoder, MobileClinician, and eMD2. I would love to hear from other users implementing Windows Mobile EHR, eRX, and other software I have not mentioned. I encourage you to get the book The Guide to Handheld and Palmtop Computing Resources for Health Care Professionals from http://www.medicalsoftwarefo... for more information on these various programs.

Indispensable tools for OB-Gyns

AirStrip OB (http://www.airstripob.com) offers portable, real-time fetal heart/maternal contraction monitoring on your Pocket PC Phone Edition. It's available on Labor and Delivery units using GE Healthcare's central fetal monitoring stations. This is truly a state-of-the-art technology allowing obstetricians to use Windows Mobile devices to remotely monitor fetal heart tracings, maternal contraction patterns, and other critical, real-time data from labor and delivery units. See the article in this issue about this excellent product.

ObGynPocketPro from ObTechs (http://www.obtechcorp.com ) was developed by a full-time practicing Ob-Gyn. I have found it invaluable. It even works in landscape mode on my Windows Mobile 2003 Second Edition devices, indicating to me that ObTechs is keeping their software up to date.

Complete list of medical software for PDAs

The Guide to Handheld and Palmtop Computing Resources for Health Care Professionals is the most complete guide to medical software on PDAs that I have ever seen. The current version, published in 2000, is excellent, but in view of the massive emergence of WM Healthcare software, this well thought out reference is sorely in need of updating. The editor has promised that a completely revised, updated edition will be available in January or February of 2007. So, I highly recommend you periodically visit http://www.medicalsoftwarefo... to see if the update version is available, and then download it.

There will be two versions, one for Windows Mobile and the other for the Palm OS. The current copy is a 165-page book covering over 490 relevant resources for Palm OS, Windows Mobile, Psion 3/5, and Newton OS platforms. Explanatory notes accompany each product and screen shots have been included for a number of the applications. Together with an introduction to handheld/palmtop PCs in medicine, this guide is the most comprehensive available today! As complete as is this document, I anticipate that the next guide will be the true bible for medical software on Windows Mobile devices.

The current (and future version) is available as a download for $4.99. A printed version of the guide is also available. It may contain more information than you need, but it's certainly the best resource on the planet in this area! I strongly recommend you check out their Web site for more information.

Final thoughts

I never again want to hear from my colleagues, "There is no medical software available for Windows Mobile that compares with Palm software." At the rate new medical applications are being released for Window Mobile, I should get my wish. The future is bright for the healthcare vertical, and will continue to develop nicely as developers continue to create products to make medical practices and healthcare delivery safer for patients (and easier for doctors and caregivers). Medicine is getting "evolutionized," and Windows Mobile is providing the platform for this growth and improvement.

Web sites for Windows Mobile Healthcare

The Windows Mobile healthcare software market has been expanding rapidly over the past two years as device manufacturers shift from the Palm OS to Windows Mobile. For an overview of Microsoft's view of the current state of mobility in healthcare and its future, I recommend the Microsoft/Bill Crounse, M.D. interview

Unfortunately, there is no way I can cover all of the software, Web sites, and companies making PDA Medical Software, hardware and peripherals. In addition to those mentioned earlier, here are some other Windows Mobile healthcare sites:

• http://www.Avantgo.com offers medical journals and more.
• Evidence Based Medicine to Go http://www.ebm2go.com contains information delivered free to your PALM or Pocket PC handheld device.
• George Washington School of Medicine http://www.gwu.edu/library/r... has an excellent PDA resource listing.
• http://www.Handango.com is the best site on the web for ALL of your Windows Mobile software needs. Healthcare professionals can also purchase medical titles from major developers such as Skyscape.
• http://www.Handheldmed.com is an information source for physicians, residents, medical students, and healthcare professionals. It is devoted to clinical handheld computing news, reviews, and informatics in medicine and provides a forum specifically for users of the Palm OS and Windows Mobile platforms.
• http://www.Lexi.com
• http://www.Mdconsult.com offers journals (abstracts), medical news, and more. (I have not used this product.)
• http://www.Medicalpocketpc.c...
• http://www.Medspda.com is a comprehensive medical software catalog for the PDA.
• http://www.Patientkeeper.com provides free downloadable software that stores everything from names and medical record numbers, to problem lists and labs. Generate H&P's, SOAP notes, checkouts and additional utilities.
• http://www.Pdamd.com offers medical news, hardware, software reseller.
• http://www.Pepid.com
• http://www.UnboundMedicine.c... is the engine behind Mobile Merck Medicus.

http://www.Usbmis.com is a software solutions company that specializes in developing interactive, mobile applications for the healthcare industry.

Edward M. Zabrek, M.D., F.A.C.O.G., is our staff chief medical editor, and a full time, practicing Ob-Gyn at Memorial City-Memorial Hermann Hospital Systems in Houston, Texas, USA. He has an ambitious dream to "evolutionize" the practice of patient care with Windows Mobile devices. Formerly an independent consultant to Samsung Electronics’ Wireless division, he is always seeking ways to advance this dream. He can be reached via e-mail at MedicalEditor@PocketPCmag.com.