November 6th 2000 - AMIA Conference in Los Angeles.

A paper presented by investigators at Brigham and Women's Hospital, a teaching affiliate of Harvard Medical School, reports:

50% of physicians using ePocrates qRx handheld drug reference guide avoided one or more serious adverse drug events per week

Over 90% of clinicians surveyed reported that it took them 20 seconds or less to find information
80% said that ePocrates qRx improved their drug knowledge
83% said that their patients were better informed as a result
54% reported higher levels of satisfaction with their medical care

Below is an Abstract from the Brigham and Women's Hospital research findings.

Survey of Physicians' Experience Using a Handheld Drug Reference Guide

Jeffrey M. Rothschild MD1, Thomas H. Lee MD2, Jan Horsky MA1, Taran Bae MD2, Rena Yamamoto2, David W. Bates MD1 1 Division of General Medicine, Brigham and Women's Hospital, Boston, MA; 2ePocrates, Inc., San Carlos, CA

Background

Data suggest that problems with drug knowledge are one of the commonest causes of serious medication errors1. While the information clinicians need is available somewhere, getting it expeditiously has been problematic. At the same time, clinicians are faced with an ever-expanding pharmacology knowledge base, including new medications, dosages, adverse reactions, drug-drug interactions and other prescribing-related data.

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. Approximally 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.