March 28, 2006
PDAs Reach the Tipping Point
iHealth Beat: Reporting the Internet's Impact on Health Care
By: Jane Sarasohn-Kahn
Persuasive surveys, new medical school mandates and growing payer support point to a ripening market for PDAs in health care.
In December 2005, Manhattan Research reported that 50% of U.S. physicians were using some flavor of handheld device in their practices. According to a new survey conducted at Brigham and Women's Hospital, nearly 40% of physicians use PDAs for at least half of their patient encounters. Another survey, recently released by Skyscape, confirms that those physicians using PDAs believe the devices are important to their practice of medicine.
PDAs Can Improve Care Quality
The Brigham and Women's study — which was sponsored by Epocrates and presented at the American Medical Informatics Association's 2005 Annual Symposium in Washington, D.C. — finds that more than 60% of physicians using a drug-reference tool reduced the likelihood of an adverse drug event at least three times per month. In a separate Epocrates study of a random sample of 3,400 Epocrates-using physicians, more than 95% of respondents reported that clinical PDA software helps them provide better quality of care and save time. Further, nearly 60% reported avoiding at least one adverse drug event or medical error each week.
In the Skyscape survey, which was conducted in November 2005 and queried 2,800 physicians, adoption of PDAs in health care settings were shown to reduce medical errors and increase clinician productivity.
Drug reference — including clinical and drug-interaction references — is the foremost PDA application used by physicians. In the Skyscape survey, 84% of those physicians using PDAs reported a decrease in potential medical errors, and 88% achieved increased efficiencies. Nearly three-quarters of physicians using a PDA said they could provide more care in less time. Overall, 70% of medical professionals in the Skyscape survey called their use of PDAs either "important" or "critical" to their practice.
Economic Case for PDAs
Reducing medical errors and improving patient safety are lofty goals in and of themselves. However, what is compelling to physicians is also improving productivity in the practice, which adds to physicians' bottom-line revenue.
Let's use one of Epocrates' findings from the Brigham and Women's study to calculate potential revenue savings generated by using a PDA for drug reference information alone. The study found that 35% of Epocrates physicians saved at least 30 minutes per day. Assuming the average physician generated $1.26 a minute (according to the MGMA's 2004 physician compensation survey), using a PDA for drug reference could produce about $10,000 a year saved for a single physician. Now, consider additional applications for the PDA and what they could generate in productivity savings (and thus income enhancement).
Epocrates' recent survey on Medicare Part D offers another factoid to consider: 70% of physicians surveyed believe accessing Medicare Part D formularies via Epocrates software will help them save at least an hour per week. These time savings would be in addition to the drug reference savings already calculated.
Get 'Em Young
Another force driving PDA adoption is medical schools. Twenty-eight percent of medical schools require students to have PDAs, according to the most recent survey by the Liaison Committee on Medical Education, the schools' accrediting organization. Recently, Brown University joined a growing number of medical and nursing schools that require students to use PDAs. Brown's neighbor, the University of Rhode Island College of Nursing, also began requiring PDAs in 2005 for a group of students. Most students use programs produced by Epocrates, which provides the Epocrates Rx program free of charge.
Changing Prescribing Behavior
The point-of-prescribing is a powerful moment in patient care. It is when prescribers can avoid medication mistakes, compare costs of bioequivalent drugs and reduce overprescribing medications such as antibiotics.
Last month's Journal of the American Medical Association featured an important article on the excessive use of antibiotics. The authors found that about half the antibiotic prescriptions written in doctors' offices are not necessary. Tools such as PDAs were found to reduce overprescription of antibiotics.
Researchers examined prescription of antibiotics in communities with a health education campaign warning against unnecessary antibiotics and where physicians received PDAs and paper-based tools that provide guidelines for use of antibiotics. The researchers compared these communities with other sample communities that received only the public education campaign or no intervention at all.
The only significant decrease in antibiotic use occurred in the communities where doctors had the tools. Further, the more doctors used these tools, the more the inappropriate use of the antibiotics declined.
The Best PDA Programs
In December 2005, Medical Economics, the popular magazine for physician practices, published an unscientific but informative survey of what an expert panel thought were the best applications available for health care PDAs. The panel sifted through hundreds of contenders to arrive at their best:
- Epocrates, Shots 2005 (an immunization-management program);
- Griffith's 5-Minute Clinical Consult (general medical reference);
- InfoRetriever (a search engine for evidence-based medicine);
- Sanford Guide to Antimicrobial Therapy (critical in the era of bioterrorism, avian flu and drug-resistant infections);
- PatientKeeper Clinical Results (for hospital rounds);
- MedCalc (a clinical results calculator);
- STAT Cholesterol (for cholesterol guidelines used at the point of care);
- STAT E&M Coder (used for family practice diagnostic and procedure coding); and
- TouchScript (for e-prescribing, currently accounting for half of the volume of e-prescriptions).
PDA as Entry to EHR
With a majority of U.S. physicians adopting PDAs in daily practice, the PDA might provide a migration channel toward EHR adoption. Epocrates found that more than 75% of physicians would be more likely to use an EHR system if it is coupled with Epocrates' clinical applications.
This realization motivated Epocrates to partner with several EHR vendors to enable interoperability between both platforms. So far, Epocrates' collaborators include Allscripts, DrFirst, InstantDx, MercuryMD, PatientKeeper and SOAPware.
Medicare, Health Plans to Promote PDAs
A growing number of health plans this year are offering incentives for PDA adoption, especially for e-prescribing. Many Blues plans, along with other large publicly traded health plans, will subsidize PDAs and applications to support pay-for-performance, e-prescribing and patient safety initiatives this year.
With Medicare Part D continuing to push e-prescribing adoption, 2006 is poised to see a steady stream of PDA use among physicians and other clinicians in practices large and small.
CONTACT: Erica Sniad Morgenstern Epocrates Public Relations PHONE: (650) 227-6907 E-MAIL: pr@epocrates.com WEB: www.epocrates.com