Recently, point-of-care technology has become more practical with the advent of palmtop computing and represents a practical solution to this dilemma. A readily accessible and up-to-date drug reference guide may thus provide a valuable tool in patient care.  qRx (ePocrates, Inc.) is a comprehensive drug information guide downloadable from the Internet and designed for the Palm OS Platform. It contains information for more than 1500 drugs. The database is continually maintained and is capable of automatically updating devices remotely via “HotSynching.

Methods.  A  7-day online pilot survey of ePocrates users was conducted during March 2000. Physicians who have previously downloaded the qRx software were solicited for participation via e-mail. Approximately 3000 users were contacted, with a response rate of 29% (n=870).  The survey addressed issues relating to 4 domains: product evaluation, impact on physician practice and efficiency, impact on physician behavior for information-seeking and  decision-making, and impact on patient care. A 5-point Likert scale was used except for questions needing quantifiable responses.

Results. The respondents were physicians (74%) and medical students (26%). Physician characteristics are as follows: practice experience ranged from 0-40 years (mean 7.5 years, mode 3 years); 33 specialties were represented, with internal medicine generalists (28%) and specialists (14%) and family medicine (17%) most frequent. Practice settings included  only inpatient (23%), only outpatient (16%) and both settings (61%).

Product evaluation addressed experience with a handheld device (68% more than 6 months), experience with qRx (85% more than 2 months), frequency qRx used per day (60% more than 2 accesses per day), and time needed to find information in qRx (90%- less than a minute). Practice impact evaluation included time previously needed to find similar information (55%- greater than a minute), proportion of questions satisfactorily answered by qRx (more than ¾  of questions addressed - 88%), and overall efficiency improvement in inpatient and outpatient practice (71% and 69%, respectively). Product influence on users included direct contributions of qRx to improving drug-related decisions (81%), increased drug knowledge (80%), and reducing use of other drug references (92%). Finally, impact on patient care included the number of drug decisions affected per week (46%- 3 or more), the qRx features most useful in patient care (dosing, drug interactions and adverse reactions), reduction in preventable adverse drug events (ADEs) (50 % -1 or more per week), and if patients were better informed (83%- yes) and more satisfied with their care (54%-yes).

Discussion. Our survey found that physicians and medical students have been able to successfully incorporate handheld devices into their patient care workflow. With the use of a drug information database, clinicians have saved time, improved knowledge for themselves and their patients, and possibly decreased preventable ADEs. These data demonstrate the perceived value of handheld devices, which will clearly grow further as wireless communication becomes more routine.

References. 1. Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. ADE Prevention study group. JAMA. 1995;274:35-43.

© 2001 American Medical Informatics Association