The Most Relevant PDA Software for Osteopathic Family Physicians

By Daniel Clearfield, DO, MS

The amount of medical software available to use with personal digital assistants (PDAs) is available at a staggering level. Despite the plethora of PDA software options, many physicians do not use their PDA for much beyond its most basic functions.

To help assist colleagues progress beyond using PDAs as a paperweight, 10 software PDA resources most relevant to practicing osteopathic family physician have been defined and summarized.

1. Epocrates Rx
Where: epocrates.com
Price: Free (Upgrade options are available for a cost)
Works with: Palm, Windows Mobile, BlackBerry, Epocrates Online, iPhone/iTouch
Users can look up more than 3,300 drugs for continually updated information on dosage, side effects, and pricing, plus the software highlights drug interactions and compliance with health plan formularies. In 2006, Epocrates beefed up the program's safety features by prominently displaying FDA "black box" warnings about medications that pose a significant risk of serious or life-threatening adverse effects.

Epocrates also has a number of services available for a reasonable price. Epocrates Rx Pro offers all of the services of the free Epocrates Rx, but it additionally includes information on many herbal and alternative medications (which can be cross-referenced in the drug-interaction tool), Epocrates ID (infectious disease), as well as the Epocrates Tables application (including tables on ACLS/PALS, toxicology, treatment recommendation guidelines for multiple common chronic diseases, and much more).

Epocrates Sx is a differential diagnosis tool that can help users build a DDx based on signs and symptoms, lab values, gender, age, and duration of illness.

Epocrates Dx is equivalent to the infamous Griffith’s 5 Minute Clinical Consult 2008. For the more than 1,200 diseases osteopathic family physicians will encounter, Epocrates Dx allows one to gather basic and epidemiological data, signs and symptoms, causes, diagnostic modalities, treatments available, recommended medications (which links directly back to Epocrates Rx or Epocrates Rx Pro), and ICD-9 coding.

Epocrates Lab is a resource for looking up descriptions of practically every lab an osteopathic family physician might need to order, including information such as:

Epocrates Coder contains more than 20,000 ICD-9 and CPT codes, as well as E&M codes. There are three different options of searching for the desired code and there is a favorites function to store selected codes. Coding is extremely fast and efficient with this handy option.

Epocrates Dictionary contains more than 100,000 medical definitions as well as their synonyms. It is a fast and easy resource to use.
Epocrates Essentials combines several resources into one interlinked software package:

Epocrates Essentials Deluxe packages together all of the above items in addition to Epocrates Coder and Epocrates Dictionary.

On July 11, 2008, Epocrates Rx, the free mobile drug reference, was released for iPhone and iPod Touch. Reviews are starting to come in and the consensus is Epocrates Rx for the iPhone was worth the wait. The freestanding application in Apple’s newly released App Store is polished, takes full advantage of the iPhone’s interface, and has features not found in any other version.

2. Diagnosaurus
Location: books.mcgraw-hill.com/medical/diagnosaurus/index.html
Price: Free
Works with: Palm OS, Pocket PC, Blackberry
Diagnosaurus provides differential diagnoses (DDx) of symptoms, signs, and diseases. By using the pull down menu, physicians can choose to view entries by organ system, or select to view the list of symptoms only, the list of diseases only, or all of the entries. For example, to review the causes of a patient's chief complaint simply select the symptom or sign from the alphabetical listing. If the physician has made a diagnosis and wonders what other disorders to consider, select the diagnosis from the list to see its DDx.

3. Eponyms
Location: eponyms.net
Price: Free
Works with: Palm, Windows Mobile, Pocket-PC
Practically every sign, symptom, or test that has an acronym/eponym that can easily be found on this program. Users can also use the “search” function to find an eponym by its diagnostic name (i.e.: search “thrombo” to find Buerger’s disease, aka thromboangiitis obliterans).

4. iSilo Programs
Location: isilo.com
Price: iSilo costs $19.99
Works with: Palm OS, Pocket PC, Windows Mobile, BlackBerry, Windows computers
iSilo is a highly versatile document reader. Users can find thousands of ready-made documents downloadable immediately for reading with iSilo or in documents created by the user from HTML content using iSiloX.

5. Medcalc
Location: med-ia.ch/medcalc/
Price: Free
Works with: Palm OS, Windows Mobile, Pocket PC
Medcalc is designed for rapid calculation of common medical formulas and scores used in anesthesiology, family practice, pediatrics, emergency medicine, intensive care, and internal medicine. It is free and easy to use. It has more than 80 formulas that are sorted by categories. Units are available in either S.I. or local units (defaults can be set for each item). Most formulas come with bibliographic references and clinical tips. Results can be saved for later retrieval on the Palm OS operating system only.

6. MedRules
Location: pbrain.hypermart.net/medrules.html
Price: Free
Works with: Palm OS
MedRules includes 40 evidence-based calculators and scoring systems used to provide management direction or estimate disease likelihood, prognosis, and mortality. Individual rules are tap-selected from the alphabetized main menu screen or the upper-right system/specialty-specific drop-down box. Patient characteristics are easily entered via check box or drop-down selection. A lower-right "Calc" button shows scoring results and clinical implications. Note, that MedRules is essentially a stagnant program. The content has not been updated in more than four years, due to constraints of time and interest. It continues to be made available by popular demand, but please use it with the understanding that the algorithms may become outdated over time.

7. Medical Mnemonics
Location: medicalmnemonics.com
Price: Free
Works with: Web, Palm OS, PDF, AvantGo, WAP
Medical Mnemonics is a free, non-profit, online searchable database of medical mnemonics to help remember the important details. This program is very useful, as it has many good mnemonics for clinical use. Physicians can post their own mnemonics on their website to be included in the ever-growing database. This is another handy tool to have on a PDA.

8. Mobile Merck Medicus
Location: merckmedicus.com
Price: Free
Works with: Palm OS, Windows Mobile
When Mobile Merck Medicus was introduced, it instantly became a favorite mobile healthcare tool. The product includes medical news updates and journal abstracts such as Harrison’s Practice (the equivalent to “pocket” or “baby” Harrison’s), the complete Merck Manual, and the Pocket Guide to Diagnostic Tests. Harrison’s Practice also contains ICD-9 codes and a drug monograph. Physicians unable to locate a drug using Epocrates’ software, will likely find it through this drug monograph. Also included are many of the OTC drugs that are not found on Epocrates’ software.

The Pocket Guide to Diagnostic Tests includes explanations and interpretations of labs as well as imaging studies. The average cost of these services is also included, which can be of great assistance in clinical decision-making. The programs are customizable for each individual physician user. This is an astounding software solution that keeps users up to date and well informed.

9. Shots 2008
Location: immunizationed.org
Price: Free
Works with: Palm OS, Pocket PC
This site provides both online as well as PDA versions of the CDC’s recommended vaccination schedules. A new version is available free every year (you can delete the old version or keep it along with the new one).

10. MeisterMed
Location: meistermed.com
Price: Free
Works with: Palm OS, Pocket PC, Windows Mobile, Blackberry, Windows computers (iSilo must be installed for these programs to run (see item 4 on this list))
MeisterMed is a website that offers many free as well as paid medical references to be used on a PDA. Almost all medical specialties have references available on this page, and references are added or updated frequently.

Dr. Clearfield is an OGME-2 at Doctors Hospital Family Practice in Columbus, Ohio.