Tablet PCs in pharmacy practice – Making the case

I recently had an interesting conversation with a colleague over the use of tablet PCs in pharmacy practice. We both felt that tablets were a great tool and couldn’t understand the lack of interest in our profession. After the conversation, I felt compelled to do a little research. Rather than present the information in one giant post, I’ve decided to break it down into four parts. Part 1 is presented below.

Why pharmacists need to consider the tablet PC.
Let’s face it, pharmacists spend a lot of time collecting and analyzing data to provide safe and effective medication use for patients. They dig up information in all sorts of places, such as online drug information resources, medication records, laboratory systems and various nursing “flow sheets”. Unfortunately, pharmacists often have to go to several different systems to collect all this data. Creating further complexity is the lack of a standardized collection method among pharmacists. The combination of multiple systems and collection methods results in redundancy and decreased efficiency. Opportunity for errors also exits as many of these systems are manual, including good old pen and paper. As technology advances, it becomes important for us as a profession to move away from inefficient, error prone practices and evaluate newer options for accessing and collecting data. Electronic medical records (EMR), computerized provider order entry (CPOE) systems, computer based monitoring and decision support systems are becoming more and more common place in hospitals across the globe. While not every hospital uses each of these systems, a recent ASHP survey showed that a majority of hospitals are using at least some of these technologies.1 In addition to these information systems, pharmacists can frequently be found using various software programs to perform pharmacokinetic calculations and track clinical interventions.

The increasing reliance on technology in healthcare, not surprisingly, equates to pharmacists spending much of their time accessing information via computer. Incorporation of computers into the pharmacists’ daily routine is commonplace. Walk into nearly any hospital pharmacy today, and you’ll see a host of desktop computers (desktop PCs) lining the countertops. While desktop PCs work well in a centralized pharmacy model, they present several challenges for pharmacists at the patient’s bedside.

Lack of access to desktop PCs at the point-of-care coupled with the growing need for real time access to information has led to the introduction and rapid growth of small, portable devices such as “personal digital assistants” (PDAs), and to a lesser degree mobile phones, in pharmacy practice. The popularity of mobile devices is evident by the volume of information in the medical literature supporting their use. Widespread use has led to significant advances in mobile computing within healthcare as well as acceptance into mainstream pharmacy practice.

Common uses for PDAs and mobile phones include documenting clinical interventions2-5, carrying individually created documents and “peripheral brains”6,7, performing pharmacokinetic calculations, accessing drug information and performing drug interaction checking.8-13 PDAs and mobile phones offer this functionality in a surprisingly small form factor for easy use at the bed side. However, the portability of these devices comes with a price. Today’s PDAs and mobile phones do not posses the processing power or the screen real estate necessary to manage complex pharmacy software. Systems such as the Apple iPhone have made tremendous strides in handling graphics and providing real time access to many web based drug information and decision support resources, but screen size remains problematic. PDA and mobile phone screens are often times several orders of magnitude smaller than that of a full size desktop PC.

The complexities of pharmacy systems and information resources have not made PDAs and mobile phones obsolete per se, in fact their use in healthcare continues to grow. There is, however a void between these mobile devices and desktop PCs. While it is true that desktop PCs lack portability, they offer significantly more processing power, memory, screen size, improved back-up solutions for data integrity, improved views of complex healthcare records, better integration with hospital systems and limitless access to drug information. Despite their lack of mobility, desktop PCs have been shown preference over PDAs in certain clinical situations14 and mobile drug information databases have never been shown to be superior to their online counterpart.15 While tremendous advances in technology have been made over the past several years, there remains a gap between the lack of mobility from desktop PCs and the limitations of a PDA or mobile phone. Anecdotal information is available for possible solutions for this gap, but the literature within healthcare and pharmacy in particular, is lacking. What we need is a device small enough to be portable, but powerful enough to handle the needs of today’s technologically advanced pharmacy; I present to you the tablet PC.

References
1. Pedersen CA, Gumpper KF. ASHP national survey on informatics: Assessment of the adoption and use of pharmacy informatics in U.S. hospitals–2007. Am J Health Syst Pharm. 2008;65(23):2244-2264.
2. Bosinski T, Campbell L, Schwartz S. Using a personal digital assistant to document pharmacotherapuetic interventions. Am J Health Syst Pharm. 2004;61(9):921-934.
3. Clark J, Klauck J. Recording pharmacists’ interventions with a personal digital assistant. Am J Health Syst Pharm. 2003;60(17):1772-4.
4. Ford S, Illich S, Smith L, Franklin A. Implementing personal digital assistant documentation of pharmacist interventions in a military treatment facility. J Am Pharm Assoc. 2006;46(5):589-593.
5. Fox BI, Felkey BG, Bruce A Berger, Krueger KP, Rainer RK. Use of personal digital assistants for documentation of pharmacists’ interventions: A literature review. Am J Health Syst Pharm. 2007;64(14):1516-1525.
6. Felkey BG, Fox BI. Pharmacist PDA document managment considerations. Hosp Pharm. 2008;43(6):518-519.
7. Felkey BG, Fox BI. Creating the digital peripheral brain. Hosp Pharm. 2002;37(11):1222-1224.
8. Honeybourne C, Sutton S, Ward L. Knowledge in the Palm of your hands: PDAs in the clinical setting. Health Info Libr J. 2006;23(1):51-9.
9. Galt K, Rule A, Houghton B, Young D, Remington G. Personal digital assistant-based drug information sources: potential to improve medication safety. J Med Libr Assoc. 2005;93(2):229-36.
10. Clauson K, Seamon M, Clauson A, Van T. Evaluation of drug information databases for personal digital assistants. Am J Health Syst Pharm. 2004;61(10):1015-24.
11. Perkins N, Murphy J, Malone D, Armstrong E. Performance of drug-drug interaction software for personal digital assistants. Ann Pharmacother. 2006;40(5):850-855.
12. Robinson RL, Burk MS. Identification of drug-drug interactions with personal digital assistant-based software. Am J Med. 2004;116(5):357-8.
13. Barrons R. Evaluation of personal digital assistant software for drug interactions. Am J Health Syst Pharm. 2004;61(4):380-5.
14. Chang P, Tzeng Y, Wu S-, Sang Y, Chen S. Development and Comparison of User Acceptance of Advanced Comprehensive Triage PDA Support System with a Traditional Terminal Alternative System. AMIA Annu Symp Proc. . 2003;2003:140–144.
15. Clauson KA, Polen HH, Marsh WA. Clinical decision support tools: Performance of personal digital assistant versus online drug information databases. Pharmacotherapy. 2007;27(12):1651-1658.

4 thoughts on “Tablet PCs in pharmacy practice – Making the case”

  1. Hi Jerry, at Pharmacy OneSource we have been recommending the eee PC (http://eeepc.asus.com/global/index.html) to our web-based software customers when they are looking for something their pharmacists can use on the floors. If the hospital has wireless internet, it’s easy to see the benefits over a PDA.

  2. Hi Maeghan – You make a great point. The eeePC is a definite option, especially with their new touch screen model (T91 – http://eeepc.asus.com/global/productt91.html?n=0). I like the option of being able to fold the screen back over the keyboard. It makes handling the device so much easier. Thanks for stopping by and leaving a comment.

  3. Hi Jerry,
    Enjoyed this first part of the series. Thanks for focusing on mobile technology as a discussion with your audience. Your readers might also be intersted in seeing some case studies, videos and best practices at http://www.healthcaregoesmobile.com, a free online community for those interested in mobile point of care technology. Specifically, this case study shows how connected prescriptions are helping to streamline workflow. (http://www.healthcaregoesmobile.com/content/%E2%80%98connected-prescription%E2%80%99-arras-hospital). Thanks again.

  4. Hi Gary – Thanks for the comment and for the new link. I took some time to roam around HCMobile and was quite impressed, especially with the Video Success Story on UCSF. ;-)

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