Medical Errors: How Handheld Devices can Help

If you searched for “medical errors” in PubMed, you will find that it is a MeSH term:

“Errors or mistakes committed by health professionals which result in harm to the patient. They include errors in diagnosis (DIAGNOSTIC ERRORS), errors in the administration of drugs and other medications (MEDICATION ERRORS), errors in the performance of surgical procedures, in the use of other types of therapy, in the use of equipment, and in the interpretation of laboratory findings. Medical errors are differentiated from MALPRACTICE in that the former are regarded as honest mistakes or accidents while the latter is the result of negligence, reprehensible ignorance, or criminal intent.”

I’m not aware if we have data on medical errors for the Philippines but an Institute of Medicine report estimates that at least 44,000 Americans die each year from preventable medical errors.  So much for honest mistakes!

I started using a handheld device in 1997. Back then, it was a Palm Pilot Professional. It only had 1 mb of RAM and a monochrome screen.  It ran on two AAA batteries.   One of the first applications I had on it was Epocrates, a free drug database. Currently, Epocrates not only offers the “premium” drug database version but also applications that deliver medical content (CME) and information about lab tests and diseases. I continue to have Epocrates in my iPod touch and I mainly use it to check for drug interactions and renal dosing. Occasionally, I will check it for drug contraindications (i.e. in pregnancy) and adverse reactions.  I truly believe that having a drug database in my handheld device (a long line of Palm devices, and lately the iPod touch) has helped me to avoid one type of medical error – medication error.

A paper by Dallenbach MF et al, tested the ability of Epocrates RX (used by a general internist) to correctly identify clinically significant adverse drug reactions (ADRs) in the outpatient clinic.  The comparator was a clinical pharmacologist using a drug-drug interaction compendia.  1801 prescriptions from a clinic were reviewed retrospectively. The first eye-opening piece of data from this paper was that the prevalence of potential ADRs was 23%!  When Epocrates RX was compared with the clinical pharmacologist, the sensitivity of Epocrates RX to correctly identify clinically relevant adverse drug interactions was 81% (95%CI 77%–85%) and the specificity was 88% (95%CI 86–89%). The positive predictive value was poor (67%, 95%CI 62%–71%) but the negative predictive value was excellent (94%, 95%CI 92%–95%). The authors discuss the shortcomings of the Epocrates RX but I believe these can be easily overcome as the software releases updates regularly.  What might be a problem is if the MD user does NOT regularly update his device (requires an internet connection).

I have also installed other drug databases on my iPod touch like Medscape (which also contains information about common conditions and procedures) and Medicinal Herbs, since more and more patients use herbal supplements.

Lastly, what I particularly like about Epocrates RX for the iPod touch is the pill ID picture. While this feature requires an internet connection, I have used it several times to identify drugs that my patients could describe but not recall the name. “Doctor, it’s white, round and small!”  Just how many tablets look that way?!

Reference:

Dallenbach MF, Bovier PA & Desmeules J. Detecting drug interactions using personal digital assistants in an out-patient clinic. QJM 2007; 100(11):691-7.