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
Below is an Abstract from the Brigham and Women's Hospital research
Survey of Physicians' Experience Using a Handheld Drug Reference
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
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
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."
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.
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).
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.
1. Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of
adverse drug events. ADE Prevention study group. JAMA. 1995;274:35-43.