You are in: eMedicine Specialties > Dermatology > TECHNOLOGY AND DERMATOLOGY Handheld Computers in DermatologyArticle Last Updated: Mar 27, 2008AUTHOR AND EDITOR INFORMATIONSection 1 of 10
  Author: Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice Noah S Scheinfeld is a member of the following medical societies: American Academy of Dermatology Coauthor(s): Orin M Goldblum, MD, Consulting Staff, Department of Medicine, Division of Dermatology, University of Pittsburgh Medical Center South Side Editors: Harold S Rabinovitz, MD, Clinical Professor, Department of Dermatology, University of Miami School of Medicine; David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic; Amanda Oakley, MBChB, FRACP, Clinical Director, Clinical Associate Professor, Department of Dermatology, Waikato Hospital, Hamilton, New Zealand; Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center Author and Editor Disclosure Synonyms and related keywords: personal digital assistant, personal digital organizer, handheld, Palm, Palmtop, PDA, Palm pilot INTRODUCTIONSection 2 of 10
  The use of computer technology has grown in the United States in general and in medicine and dermatology in particular. Tens of millions of personal computers were sold in the 1990s. In Germany, one survey found that 96% of dermatologists who responded used a computer in their private practice. Computers are widely used in hospitals as well as in dermatologic outpatient clinics and private offices, mostly for scheduling and billing. The personal digital assistant (PDA) (also called the personal digital organizer) is a type of computer technology whose use has expanded vastly in the last decade. From its humble beginnings with Apple's Newton, PDA use has exploded with the development of devices by Palm using the Palm operating system (OS). Later, the Palm OS was adopted by Handspring and Sony. Microsoft developed its PocketPC computer software and other Windows CE handheld OSs, and these were deployed on a variety of devices. Another group of PDAs has used the Symbian OS. It is used by devices such as the Nokia Smartphone 9210 and Epoc PDAs in the Psion series. Epoc PDAs are more popular in Europe than in the United States. Some PDAs run a version of Linux, but Linux PDAs are not widely used. PDAs can fit into existing information technology systems. PDAs can share data with desktop systems (syncing) and act as organizers, data platforms, and data gathering aids. Compared to desktop or notebook computers, PDAs are light (usually 8 oz or less), they have long battery lives, and they are mobile. Unlike Windows-based computers, they can be turned on and off without booting up. The small size of PDAs and even small laptops has limited their ultimate exceptance. The small size of PDAs and even small laptops has limited their ultimate acceptance. An example of this is eBooks available for PDAs and laptops. Students perceived eBooks as an effective way to distribute course content and as a study tool, preferring paper to eBooks to take notes during lectures.1 HarrisInteractive's Computing in the Physician's Practice Health Care News, August 15, 2001 stated that 15% of physicians in 1999 used PDAs. In 2001, 26% of physicians used PDAs. Specifically, among physicians younger than 45 years, use was 33%; among physicians older than 45 years, use was 21%. Of hospital-based physicians, 33% used PDAs, and, of office-based physicians, 23% used PDAs. By 2005, an estimated 50% of physicians will use PDAs. As of the middle of 2002, the following medical schools required the use of PDAs: Wake Forest, University of Southern Florida, University of South Dakota, Harvard, East Carolina University, and University of North Carolina at Chapel Hill. In 2005, the author2 explored the use of PDAs to compile a multimedia electronic medical record for dermatology medical records. GENERAL USES OF PDAS IN DERMATOLOGYSection 3 of 10
Medical references
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PDA and computer-based systems used for prescribing medication can substantially reduce medication errors. According to a study by the Institute for Safe Medication Practices, the use of computers or handheld devices to prescribe pharmaceuticals reduced all medication errors by 55%. POPULAR APPLICATIONSSection 4 of 10
ePocrates is the most popular PDA medical application. ePocrates Rx was one of the earliest drug reference resources available in a dedicated handheld format. Originally released in October 1999, this software currently has more than 250,000 physician subscribers. This free electronic pharmacopeia (through ePocrates) lists drug dosages, indications, warnings, alerts, and other information. The cost of maintaining the software is defrayed by the sale of aggregated prescribing information to drug manufacturers and marketing firms. Generally, ePocrates has not included all dermatologic medications and materials. Specifically, ePocrates Rx includes information on more than 2,700 prescription and nonprescription medications. The database may be searched and displayed alphabetically or by drug class. Content for each entry includes dosing, contraindications/cautions, drug interactions, adverse reactions, cost/packaging, and other categories. Pop-up lists show these sections. Personal notes may be added to each drug entry (and are beamable to other handheld devices). Users may further customize the program by defining favorite categories (upper right drop-down on main page) or assigning drugs in a manner a user wants. ePocrates is available for the PocketPC and in both basic (free) and ePocrates Rx Pro versions. ePocrates Rx Pro forms a suite of applications, including the core drug database, a compendium of alternative medicine monographs, ePocrates ID (infectious disease recommendations), and a medical calculator. It costs $69.99. As reported by Fox et al4 in 2005, the latest offering of ePocrates is ePocrates Essentials, which adds sections on diagnoses and laboratory values to ePocrates Pro. It is a valuable tool, especially for medical trainees and allied health professionals. A program that has great utility in dermatology is the Pocketbook of Drug Eruptions for Palm OS by Jerry Litt, MD. It contains a large amount of specific dermatologic information. It can be obtained through The Parthenon Publishing Group or through CRC Press. The program is an encyclopedia of dermatologic adverse drug reactions. It is based on desktop and paper versions of the same data. It has more than 3,000 adverse cutaneous drug reactions for almost 800 medications, dietary supplements, and others. The database can be searched by a drug's trade name or generic name. The 2003 version of DermRx issued by the American Academy of Dermatology (AAD) includes a dermatologic drug database (Derm DRUGS/Rx Therapy). Another useful program has been developed by Timothy Dergerat UCSF. Called eDerm, it is an algorithm that can be downloaded to a PDA. It has a tutorial to help understand dermatology terminology. It allows the user to answer a series of questions while examining a suspicious lesion and includes a differential diagnosis and an appropriate management strategy. A new product in development is Dermland, which will be an encyclopedia of dermatology for Palm PDAs. The components of chapters of Dermland include, but are not limited to, (1) a dermatologic differential diagnosis guide and memory study aids (mnemonics); (2) educationally- and board-relevant teaching points in clinical and basic science, dermatology, and its subdisciplines, including dermatologic surgery, dermatopathology, dermatoepidemiology, and dermatopharmacology/therapeutics, presented in a concise, searchable format; and (3) standard approaches to clinical and inpatient workups. The content is peer-reviewed prior to publication and is dynamically updated in a manner that is transparent to the end-user. A number of prominent academic dermatologists have already agreed to serve as editors of various sections of the site, such as Dr. R. Brodell, Dr. C. Zachary, Dr. R. Pollack, and Dr. C. McCall. It is still under development to fill out its content. Thus far, it has not reached its potential Clinical Dermatology 2004 by Carl Weber, MD, which costs about $10.00, is available for Palm OS (minimum OS version 3.0) and has a download size of 443 KB. It requires iSilo to be fully loaded as a reader program. This program contains information on management, drugs, dosages, and evidence-based medical pearls related to dermatology, and it includes references. It has been edited by a board-certified dermatologist. A free 79-KB demonstration version is available. It has the table of contents and links to various topics. The full version is 287 KB. The following topics are included:
Checklist in Dermatology is available from PocketMedicine for Palm OS, Pocket PC, and Windows CE. This program presents differential diagnoses of more than 95 of the most common and important cutaneous diseases in a convenient, easy-to-use, checklist format. Laboratory workup recommendations and a step-wise outline of the treatment options are also included. This is an invaluable program for all health care providers who care for patients with skin diseases.
Diagnostic Criteria in Dermatology 9.0.6 is another new application to aid in diagnosis. The authors are Benjamin Barankin, MD, FRCPC, and Derm Notes: Dermatology Clinical Pocket Guide 9.0.5 is another new application. It costs $29.95. The operating system is Windows Mobile PocketPC/Windows Mobile Smartphone, and the file size is 7.90 MB, which can be downloaded as quickly as 1 minute, 24 seconds, depending on connection speed. It was last updated January 27, 2007. Key features of Derm Notes are as follows:
The Pocket Advisor series by Skyscape is designed to assist dermatologists from the initial workup through ongoing management of treatment. The information is written by leading authorities and is organized in a user-friendly format specially designed for mobile devices. It uses SmartLink software with has cross-linking capability with which the user can access any related disease and diagnostic topics within a mobile reference library. Additionally, the Table Viewer feature helps the user view tables easily by rows and columns on the small screens of mobile devices. Two products include Dermatology Diagnosis & Treatment and Checklist in Dermatology.
DATABASES AND BILLINGSection 5 of 10
For Palm OS, HanDBase database software made by DDH Software is among the most popular software popular programs. DDH Software also makes a program called HanDBase Forms 3.0, which can be used to design forms that can be used to assemble data for its database program. Hundreds of databases are readily available free from HanDBase. A number of other database programs exist and include Pendragon Forms, dbNow, MobileDB, and thinkDB, among others. One of the most popular programs for dermatologists who use Palm PDAs is DermPilot (Inga Ellzey Practice Group; Casselberry, Fla). DermPilot is a dermatologic coding data and fee determination program for Palm OS PDAs. It uses a HanDBase shell and includes lists of International Classification of Diseases (ICD-9) codes that can be alphabetized or put in numerical order. It also has current procedural terminology (CPT) codes and guidelines; J-codes (ie, medication reimbursement codes); locality information; modifiers; V-codes (the V-code section addresses those occasions when circumstances other than a disease or an injury classifiable to the main part of the ICD are recorded as diagnoses or problems); and a locality database, containing geographic conversion factors used to calculate Medicare fees. Using a stylus, information can be accessed by tapping up and down arrows. Information can be added to the database. Some have found this program to run slowly on older Palm OS devices. DermPilot is available through Wind Wireless. DOCUMENTS AND DOCUMENT READERSSection 6 of 10
Books can be read on PDAs. Such books are referred to as e-books. To read e-books, a software document reading program must be loaded onto the PDA. This section surveys some of the document reader programs and e-books on dermatology that are available for PDAs. Document reader programs include iSilo, DOC, CSpotRun, and Palm Reader. They compress documents and medical texts—even large reference works—for storage on PDAs. Palm Reader is also available for PocketPC. For Pocket PC, Microsoft provides a PocketPC reader. Adobe makes a portable document format (PDF) reader for Palm, PocketPC, and Symbian OS PDAs. A program called Handheldmed Reader (also free for download) can link with such programs as Patient Tracker. The Handheldmed Reader is used to open and view a series of medical books in the PocketClinician Library. Titles in this library include Physician's Drug Handbook; 5 Minute Infectious Diseases Consult; 5 Minute Emergency Medicine Consult; 5 Minute Clinical Consult 2002; Taber's Cyclopedic Medical Dictionary, 19th edition; The Merck Manual of Geriatrics, Third Edition; A to Z Drug Facts from Facts and Comparisons; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR); Davis' Guide to IV Medications, 3rd edition; 5 Minute Pediatric Consult; Red Book 2000; a variety of medical Survival Guides and Clinical Pearls; Medicine for the Outdoors; and American Psychiatric Association Practice Guidelines. Journal abstracts can be downloaded to a PDA during syncing. Applications that allow this include JournaltoGO (Healthtech Solutions; St. Louis, Mo) and AvantGo (AvantGo; Hayward, Calif). AvantGo, in particular, allows for connection to other wireless web devices. For example, an application called Blazer (Handspring; Mountain View, Calif) can work with a Palm OS browser to help display abstracts from MEDLINE. Unbound Medicine has developed CogniQ, which is an interface that allows MEDLINE journals, such as the Archives of Dermatology and the Journal of the American Academy of Dermatology (JAAD), and other publications, such as Clinical Evidence, to be displayed. A free 6-month subscription is available through the British Medical Journal (BMJ). It can be obtained through Unbound Medicine. Several e-books on dermatology are available for PDAs. eMedicine from WebMD PDA e-book is a comprehensive e-text book whose articles are written by many dermatologists. It can also be viewed as a web-based text through eMedicine. To be viewed as an e-book, it has been converted into a graphic-free, compressed format, which is viewable with Mobipocket Reader (Mobipocket; Paris, France), a free reader that works for Palm OS and PocketPC OS. Topics in the text are linked by hyperlinks. The sections and file sizes are listed below. Book section file size
One can tap between subjects, and because so much data are available, downloading the whole book is not necessary; specific articles can be downloaded. Clinical Dermatology-PC 2.7, which is a shareware program, costs $9.99; it has detailed workup and treatment plans, medications, and differentials for a myriad of medical conditions. Topics include dermatitides, psychocutaneous disorders, psoriasis, tinea, scabies, lice, seborrheic dermatitis, onychomycosis, skin cancers, hyperhidrosis, pigmentary problems, UV-light problems, blistering disorders, and alopecia. The text also provides illustrations. The program was edited by a board-certified dermatologist. It works on PocketPC and requires MobiReader. Derm Rx, from the American Academy of Dermatology, is available for Palm OS PDAs. It is adapted from the Derminfodisk CD-ROM that the AAD sells. It has information relating to about 1,000 diseases and provides treatment information and ratings. It has browse and search modes. The 2003 version has a dermatology drug database. The AAD also publishes Guidelines of Care for the following topics that are available on Palm and PocketPC OSs: acne vulgaris; actinic keratoses; alopecia areata; androgenetic alopecia; atopic dermatitis; basal cell carcinoma; chemical peeling; complex closures, flaps, and grafts; contact dermatitis; cryosurgery; cutaneous adverse drug reactions; cutaneous lupus erythematosus; cutaneous squamous cell carcinoma; dermabrasion; dermatologic conditions in patients infected with human immunodeficiency virus (HIV); dermatologic drug formulary; dermatomyositis; hemangiomas of infancy; laser surgery; neurofibromatosis type 1; and recommendations for credentialing and privileging. Another e-book is a version of Lebwohl's Treatment of Skin Diseases (Mosby). It is available through 2 sources, Elsevier or Treatment of Skin Disease for Palm or PocketPC OSs. It has data on more than 200 diseases and a medication index. It lists important disease data, management strategies, specific investigations, and therapeutic data. It also has color images. General medical texts that are available for handhelds include the Merck Manual, Harrison's Principles of Internal Medicine, 5 Minute Consults, Physician's Desk Reference, and Davis Drug Guides. Specialty medical calculators that calculate medical formulas are available and include MedCalc (freeware medical calculator sorted by category); it contains more than 60 formulas, PregCalc, and MedMath. Other programs that exist for dermatology include ABCDoscopy written by William Pekruhn, MD (no Web site available, contact wppekthun@geisinger.edu); Dermpath companion written by Matthew G. Fleming, MD (no Web site available, contact mgf@mcw.edu); Laser Automated Reporting System (LARS), which was available from www.lightinnovations.com, is not currently available on the Internet; and Mohs Automated Reporting System (MARS), which was available at www.paracelussoftware.com, is not currently available on the Internet. Dermdex, a company that provides dermatology practice Web sites and information, has a set of information that relates the differential of hyperpigmentation and an overview of melasma, and in the future, the company has promised that it can be loaded onto the Palm OS PDA. For unknown reasons, Dermdex is currently unavailable on the Internet. ELECTRONIC MEDICAL RECORDS AND PRESCRIBINGSection 7 of 10
A variety of programs are available for assembling EMRs on PDAs. They include PocketChart, PocketMD, HanDBase, PatientKeeper, Patient Tracker, and WardWatch. None is specifically designed for dermatology. As an example, Patient Tracker allows a user to compile patient lists. These lists are searchable and sortable. The user accesses basic program features from the main screen. Tapping icons in the upper left of the display (screen-bottom toolbar on Pocket PC) allows the user to perform the following functions (from left to right): add laboratory results, add a new patient, record medications on a selected patient, record clinical data (vital signs, intakes and outputs, weights), and input study results. The user can also prepare SOAP (4 part notes that contain subjective, objective, assess, and plan sections) notes and connect them to the program. Programs that prepare prescriptions by using PDAs include iScribe, ePhysician, and AllScripts Touchworks. Computerized order entry, especially involving prescriptions, has repeatedly been shown to reduce prescription errors.5, 6 MISCELLANEOUS APPLICATIONSSection 8 of 10
A variety of programs are available to facilitate security of PDAs, to use PDAs to facilitate scheduling, and for a variety of other purposes. A few examples are given. PDASecure is an easily configured, flexible security application for Palm and Pocket PC handheld computers. DateBk5 is a full-featured calendar program for Palm OS handheld devices. DiagnosisPro 5.0 performs differential diagnosis by using signs, symptoms, laboratory reports, x-ray findings, and other related tests and disease attributes. RESOURCESSection 9 of 10
Individual company Web sites, such as Microsoft, Casio, Palm, and Handspring, have a wealth of data relating to PDAs. Generalized sites are available and offer many different types of software for handhelds. Some, such as www.pdaMD.com,7 also have discussion groups where visitors share information and experiences. Other important sources include Handango and PDAbuzz. REFERENCESSection 10 of 10
Handheld Computers in Dermatology excerpt Article Last Updated: Mar 27, 2008 |
