After Michelle Eads, MD diagnosed her pregnant patient with a bladder infection, she quickly reached for her Apple iPhone. The Colorado primary care doctor wasn't planning to call an urologist for a consult, however. She used the smartphone to research antibiotics that are safe for pregnant women using Epocrates, a comprehensive drug and disease reference application developed by San Mateo, CA-based Epocrates, Inc.
Eads doesn't have a list of antibiotics that are safe for pregnant women committed to memory. But, she does know that physicians need to be very careful about prescribing medications that may harm an unborn baby.
"With Epocrates, I'm able to research very quickly and figure out what the safest options are, review them with the patient, and make a decision," she says.
Eads is one of a growing number of physicians using smartphones—mobile phones that combine online access to information with PDA functionality. According to an April report by Manhattan Research, the number of physicians using smartphones more than doubled to 64% over the past year.
The results of the survey indicate that physicians like Eads are spending more time online using smartphones to access medical and pharmaceutical resources during the course of their busy day.
"It's rare for me to have an encounter—whether it's a phone visit, a virtual visit, or an office encounter—that I don't use Epocrates," says Eads. "If I'm getting ready to talk to a patient and I want to know what the different alternatives and side effects are, I do a little research before the appointment. I'm using it constantly."
Avoiding medication errors
Eads primarily uses the Epocrates application to look up drug interactions, side effect profiles, adverse reactions, and contraindications. Epocrates, Inc. launched the application in 1999 and offers users a free version of the tool as well as subscription-based versions with additional functionality. Michelle Snyder, Epocrates senior vice president of subscriptions, says over one in three doctors in the United States are actively using the application on a mobile device.
According to Eads, this use of her smartphone increases her productivity. If a patient is concerned about stomach upset, for example, Eads looks at antibiotics that are least likely to cause that.
It also allows her to look up drug interactions, including drug herbal interactions, which she says are somewhat popular with residents in Colorado. "There are a lot of people on some strange things out here," she says.
In a study of how examining if Epocrates helps doctors reduce medication errors, researchers at Brigham and Women's hospital found that 50% of Epocrates physicians surveyed reported averting one to two errors per week.
"It really helps them prescribe the right medication and avoid adverse drug events," says Snyder. She says when a drug is recalled, the company is able to update their drug database within the hour so physicians are constantly accessing the latest information.
Eads can view different types of medications in the same family or the same class. The application also tells her what the patient's copayment will be given their insurance plan (not all insurers pay Epocrates to include this information). Eads says this allows her to find lower copayment options for her patients. It also reduces the need for a callback from the patient's pharmacy if a particular drug isn't covered by the patient's insurance plan.
"My patients like that I can check and find out what medicine they can use given their insurance," she says. "It's nice to have that information to give them more choices."
According to Snyder, when the new Medicare part D program went into effect, Epocrates had all of the plans already loaded into their application. "That was a huge help to physicians. It's difficult for the physician to keep track of what's covered under which plan."
In general, the response that Eads has gotten from her patients regarding her use of the smartphone has been extremely positive. "My patients know that I'm very technology oriented and that it allows me to spend more time with them."
She says they don't view her reliance on the phone's reference applications as a weakness. "I don't know absolutely everything," she says. "I think they're glad to see that I'm double checking things and also making sure that there aren't interactions or problems."
For example, when she has a patient who isn't quite sure of the name of the medication he or she is taking but can describe what the pill looks like, Eads can use the search function in the application and show the patient a picture of it.
"So many times people say it's the little red pill that I need to have refills on. Finding the actual picture is very helpful."
The infectious disease information in the Epocrates application is also helpful, she says. If she is treating a patient who has sinusitis, it allows her to see what the current recommended antibiotic is.
"If you have an idea of what you're treating, then you can search for it by what part of the body is affected with the infection and you can find out what the recommendations are."
The end of test result phone tag
Sean Khozin, MD, MPH takes his prescribing to the next level using his iPhone. Like Eads, the NY-based hellohealth internal medicine physician consults Epocrates to select a medication for one of his patients, but then submits the prescription electronically through his smartphone using an application called Care360 by Mason, OH-based MedPlus, Inc. (a Quest Diagnostics company).
"When I e-prescribe I can see an electronic record of the patient's medication history," he says. "If the patient forgot to tell me about an active medication, I could catch that right there on the spot because I'm looking at it on my iPhone as I'm prescribing the medication."
Khozin also uses Care360 to review laboratory and blood work results. Results are sent to his iPhone as soon as they are completed. He can examine them, mark them as being reviewed, and e-mail the patient the results.