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Program aims to improve efficiency of care
When David Slawson, MD, was examining a 2-month-old baby with a high fever and bladder infection, he recalled reading an article that compared the recovery of children with similar problems who were hospitalized and treated at home.
He punched a few keys on his hand-held computer and instantly had the details of the article at his fingertips. Instead of hospitalizing the patient, he decided to treat the baby at home. Next, he looked up the recommended drug dosage and checked the patient’s insurance company’s formulary — all in about three minutes.
"I was able to keep the patient out of the hospital and send him home with the right information. In just a few minutes, I knew I had the most up-to-date information available," says Slawson, a family practitioner with the University of Virginia Medical Center in Charlottesville.
Slawson’s hand-held computer is equipped with InfoRetriever, a database program that allows doctors quick and easy access to the best available information on a topic.
InfoRetriever contains diagnostic calculators that help determine the advantages of different treatments, summaries of the latest published papers, systematic reviews of the best available evidence, treatment guidelines, and a customized database of formulary information for each insurance plan with which doctors contract, along with prescribing information for more than 1,100 medications.
Before he started using the computer, Slawson asserts that he probably would have ended up putting the child in the hospital.
"Most of the time, if there’s a question about treatment, physicians just guess at it, and they may end up spending money and subjecting patients to unnecessary and potentially harmful treatments and tests," he adds.
He cites a recent study at the University of Iowa that showed that physicians seek answers to questions regarding patients care less than half the time. (For details on the study, see p. 188.)
Slawson and his colleague Mark Ebell, MD, a family practice physician and associate professor at Michigan State University in East Lansing, are among the developers of the InfoRetriever data base. The program is being tested by 200 physicians at Michigan State and the University of Virginia. Other developers are Henry Barry, MD, associate professor of family practice at Michigan State University, and Allen Shaughnessy, MD, director of research at Harrisburg (PA) Family Practice Residency.
"Doctors have ever-increasing demands placed on them, not only to improve the quality of care, but to improve the efficiency of care, to keep costs down, and to see more patients more quickly," Ebell says.
He cites an example of a patient who comes in with a sore throat, and the physician has to determine if it’s a strep infection. The physician can feed information on a patient into the computer and determine the patient’s risk of strep. Then he or she can decide whether to treat the sore throat presumptively as strep throat until the results of a culture come in three days later, use a rapid strep test, or just wait until the test results are in to prescribe treatment.
"Instead of having to remember all of this, instead of having to find a published paper, it’s all right there at the fingertips. It makes it very easy to apply the results of research and individualize care to a patient’s needs," Ebell says.
Patients benefit by getting better treatment and avoiding tests and procedures that may involve risk, Slawson says.
"Every time a patient goes through a test they don’t need, there is harm. We want to make sure the patients get the best treatments they possibly can," he adds.
Computers in a physician’s office are nothing new, Ebell asserts. The difference is that the computers are in the treatment room.
"The people who have used it at UVA are constantly saying how useful it is. The residents who have tried it say they can’t imagine practicing medicine without it," Slawson adds.
Eliminating the hassle of formularies
In addition to providing the latest information on treatment and practice guidelines, the data base aims to solve one of the biggest frustrations today’s doctors have: coping with the different drug formularies for the managed care firms which they contract.
"Every January, I get several booklets, each about 100 pages long, listing the drugs each HMO says I can use to treat every disease and every diagnosis. When I’m seeing a patient every 12 to 15 minutes, there’s no way I can find out exactly which drug their insurer will approve," Slawson says.
Using InfoRetriever, in less than 40 seconds, he can find out which drugs an HMO approves for a particular condition. Then he can click again and get information on the drug’s dosage, side effects, and cost.
The drug formulary section gives practitioners information on how to download the information from their HMOs into the program. At UVA, it took a secretary about two hours to download the information, Slawson says.
The software currently is available for computers that run on Windows CE. The company is in the process of creating other packages for other types of hand-held computers.
"The current database is geared toward people in family practice or general practice. Our vision is to create a database of each specialty," Slawson says.
Developers of the program have formed a company called InfoPOEMS, Inc., which markets the program. POEMs stands for Patient Oriented Evi dence that Matters, Ebell says. The company also maintains a Web site containing journal articles, information on the InfoRetriever, and other information on evidence-based medicine.
To create the database, which is updated periodically, a team of physicians reads 92 medical journals containing about 1,500 articles each month. They review the information and include the valid information on the Web site and in the database.
People who want to try out the program without purchasing it can download it from the Web site and use it 30 times for free. The Web site address is www.infopoems.com.