hardware software and wetware how information technology will help you take better care of patients l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Hardware, software and wetware : how information technology will help you take better care of patients PowerPoint Presentation
Download Presentation
Hardware, software and wetware : how information technology will help you take better care of patients

Loading in 2 Seconds...

play fullscreen
1 / 63

Hardware, software and wetware : how information technology will help you take better care of patients - PowerPoint PPT Presentation


  • 250 Views
  • Uploaded on

Hardware, software and wetware : how information technology will help you take better care of patients. Mark H. Ebell MD, MS Associate Professor, University of Georgia Deputy Editor, American Family Physician

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Hardware, software and wetware : how information technology will help you take better care of patients' - cassia


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
hardware software and wetware how information technology will help you take better care of patients

Hardware, software and wetware: how information technology will help you take better care of patients

Mark H. Ebell MD, MS

Associate Professor, University of Georgia

Deputy Editor, American Family Physician

Editor in Chief, Essential Evidence, and co-founder, InfoPOEMs, John Wiley & Sons

slide3
120
  • Median number of patients seen per week by a family physician
slide4
15
  • Median minutes per patient encounter
slide5
8
  • Average number of decisions made per encounter by a family physician
slide6
3
  • Average number of clinical problems addressed per encounter with a family physician
slide7
Primary care is hard: 120 patients, 360 problems, and 960 decisions per week
  • Primary care is important
  • Primary care is undervalued

Is information technology

part of the solution?

not surprisingly we have a lot of questions
Not surprisingly, we have a lot of questions!
  • Adults learn by solving problems
  • Our “problems” are our point-of-care clinical questions
  • Research:
    • 10-15 clinical questions per day
    • Answer less than half (easy or urgent)
    • When answered, non-pursued questions would have changed patient care ½ the time
  • So: questions are common, central to learning, and important for patient care
attitude
Attitude
  • Value your questions
  • Question authority
  • Ask and answer at least one hard, non-urgent question per week with the best available evidence
questions study
Questions Study
  • Funded by Physician’s Institute for Excellence in Medicine in Georgia
  • We want to learn what questions you have, so we can design:
    • Better educational programs
    • Better search software
    • Better journals and references
  • Please send us your questions!
  • See packet…
wetware
Wetware

Information Overload

  • 20,000+ articles /yr in 100 top clinical journals
  • 30-60 min/week to keep up with literature

Solution: focus on only the most useful information

wetware13
Wetware

Most useful information (Shaughnessy and Slawson)

  • Highly relevant
  • Highly valid
  • Low work

Usefulness = Relevance x Validity

Work

wetware14
Wetware

High validity

  • Do it yourself or rely on others?
  • Look for:
    • Independent: no pharma support
    • Critical assessment of study quality: not just author’s abstract
    • Recommendations labeled with strength of evidence: transparency
wetware15
Wetware

High relevance

  • Common or important problem in your practice
  • Improved patient oriented outcomes
  • Would change your practice

Patient Oriented Evidence that Matters

wetware16
Wetware

Reduced work

  • Regular literature surveillance
  • Structured critical appraisals
  • Easy access with push (email, newsletter) and pull (Web, PDA) service
  • Interactive tools (not just static text)
wetware17
Wetware

Two sources needed

  • Push source: updating service providing most relevant, valid new information
  • Pull source: answer questions at point of care with best available evidence
wetware18
Wetware

Your current push sources

  • Drug reps
  • Colleagues
  • Journals and medical newspapers
  • Independent newsletters
  • Evidence-based updates via email

Usefulness = Relevance x Validity

Work

wetware19
Wetware

Your current pull sources

  • Colleagues
  • Journals
  • Books (average = 10 years old)
  • General medical Web sites
  • Expert-based medical references
  • Evidence-based independent medical sites

Usefulness = Relevance x Validity

Work

wetware20
Wetware

Criteria for evaluating new information source

  • Relevance: clear focus on patient oriented outcomes?
  • Work: tools, calculators, summaries, bullets, algorithms, tables?
  • Validity: truly independent, with transparent rating of evidence strength?

Usefulness = Relevance x Validity

Work

smartphones operating systems os
Smartphones: Operating Systems (OS)
  • OS is as important as who makes phone
  • Can be confusing: Palm phone running Windows Mobile OS!
  • Common smartphone operating systems;
    • iPhone
    • Google “Android”
    • Windows Mobile
    • Blackberry
    • Palm WebOS
smartphones what to look for
Smartphones: What to Look For

Cost

  • $50- $200 is typical for device
  • Monthly cost for data access: $30-$50

Network Access

  • 3G versus 2G (versus 4G?)
  • Quality of coverage in your area

Other

  • Keyboard on screen or physical?
  • Extent of medical software available?
windows mobile 6 1
Windows Mobile 6.1
  • Extensive range of medical software
  • Many networks
  • Various keyboard options
  • Clunky OS
  • Open software library
palm webos
Palm WebOS
  • Several models, cost varies ($49 to $300)
  • Extensive range of medical software
  • Physical portrait style keyboard
  • Almost no medical software
blackberry
Blackberry
  • Several models, cost varies ($100-$300)
  • Limited medical software
  • Many networks
  • Physical portrait keyboard or on-screen (Storm)
iphone
iPhone
  • $199
  • Good medical software library
  • Single network (AT&T) but likely to change soon
  • On-screen keyboard only
  • 8 – 16 gb memory with best music, video, podcast player
google phone t mobile g1
Google Phone:T-Mobile G1
  • Verizon (Motorola Droid, above) and T-Mobile (HTC Hero, below)
  • Limited medical software
  • Fewer apps overall (10,000 vs 75,000 for iPhone)
  • Rapidly increasing apps and market share
netbooks
Netbooks
  • Brands: Asus, HP, Dell
  • Compact (1.5-3 lbs)
  • Cheap: $300 - $500
  • Durable
  • Look for those with 8-10 hour battery life
3 steps to becoming a point of care ebm expert
3 Steps To Becoming a Point of Care EBM Expert
  • Use secondary sources first
  • Optimize Medline searches
  • Load up your smartphone
1 use secondary sources first
1. Use secondary sources first
  • Find and use a push tool, i.e.:
    • Journal Watch
    • ACP Journal Club
    • InfoPOEMs
    • American Family Physician “Tips”
    • BMJ EvidenceUpdates
  • Is your source:
    • Independent of industry support?
    • Evidence-based, with evidence rated?
    • How is relevance evaluated? POEMs?
1 think secondary first
1. Think secondary first
  • Find and use a pull tool, i.e:
    • ACP PIER: pier.acponline.org
    • Clinical Evidence: www.clinicalevidence.com
    • Cochrane Library: www.cochrane.org
    • DynaMed: www.dynamicmedical.com
    • Essential Evidence: www.essentialevidence.com
  • Is your source:
    • Evidence-based, with evidence rated?
    • Include interactive decision support tools?
    • Available on smartphone as well as Web?
translating research into practice trip
Translating Research Into Practice (TRIP)
  • From the United Kingdom
  • Searches dozens of evidence-based sites from around the world at once
  • Freely available
  • www.tripdatabase.com
bandolier
Bandolier
  • Monthly online and print journal of evidence-based healthcare
  • Witty, thoughtful essays
  • Provides non-US perspective
  • http://www.medicine.ox.ac.uk/bandolier/
national guidelines clearinghouse
National Guidelines Clearinghouse
  • Any group can submit guidelines, which are presented in a consistent format
  • Does not require that guidelines be evidence-based (can be consensus or other methodology)
  • http://www.guidelines.gov
dynamed
Dynamed
  • Online and PDA evidence-based reference
  • By subscription only
  • Organized by disease/symptom topic
  • http://www.ebscohost.com/dynamed/
clinical evidence
Clinical Evidence
  • From the British Medical Association
  • Evidence-based summaries of the evidence for common clinical topics
  • Free to most US physicians through United Healthcare Foundation
  • www.clinicalevidence.com
american college of physicians physicians information and education resource pier
American College of Physicians Physicians Information and Education Resource (PIER+)
  • Evidence-based online textbook that addresses over 300 common topics
  • Freely available to members of the ACP
  • Available by subscription to others
  • http://pier.acponline.org
essential evidence43
Essential Evidence
  • 700 Essential Evidence clinical topics
  • 3500 POEMs
  • 3000+ Cochrane reviews
  • 300+ decision support tools
  • 3000+ diagnostic calculators
  • Evidence-based guidelines from NGC
  • Disclosure – I am the editor-in-chief
essential evidence demo
Essential Evidence demo
  • www.essentialevidence.com
2 optimize medline searches
2. Optimize Medline searches
  • Learn to use PubMed’s “Clinical Queries” feature
  • Gradually narrow your search
  • When you find a useful article, select “Related articles”
3 load up your smartphone
3. Load up your smartphone
  • Prescribing:
    • ePocrates, Lexicomp, Tarascon Pharmacopeia, Theradoc
  • Decision support and calculators:
    • AHRQ EPS, Essential Evidence, Archimedes, MedRules, MediMath
  • Complete references:
    • DynaMed, Essential Evidence, UpToDate, PubMed on Tap, Best Evidence
epocrates
ePocrates
  • Widely used drug reference for Palm, Blackberry, iPhone, and Pocket PC
antibiotic guides theradoc
Guide for selecting best antibiotic

Free and easy to use

http://www. theradoc.com/downloads/

Antibiotic Guides: Theradoc
pubmed on tap
PubMed on Tap
  • Palm, Pocket PC, or iPhone versions
  • Palm and PocketPC versions include “Clinical Queries”, “Related Articles”, and “Limits” features
ahrq epss
AHRQ ePSS
  • Select a patient’s basic risk factors, then view recommendations by strength of evidence (A, B, C, D or I)
medical calculators general
Medical Calculators - General
  • Archimedes (www.skyscape.com)
  • MediMath (www.medimath.com)
  • Essential Evidence (www.essential evidence.com)
iphone medical apps
iPhone Medical Apps
  • Several thousand
  • Lots of junk or information aimed at patients
  • Some good ones:
    • HemeCalc, GI Calc, Cardio Calc,
    • Medical Calc
    • AHRQ ePSS
    • ePocrates
getting the word out with podcasts
Getting the word out with podcasts

What is a podcast?

  • Think of it as a radio show that you subscribe to; audio goes from your computer to your iPod or MP3 player

What can you podcast?

  • Lectures and CME
  • Case discussions
  • Critically appraised topics and POEMs
finding and listening to podcasts
Finding and listening to podcasts
  • Download and install iTunes (www.apple.com/itunes)
  • To to iTunes Store
  • Select “Podcasts” and then “Science and medicine” or “Health”
  • Subscribe to one or more podcasts
  • Sync your iPod or iPhone
examples of medical podcasts
Examples of medical podcasts
  • InfoPOEMs – Mark Ebell and Mike Wilkes, weekly discussion of a “POEM”
  • New England Journal of Medicine
  • This Week in Cardiology
  • A Gobbet o’ Pus: Persiflagers ID Podcast
questions study62
Questions Study
  • Funded by Physician’s Institute for Excellence in Medicine in Georgia
  • We want to learn what questions you have, so we can design:
    • Better educational programs
    • Better search software
    • Better journals and references
  • Please send us your questions!
  • See packet…
thank you questions
Thank you! Questions?

http://www.fmdrl.org ebell@uga.edu