The iPod Touch Medical PDA: Foot in the Door

Several months ago, I wrote about my plan to use my new iPod Touch as a medical PDA in lieu of purchasing a PDA phone and using the outdated Palm OS or the volatile Windows Mobile OS. So far, I have been quite pleased with the results and can report, at the very least, marginal success in my use of the device. My fiancée and a classmate/friend have both followed the same path to the use of an iPod Touch as a medical PDA. Here are the details:

Advantages

1. Flexibility – Both the iPod Touch and the iPhone have a considerable amount of flexibility with respect to the content that can be placed on the device. With the arrival of Apple’s App Store, it is now possible to install a variety of programs onto either device that can expand their range of uses and the range of storable content. Several programs offer the ability to store, organize, and view PDFs, Microsoft Office documents (Word, Excel, Powerpoint), videos, images, and sound files. The devices themselves already have built-in capabilities provided with Apple efficiency through iTunes for viewing images (Photos – which I use for medical images from Gray’s Anatomy, Netter’s Anatomy, and Access Medicine, including Chest X-Ray reading guides), videos (Videos – which I use for NEJM Procedure Training videos, and also downloaded movies and TV shows for long plane flights), and sound (Music – which I use for music and more recently podcasts from NEJM audio interviews, Johns Hopkins Medical School discussing new studies, from Discover Magazine’s Vital Signs discussing mysterious medical cases, and from Coffeebreak Spanish to begin learning Spanish). When I discussed potential options with my fiancée for her desired new device, she spoke of how an Apple device in particular would do wonders for adding new functionality to her lifestyle: providing video/audio entertainment during gym workouts, allowing her to store cooking/baking recipes in a single location that can be readily consulted in the grocery store, etc.

2. Financial Savings – This advantage may be more tenuous, depending on how one uses the device. The iPod Touch cost me $300 to purchase, and I have since spent another $40 on iTunes App Store applications (Netter’s Neuroscience Flash Cards) to expand its uses as a medical PDA. Several programs I use as medical references are free, however: Epocrates Rx (the program I consult 20-30 times each day to look up generic names and pharmacologic classes of medications, drug prices, adverse reactions, and interactions between two or more drugs), Eponyms (a neat little program providing concise descriptions of a vast number of diseases and clinical signs with eponyms), and Unit Convertor (for changing Celsius to Fahrenheit and vice verca, since temperatures are often recorded on the same day in either modality depending on the thermometer used). Similarly, I have been able to store PDFs from Access Medicine on the device including reference materials from Harrison’s Internal Medicine, Current Diagnosis and Treatment, and Current Consult, as well as assorted files including the Walmart $4 prescription list. This has thus far allowed me to avoid having to purchase an expensive new data plan, a yearly subscription to Epocrates Essentials, new copies of pocket pharmacopeias and medical references, etc.

Disadvantages

1. New Device with Limited Medical Software Repertoire – Since the iPhone/iPod Touch is new to the market, medical software companies are still taking their time to convert their packages to these devices. Epocrates did an excellent job of making Epocrates Rx available at the opening of the App Store in July, but it has not yet provided versions of its Essentials software which would be desirable for medical professionals with less time to customize and seek out free content.

Nonetheless, Epocrates Rx, as one of the most readily updatable pharmacopeias, has given me an edge in providing my medical teams with up-to-date knowledge on medications, their prices, and interactions they might have with other drugs (the program has a handy Interaction Checker in which you can input several drugs, and it will determine any possible interactions), something the pocket pharmacopeias do not provide as well (despite being a few seconds quicker to access).

I have also found the use of Epocrates Essentials by my colleagues to be of limited use so far: the information is usually accessed on a mobile device in the context of pimping, but I don’t think it necessary looks particularly good to be asked a knowledge question and immediately pull out one’s PDA. I feel much more comfortable saying “I don’t know,” learning from the attending physician or resident, and then reading up more about the disease, clinical sign, or treatment method at home. Using medical software for guiding treatment can usually be done at the computers provided at the Nursing desks or elsewhere in the hospital, all of which should usually have access to UpToDate and similar high-quality, online medical resources. By the nature of most medical PDAs running Palm or Windows Mobile OS, the information provided by mobile medical software packages has to be more concise and abbreviated, which might not always be useful in the context of guiding subtle treatment decisions.

Unbound Medicine has opened access to its “medical software” (Harrison’s, 5-Minute Consult, etc.) to the iPhone/iPod Touch, but these packages require the Safari browser and an internet connection. For me with my WiFi-only iPod Touch in WiFi-scarce hospital areas, it makes more sense to rely on downloadable information.

2. Single Carrier – One of the reasons I chose the iPod Touch over the iPhone is to avoid having to switch cell phone carriers. While I am not pleased by the business model, expensiveness, and general lack of user friendliness of Verizon Wireless (my current carrier), the service has the best signal in the hospitals in which I work. Personally, I find that it is very frustrating (and seemingly unprofessional) when I call someone and consistently receive their voice mail because they lack cell phone signal. Frankly, I don’t want to be that person. However, AT&T is the only carrier for the iPhone right now, and their cell phone reception is very poor in virtually all of the areas in which I work. This limits the utility of the cell phone and Internet-based capabilities of the device.

Summary

Overall, my experience has been quite good, and I have found that between my iPod Touch and Pocket Medicine, I can cover most of my information needs (occasionally supplemented with a small field-specific reference, such as for Psychiatry, my current rotation). I look forward to what the future has to offer for these devices! (Already, there are several EMR/EHR and radiological imaging viewing packages.)

My iPod touch allows me to:

Medical
• Access the most up-to-date, user-friendly, and free drug database I am aware of – Epocrates Rx
• Reference anatomy and neuroanatomy resources – Netter’s Neuroanatomy, images from Gray’s and Netter’s Anatomy
• Quickly convert units – Unit Convertor
• Manage work tasks – iProcrastinate Mobile
• Locate inpatient and outpatient work sites – Apple’s Maps
• Learn medical procedures such as inserting femoral venous catheters and performing lumbar punctures – Videos – NEJM Procedure videos (downloaded)
• Stay up to date with recent studies and medical news – NEJM audio interviews, Johns Hopkins PodMed medical news discussion podcast, Discover magazine’s Vital Signs medical mysteries podcast

Life Management
• Keep a tight Calendar that syncs with iCal on my laptop – Apple’s Calendar
• Check, manage, and reply to e-mails within WiFi range – Apple’s Mail
• Surf the web and check my RSS Feeds – Apple’s Safari browser
• Check the weather and storm alerts – WeatherBug
• Write and post blog posts away from home – WordPress app
• Set recurrent alarms, use a stop watch – Apple’s Clock
• Maintain a contact database that syncs with Address Book on my laptop – Apple’s Contacts
• Write notes – Apple’s Notes
• Stay in contact with friends using Twitter and the Facebook – Twitterific, Facebook app
• Learn Spanish – Coffeebreak Spanish podcast
• Read Associated Press news offline – Mobile News app
• Use a tip calculator – Tip

For Fun
• Use language references for learning – LastMinute Spanish/French/German/Italian, Lonely Planet Mandarin
• Play weekly crossword puzzles – 2 Across (I blame my fiancée for getting me into this)
• Play random games – Sol Free (solitaire), Jawbreaker, Cube Runner
• Watch YouTube – YouTube built-in app
• Watch movies and TV shows – Videos (downloaded content)