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Physician residents use personal digital assistants most for drug references and medical calculations

When caring for patients, physician residents are more likely to use personal digital assistant (PDA, handheld computer) drug reference and medical calculator programs, for example, to check medication dosages or interactions. Residents are less likely to use PDA clinical prediction rule or diagnostic programs, according to a new study.

Researchers at the University of Alabama at Birmingham tracked PDA use by 68 internal medicine residents at an urban teaching hospital. The PDAs used in the study contained a suite of clinical decision support (CDS) programs. These included three programs available on the Web: Epocrates RS (a drug database) and MedMath and MedCalc (medical calculators that aid calculation of formulas often used in the clinical setting). The other two programs included a proprietary diagnostic program, MedWarrior, and a locally developed CDS suite of clinical prediction rules (MedDecide).

Overall, 94 percent of the residents found the CDS programs clinically useful. They reported using an average of 3.14 and 3.94 CDS programs per typical clinic session and inpatient day, respectively. Residents installed a mean of 1.63 to 1.79 programs in addition to the 5 targeted CDS programs. Based on tracking data, the researchers found that 68 percent of residents used Epocrates Rx, and 39 percent used MedCalc, followed by MedMath (28 percent), MedWarrior (25 percent), and MedDecide (17 percent). In the ambulatory clinic, 64 percent of residents reported using Epocrates Rx and 70 percent reported using MedCalc. In the inpatient setting, 61 percent reported using Epocrates Rx and 58 percent reported using MedCalc.

Handheld computers that are not connected to an electronic health record, which require clinicians to choose to access the clinical decision support program rather than automated decision support tools, may not be the right delivery format for diagnostic and clinical prediction rule systems, suggest the researchers. The study was supported in part by the Agency for Healthcare Research and Quality (HS11820 and HS13852).

See "Patterns of use of handheld clinical decision support tools in the clinical setting," by Feliciano Yu, M.D., M.S.H.I., M.S.P.H., Thomas K. Houston, M.D., M.P.H., Midge N. Ray, R.N., M.S.N., and others, in the November/December 2007 Medical Decision Making 27, pp. 744-753.

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