Lexi-Drugs6 is another popular handheld drug reference guide, which is known for having additional information, such as Canadian and international brand names, as well as pharmacokinetic and pharmacodynamic information. The Tarascon Pharmacopoeia,7 which many physicians used in medical school, is now available on the handheld platform. Many of these drug references provide a medical calculator to facilitate, for example, determination of body mass index, corrected QT interval, and absolute neutrophil count. However, numerous publishers also have created stand-alone medical calculators, such as Mediquations,8 for the iPhone and Android.
Medical references (eg, practice guidelines and textbooks) are readily available on multiple smartphones. If Internet access is available, either via WiFi or the cellular data network, users can access PsychiatryOnline.com9 on their device via the Web browser. PsychiatryOnline provides access to DSM-IV, APA practice guidelines, and numerous psychiatric textbooks and journals, as well as handouts for patients and their families. Access on the go is possible because the site detects the mobile browser and adjusts the graphics and layout to make it accessible for the smaller screen of the smartphone.
If access to wireless networks is a problem at times, then having medical references installed on the smartphone is a highly recommended strategy. Skyscape,10 an extremely popular medical information provider, licenses many popular titles from various publishers, including American Psychiatric Publishing Inc, Oxford University Press, and Lippincott Williams & Wilkins. This medical information platform distills texts into readable chunks, with excellent navigation and hyperlinks between different references. These titles are available on a subscription basis and can be viewed on practically all platforms, including the new Android and Palm Pre. If a particular title is not available on the Skyscape platform, it may be available at Unbound Medicine11 or Handango.12
Although there are numerous online sites for continuing medical education (CME) credits, many physicians overlook the smartphone as a mechanism to earn CME credits. Its obvious advantage is portability: CME tests can easily be completed, whether at the beach or at the airport. ReachMD13 provides medical news programs on Sirius-XM satellite radio and offers podcast downloading onto an MP3 player. It also produces CME audio vignettes in various 0.25 CME credit increments, with questions to be answered on the device. Epocrates also has mobile CME bundled with its drug reference product, and Medscape14 has created more traditional text-based CME with follow-up questions for the iPhone and BlackBerry smartphones.
One of the key features of the smartphone is its ability to browse the Internet for medical content available on many Web sites, such as PubMed.gov.15
Not all mobile Web browsers are created equal, however. The Apple iPhone and Palm Pre have excellent Web browsers that are quick with multitouch navigation; in comparison, the BlackBerry browser is slower and requires use of menu buttons to zoom. The one feature that sets the Palm Pre above its smartphone competitors is that its browser does have an Adobe Flash Player, which enables this device to access more Web pages with multimedia content. For example, the National ePrescribing Patient Safety Initiative Web site16 is compatible with the Apple iPhone Safari browser and Windows Mobile Internet Explorer mobile, but not with the BlackBerry browser or Palm OS browser. The one feature that sets the Palm Pre above its smartphone competitors is that the Palm Pre browser does have an Adobe Flash Player that enables this device to access more Web pages with multimedia content.
Although many EHR systems provide e-prescribing on both the computer and the smartphone, the National ePrescribing Patient Safety Initiative provides a free Web-based system for every physician in the United States. Many vendors including Microsoft, Google, Yahoo, Aetna, Dell, WellPoint, and Sprint have provided funding, while Allscripts and Surescripts provide the technology infrastructure. The goal is to reduce medication errors typically associated with paper-based prescriptions, such as transcription errors.
Once a doctor’s account is set up, patient information is entered into the system either manually or via a spreadsheet generated from practice management or billing systems. Information includes demographic details and the patient’s retail and/or mail-order pharmacies. After the patient’s information is input, the medication is selected with the appropriate instructions for its use. The system automatically checks the dosage and potential drug-drug interactions and also flags duplicate prescriptions. Once the prescription(s) is reviewed, it is sent electronically via the Internet to the pharmacy fax line. The system is able to manage restricted medications with purchase of the appropriate security prescribing paper for the state.
Key features of this system are that it provides formulary status as well as formulary alternatives and that it describes the patient’s coverage and copay. Reports can also be generated to determine the patient’s medication history. The physician’s prescribing habits can also be reviewed for practice-based learning and self-assessment, which is required to maintain American Board of Psychiatry and Neurology certification.17
The bottom line is that there is no excuse for not using e-prescribing if there is a computer in the office.