Evaluation of paediatric medicines information content on smartphones & mobile devices
One of the benefits of working at a large university is all of the different faculty you get a chance to work with. In this case, I collaborated with a group led by someone I have immense respect for – Dr. Sandra Benavides. She relayed that, “Medication safety and dosing information is often poorly delineated for paediatric patients as 75% of medications demonstrate insufficient labelling for these two purposes.” [1] So off-label or ‘unlicensed’ use of meds in peds is very common, with accompanying safety problems exacerbated by the more narrow therapeutic window in this population. Since use of clinical decision support tools is one strategy that has demonstrated the ability to help prevent med errors in peds [2] and the use of mobile devices in clinical practice has expanded substantially – we decided to systematically examine the quality of medicines information in a sample of commercially available tools. The article that came out of the study was recently published in Informatics in Primary Care.[3]
Paediatric-specific tools evaluated included: British National Formulary for Children, Harriet Lane Handbook, and Paediatric Lexi-Drugs. Generalist tools included: A to Z Drug Facts, American Hospital Formulary Service Drug Information, Clinical Pharmacology OnHand, Epocrates Rx Pro, Lexi-Drugs, and Thomson Clinical Xpert. 108 questions (e.g., Can the sudden appearance of extrapyramidal symptoms in an 11-month-old infant be attributed to administration of metoclopramide for injection?) were distributed evenly across infant, children and adolescent subgroups. Answers for the evaluative questions were sourced from established sources and (due to the high rate of off-label prescribing for which no conventional source exists) clinical guidelines.
The verdict? “The best performer [Pediatric Lexi-Drug] provided 75.9% of the answers…Databases generally performed less effectively in providing answers sourced from clinical guidelines compared with more conservative sources such as package inserts”. Obviously the article itself goes into much more detail regarding scope and completeness of the tools and their performance based on several criteria. Hopefully the article adds some useful guidance and identifies both strengths and shortcomings with which these increasingly important tools and their nextgens can be improved upon.
@kevinclauson
1. Benjamin DK, Smith PB, Murphy MD et al. Peerreviewed publication of clinical trials completed for pediatric exclusivity. Journal of the American Medical Association 2006;296:1266–73.
2. Fortescue EB, Kaushal R, Landrigan CP et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics 2003;111:722–9.
3. Benavides S, Polen HH, Goncz CE, Clauson KA. A systematic evaluation of paediatric medicines information content in clinical decision support tools on smartphones and mobile devices. Informatics in Primary Care 2011;19(1):39-46.
Consumer Health Informatics Elective: Expertsourcing
The Consumer Health Informatics & Web 2.0 in Healthcare elective I coordinate for the college of pharmacy wrapped up in December and the ‘votes’ are in about the course. I felt the course went more smoothly this semester and was thrilled to again be able to expertsource several topics by benefiting from guest lecturers. However, the final decision (as always) rests with the students, whose opinions were solicited in the quest to improve the course.
The final exam is an all essay affair (which is not exactly universally popular) and at the end prompted the students to share their opinions on the most and least useful/interesting lectures of the semester along with other feedback.
Based on the comments they wrote, the topics that generated the most traction among students were mHealth and eProfessionalism. Students conveyed they were most intrigued about the potential of mHealth and felt like the issues within eProfessionalism were most personally relevant in their lives. Contributing guest lectures on these topics were leading social media & pharmacy thinker and University of Kentucky professor Jeff Cain (@DrJeffCain) and pediatric endocrinologist-turned-entrepreneur Jen Dyer (@EndoGoddess), who has created an eponymous app. Dr. Cain’s contribution, in particular, may end up having the most longevity of all topics within the course.
However, the most polarizing topic (and lively discussion) was spurred by the guest lecture “Spread the Love, Nothing Else” by Ramin Bastani (@RaminB) of Qpid.me. I first met Ramin at @BJFogg’s excellent Mobile Health @ Stanford. While I wasn’t entirely sure what I thought of the STD-notification idea initially, I certainly believed it would be a great tool to engage students about issues surrounding mHealth, the changing nature of communication via social media, and public health. It was. They were.
A sneak peek of data and a physician perspective on use of social media caught the attention of a group of our students as well. Stanford Medicine X creator and AIM Lab Director Larry Chu (@LarryChu) provided an interesting look via his analysis of 4999 online physician ratings.
The most pharmacy informatics-centric and global perspectives that resonated with students were provided by Jerry Fahrni (@JFahrni) of Talyst and Brent Fox (@Brent_Fox) of Auburn University, respectively. The course (unsurprisingly) is focused on the consumer health subspecialty of informatics, but those students who already are planning a path in pharmacy informatics clearly took to Dr. Fahrni’s lecture.
One of the new topics this semester was #SocialGood where we talked a bit about efforts like Free Rice and Kiva. It was really inspired by The Dragonfly Effect lecture from the 2011 Medicine 2.0 Congress. It was pretty primer-y and could likely benefit from a guest lecturer (suggestions?).
All-in-all, the course had some great moments, I think the students took away some useful tools and ideas, and I definitely learned an enormous amount from them and the guest lecturers!
@kevinclauson
Launching a Center for Consumer Health Informatics Research
We are very excited that the Nova Southeastern University College of Pharmacy has officially launched our Center for Consumer Health Informatics Research (CCHIR)! Like all undertakings of this magnitude, it has been in the works for some time and has benefited from tremendous support from many corners – in particular the Chair of the Department of Pharmacy Practice and the Dean of the College of Pharmacy. Below is a presentation outlining some basics about the Center. I look forward to working with its faculty and collaborators and steering the CCHIR toward many great developments in the future.
@kevinclauson
UPDATE: The dedicated site is up at www.CCHIR.com
Pharmacy: Is there an app for you
The 45th Annual Meeting of the Florida Society of Health-System Pharmacists (FSHP) was held in Orlando during the weekend. Since it is a state organization conference, it is much smaller than gatherings like the ASHP Midyear Clinical Meeting. This allowed for a streamlined set of programming tracks and a more relaxed atmosphere. There were also some interesting individual sessions (and necessities) on medication errors, pain management, etc. I particularly liked the presentation on “Cyberhealth”, which focused on issues with Internet Pharmacy. Additionally, I had the opportunity to present “Pharmacy: Is there an app for you” at the meeting.
@kevinclauson
Knowledge, Skills, and Resources for Pharmacy Informatics Education
The most recent issue of the American Journal of Pharmaceutical Education featured a Technology in Pharmacy Education section. There is some really interesting reading in this section including, “Use of Twitter to Encourage Interaction in a Multi-campus Pharmacy Management Course” by @Brent_Fox. Brent actually authored several articles including, “Knowledge, Skills, and Resources for Pharmacy Informatics Education“, which he wrote along with the newly installed Chair of the ASHP Informatics Section Allen Flynn, informatics luminary and frontliner Chris Fortier (@FortiPharm), and I. With this article, we tried to summarize the baseline informatics knowledge that pharmacy students should possess upon graduation, framed within med use processes. My hope is that it will be of real practical use to educators and others as specific recommendations are provided regarding activities and resources for class and curricular integration, rather than just observations made from 30,000 feet. Also, as with all articles in AJPE, this one is open access (OA) in that it can be accessed free, full-text by anyone.
@kevinclauson
Source: Fox BI, Flynn AJ, Fortier CR, Clauson KA. Knowledge, skills, and resources for pharmacy informatics education. Am J Pharm Educ. 2011;75(5):Article 93.
Community pharmacists’ use of language access services
One of my pet interests is health literacy and its far-reaching impact on quality and access to healthcare. The issues surrounding it can almost be insidious in nature. Despite this, health literacy is typically only given superficial coverage in traditional training programs.
Here in South Florida we have an especially diverse patient population with a higher than average percentage of those with limited English proficiency (LEP). It’s pretty intuitive, but LEP patients are (unfortunately) more likely to encounter barriers to health care and are associated with poorer outcomes than non-LEP patients.
In part to address this, there was actually an Executive Order mandating ”meaningful access” be given to LEP persons for Federally-funded activities (what, you didn’t think ‘meaningful use/access’ was limited to EHRs and the like?). Consequently, hospitals, clinics, etc. began incorporating translators and other language access services (LAS) as SOP (at least on paper) due to their receipt of Federal funding/payments. However, a funny thing happened on the way to implementation in community pharmacies – much as those pharmacies and the healthcare professionals that staff them are treated differently than similar entities/professionals in our system of health care…this mandate has been treated more as a voluntary compliance issue. What, if any, impact has this had on reimbursement or outcomes? The jury is still out. However, as a first step to methodically examine this issue, we conducted a national survey of availability and use of LAS in community pharmacies; the initial results of which have recently been published in the Journal of the American Pharmacists Association (JAPhA).
Pharmacist responses to the survey ranged from descriptions of widely advertised and seamlessly integrated interpretation (verbal) and translation (written) LAS services to the (rarely observed) attitude of ‘if they’re in our country they should speak English’. Overall, we identified issues regarding awareness (e.g., about half of pharmacies with LAS capacities did not report making them known to patients), use of LAS (e.g., about 40% said they ”never” used interpretation/translation tools), and workflow/time (e.g., a quarter of respondents said they simply lacked time to use LAS). Alternately, there were encouraging signs as pharmacies that did apprise patients of LAS availability used a variety of methods including in-store direct notification, signage, flyers, and targeted mailings. Additionally, more LAS products are becoming available such as Elsevier’s MEDcounselor Languages module, which advertises SIG translation and patient education materials in 14 languages. Another gem that area pharmacists have started using (albeit moreso in AmCare clinic settings) is the free MediBabble iPhone app. My understanding is that a future update will (ahem) include pharmacists in the introductions section.
Unfortunately, our article “Community pharmacists’ use of language-access services in the United States” is behind a subscription wall, but I would be happy to answer any questions that I can.
@kevinclauson
Disclosure: A couple years ago we received a grant from one of the quadrillion companies Elsevier operates for an unrelated research study. Inclusion of their product in this post is mostly due to timing (I just received an email about it), and should probably not be construed as a conflict of interest except for the most Mel Gibsonian of conspiracy theorists. Separately, this JAPhA LAS study was funded by a NSU President’s Grant. Going forward we are planning to study the LAS disconnect further, as well as possible solutions that may include tools such as automated LAS kiosks in pharmacies and online functionality as well as LAS availability notification via social media; funding source(s) TBD.
Source: Feichtl MM, Clauson KA, Alkhateeb FM, Jamass DS, Polen HH. Community pharmacists’ use of language-access services in the United States. J Am Pharm Assoc. 2011;51(3):368-72.
Mobile Health 2011: A Look Back at What Really Worked
Stanford Guest House
Mobile Health 2011: What Really Works at Stanford University (#mh11) is over, so it’s time for a quick look back at the conference. To borrow (steal?) from conference organizer, Stanford Persuasion Technology Lab director, and quick-change artist @BJFogg – I am going to take a retrospective look at my experiences there through the device of ‘home runs’. For full speaker slide decks, you can click here.
Conference Atmosphere Home Run
I have been to a lot of conferences…pharmacy conferences, medical conferences, informatics conferences, and social media conferences. However, I have never been to a conference that seemed more along the lines of an ‘event that happens to be interspersed with speakers’. This is not an indictment of the quantity or quality of the speakers; somehow there were >50 of them smoothly shoehorned into two days. The comment is more about the carnival-like atmosphere surrounding the conference that made it fun and exciting, and contributed to a very collegial vibe. One of the best aspects of Mobile Health was the extended breaks. They were just plentiful enough and twice as long as an average conference. If you think about the old chestnut ‘the best value at a conference is the hallway conversations’…voila! Those breaks doubled the value of the conference. Also helpful was Fogg’s “giving permission” to all attendees to go up to anyone there and say hello, reinforced by the speakers largely making themselves available after panels concluded. I’m still undecided about a few things (e.g., the birds and the bees); however, balancing all the West Coast wackiness was the fact that the conference was timed and chimed down to the minute. Seriously.
Lodging Home Run
It’s almost like this place is a secret or something. I stayed at the Stanford Guest House for their conference rate of $109. You can barely stay at a Roof Rouge near a major city for that. The rooms and hotel were basic and a little Spartan, but the beds were comfortable, the place was immaculately maintained, and the staff was gracious and knowledgeable. The deal-maker was that the Stanford Shuttle (Marguerite) had pick-ups ~ every 20 minutes to take you all over the campus. There was also a Guest House shuttle that could be reserved (e.g., to take you to the Alumni Center‘s conference venue). The only drawback was that there were no dining options in-house or within easy walking distance. Definitely will stay here again next time I’m at Stanford.
Almost Made Me Apply for a Job in Public Health Home Run
Sharon Bogan. You just have to love somebody with that kind of spirit, fighting the good fight, excerpting Monsters, Inc., innovating in resource-limited settings, and inviting litigation (for others). Everyone I’ve met from King County Public Health going back to the mhealth Summit has been a gem.
Goosebump Home Run [tie]
Green Goose and Proteus ingestible event markers. Check them out. Seriously. They *literally* gave me goose bumps in thinking of potential applications of their technologies during their presentations.
Honorable mention: Google Cow presented by Google’s Chief Health Strategist (@rzeiger). Technically he was focusing on Google Body, but since I had already seen Body I was pretty happy to see the bovine version.
Reunion Home Run
It was great to see @chiah @EndoGoddess @JenSMcCabe KarenCoppock @LarryChu @SFCarrie @SusannahFox and loads of others again!
New Peeps Home Run [misc]
If you are worried about our future, know that we are in good hands with people like @hcolelewis coming on the scene
Most likely to isosceles with regarding mHealth, PAHO, & Uruguay @JuanMZorrilla
Most likely to invite for Skype in guest lecture in my Consumer Health Informatics course @QpidMe
Most likely to explore the mHealth studies based out of our campus in Puerto Rico with @MarcosPolanco
Most surprised to find in my back yard Vic Shroff
Note: any conversations that included words like NDA, lawyer, or launch are not listed here for obvious reasons.
Failed to Connect at All Strikeout
I would have liked to have spoken with @enochchoi
Conversationus Interruptus Strikeout
The Keck and and PHI guys
Best Laid Plans Strikeout
Climate control and the janky A/C resulted in groups of attendees going to the outer hall and watching panels on a screen and/or going outside to cool off.
(Dis)honorable mention: minimal power outlets/juice available was surprising. This problem was offset somewhat by the length of the breaks which allowed for both networking and recharging.
Least Favorite Panel
The Partnerships panel was my least favorite. It definitely had eye-opening moments for some attendees and there were interesting discussions and placements (e.g., possibly the least and most idealistic two people at the entire conference were seated next to each other). However, most of the discussions were pretty familiar to me from having gone through many of the processes described. So my bias/preference would have been to have instead heard more specifics about MedPedia from James, Medic Mobile or Social from Josh, etc.
Overall Favorite Panel
Very tough decision as there were several really outstanding ones. I considered a tie here but was able to pull the trigger and name “Methods and Measures for Research and Evaluation” as my favorite overall panel. The moderator and panelists all had great content to share and illuminated a lot of the challenges in conducting research in this space. Plus the Open mHealth initiative is so encouraging! I think this panel is a ‘must view’ for everyone as it can help in introducing a common language that could lead to better coordination and scaling of efforts as well as providing guidance for individuals. Overall, the quality and detail of this panel was exemplary. I ended up choosing it in part based on the criteria of ‘if I could only have the full video of one panel’ because of its high utility for me and in sharing with multiple audiences. Many of the slide decks from this panel are here.
Final Verdict
I am definitely happy I attended both the pre-conference workshop by @BjFogg (although it mostly served to whet my appetite for the full Boot Camp) as well as the conference proper. I have been to some good conferences that were one-offs, but will absolutely figure out a way to make it back to Mobile Health next year. My two most substantial takeaways were that the construct of this conference was singular in nature and that it was probably easier to connect with potential collaborators here than at any other conference I’ve attended.
@kevinclauson
Update: other perspectives on the conference have previously been posted here by @thulcandrian of AIDS.gov and a take on mHealth by @geoffclapp here.
Update 2. Here is a new conference highlights post by Craig Lefebvre (who I wish I had realized was @chiefmaven when I met him there)
Update 3: ‘Text in the City’ founder Katie Malbon has written the most ambitious mh#11 wrap-up to date
Update 4: If @TextInTheCityNY had the most ambitious/complete post, @geoffclapp has added the most thoughtful and thought-provoking review to date
Update 5: From the ‘people I wish I had a chat with’ file at #mh11, @AndrewPWilson has now provided his main takeaways from Stanford
Update 6: Patient-centric thought bubbles and more from e-Patients.net rep @msaxolotl at #mh11
Update 7: Jeff Kellem (@slantedhall) provided a tech-focused list of quick hits from the conference
Update 8: David Doherty (@3GDoctor) has added the most contrarian view of the conference to the conversation here
Social Media & the Role of the Patient
Our College of Pharmacy recently held its annual student seminar night. A semester’s worth of P3 student work culminated in over 100 podium and poster presentations. There were a number of outstanding student efforts; however, I am featuring this one is it fits the theme of the blog and the student group made it available on Slideshare. The work represents their preliminary analysis and has some interesting findings. Congrats to them and to all of our students. I look forward to seeing a final version of this and several others at the FSHP Annual Meeting.
@kevinclauson
ULP Review of Asus Slate EP121 (TabletPC)
Ill try to get a better picture uploaded soon
While I am fully entrenched in the iPhone bandwagon, I have not purchased an iPad (or a TabletPC)…or really anything else other than a standard laptop since I tried a LG Phenom, and a ZX81 (Timex Sinclair 1000) prior to that. However, I recently took the plunge and picked up an Asus Slate EP121.
It is important to qualify my review by stating my intended purpose for the Asus Slate is as a laptop replacement with tablet functionality, *not* primarily as a tablet. This unit is to be a work computer. As such, it has to be powerful enough to run a full Windows 7, the complete Microsoft Office suite, etc. I anticipate about a 70/30 mix of ‘laptop’/tablet usage in my everday work activities. This, of course, subject to change during periods of travel like conferences and the like.
Specs as purchased ($1099, free shipping, free Microsoft Signature install)
Windows 7 Home Premium, Intel i5 Dual Core, Intel HD graphics, 12.1″ Gorilla Glass screen, 4GB Dual DDR3 RAM, 64GB SSD, weight of 2.5 lbs, two (2) USB ports, mini-HDMI output, SD Card reader, 2MP (videoconferencing) camera.
Also came with:
Folio case (doubles as a stand as depicted above)
MS Mobile Bluetooth Keyboard 6000
Wacom Pen/Digitizer w/Eraser
Power supply with extra embedded USB charging port
Pros
*It is faster than my current (old) laptop Dell XPS M1530 in every measurable way, so its a clear upgrade for me
*I am already trying ways to incorporate the added Tablet & Stylus functionality into teaching, taking notes in meetings, etc. I really like the seamless integration of MS Office/PDFs/OneNote with the enhancements of the Wacom pen and the sprawling screen size to write comments, notes, etc. in an unobtrusive way (vs trying similar with touch laptop where it is a little less natural and you get the occasional arched eyebrow). We will also be using tablets in some of our studies for consenting patients, getting baseline data & scores, etc. and I anticipate fewer issues with data conversion and related issues since both systems are Windows-based.
*I haven’t had any problems with its touch interface so far…then again, my only real long-term comparator is the iPhone4
*Boot time is much faster than anticipated (<30 sec from pressing button to surfing the net) and hibernate mode works really well as it consumes almost no battery and launches in about 3 seconds
*I can’t imagine having any handheld device without a webcam for videoconferencing (e.g., meetings and teaching classes), as well as USB ports, and a video out…fortunately, this is not an issue with the Slate
*Turns out 2.5 lbs is lighter than I thought
*I can’t believe I am excited about a keyboard, but the one that came with it is *really* good; similar sentiment for the folio
*Embedded USB in power cord is nice touch, can plug in and simultaneously charge iPhone with just one plug at airport…minor issue, but appreciated
*The ArtRage software & stylus should allow for creation of some nice infographics
Cons
*The battery life is terrible. I mean, I knew it was low based on reviews and that in order to run 7 and to power the gi-normous bright screen that it would take juice, but…I tried a couple of different tests and read about similar online. Streaming Netflix over Wifi only yields about 2.5 hours. Performing low demand work tasks, I can get about 4 hours out of it. This is normally ok as I am using it as a work computer on my desk, but for travelling, etc. it would have been nice to have been able to get in two movies.
*64GB is nice and Asus offers free ‘unlimited’ cloud storage with it (and there is always SkyDrive, etc.); plus it has USB and SD, but I have 10GB on my laptop just in licensed stock photos – so no way the Slate will comfortably holding all my files.
*Had to get a Bluetooth mouse to fully replicate workstation
*If you are expecting instant-on, power-up you will be disappointed
*HDMI is nice, but will have to navigate the plentiful VGA machines
Verdict
It’s early days, but so far I am very happy with the Asus Slate. I suspect people looking for a serious work machine with 7, Office, etc. plus the benefits of Tablet functionality will be happy with the Slate too. Others simply looking for an alternative to the iPad to surf, read, and play Angry Birds on probably will not be.
Other People’s Opinions
The Aussie ZDNet/cnet site has a pretty good video review of the Asus Slate. I think it was overly harsh on some aspects and I have no idea why they encountered any difficulty with connecting the Bluetooth keyboard – but they give a fair appraisal overall and had some glowing words about it, summed up by ”this thing’s pretty damn good”.
Click to launch to video review
Elsewhere, one ‘enthusiast’ created the most comprehensive audio/video review I have ever seen for ANY product, luckily it is for the Asus Slate. He has also been trying to answer questions about it, even prior to release in Canada. My review will give you an indicator, but his site and Product Tour is a must visit if you are seriously considering purchasing an Asus Slate EP121. Actually, even if you are not that serious, you should check out the thoroughness of this guy’s review. Amazing.
Hope this helps. Obviously, I would be very interested to hear if you get an Asus Slate and/or about your experiences with one.
@kevinclauson
Disclosure: I did not receive any consideration for this review. I did receive free overnight shipping that was available to anyone who goes to: http://www.facebook.com/windows and gets the code. However, when I tried to use the Facebook code at the Microsoft store online, it did not work. So, then I clicked on the proffered Live Chat to ask about the code. Chat told me I had to *call* customer service to ask them about it. So, then I sent a tweet at “Matt at the Windows Social Media Team” about it and never heard back. Lost opportunity. Ironic.
