Project Initiation Document


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Project Initiation Document

  1. 1. Knowledge in the palm of your hands; PDA’s in the clinical setting Project Initiation Document – phase 3 V1 08/08/04
  2. 2. Index 1. Introduction 2 2. Project overview 2 3. Project benefits 3 4. Project team 3 5. Work plan overview 3 6. Project initiation 4 7. Evaluation 4 8. Communication 4 9. Timetable 5 Appendix 1 Resources 6 included in the trial phase 1 & 2 2
  3. 3. 1. Introduction 1.1 Personal Digital Assistants (PDAs) are handheld computers that originally were designed as personal organizers. The basic features of a PDA are an address book, note pad, clock, calculator and email. The advantage of the PDA is the easy synchronization of information with the desktop – information transferred from the computer to the PDA when the PDA is plugged into the computer. 1.2 PDAs are increasingly being used in healthcare. In a recent survey1 of clinicians in Toronto 42% of general internists (mean age 46), 70% of housestaff (mean age 25) and 32% of family physicians (mean age 45) owned a PDA. Advanced features of the PDA include medical textbooks, drug reference books, journal table of contents, evidence based summaries and guidelines. In the Straus study1 the resources clinicians identified as useful for PDAs were 1.2.1 the clinical bottom line from pre-appraised resources, 1.2.2 management algorithms, 1.2.3 drug dosages and 1.2.4 numerical summaries. Clinicians did not want traditional practice guidelines on PDAs. 1.3 Handheld technology is emerging as an effective clinical tool to aid evidence-based practice and support the educational needs of clinicians. Through the use of handheld computers it is now possible to search for information at the bedside enabling information to be checked before decisions are taken with a resulting benefit to patient safety. The handheld provides a critical mass of information that is relevant, quickly accessible and in a coherent format: delivering clinical information at the point of need. 1.4 The University Hospitals of Leicester NHS Trust is now in the third phase of its handheld trials and the results of the trial so far reiterate the findings of previous research2 highlighting that use of content resources on the PDA is high when the resources provide management algorithms, drug dosages and guideline summaries. The addition of a patient information system that worked on a PDA added to the value and use of the PDA in the clinical setting. 1 Project overview 2.1 The knowledge in the palm of your hand project aims to 2.1.1 Identify the impact of handheld computers on patient care Identify how often the clinicians access the resources on handheld computers to inform their clinical decision-making. Identify which handheld resources are most useful to clinicians in the clinical setting Identify the barriers to using handheld resources to support patient care 2.2 The software will be evaluated in terms of: 2.2.1 Content 2.2.2 Accessibility 2.2.3 Ease of use (including an evaluation of the natural language query interface) 2.2.4 Relevance in the clinical setting – can questions arising in the clinical setting be answered via the software on the Palmtop 2.3 The project will offer the following 2.3.1 Products: 1 Straus SE et al 2001 Bringing evidence to the point of care [accessed 27/6/02]. 2 Straus SE et al 2001 Bringing evidence to the point of care [accessed 27/6/02]. 3
  4. 4. Full Dr Companion Professional delivered on a 256 MB SD card, including “Document Companion” software for transfer of individual material from a desktop computer to a PDA and Palm Tungsten E 2.3.2 Additional: Regional literature converted into PDA format according to agreement, Junior Doctors Handbooks and Leicestershire Prescribing Guideline. Included as well are 3 editions of the BNF and a free tutorial follow up clinic. 3. Project Benefits 3.1 Benefits to patients: Through the use of a handheld computer it is now possible to search for information at the bedside enabling information to be checked before decisions are taken with a resulting benefit to patient safety. 3.2 Benefits for junior doctors: Doctors cannot possibly carry in their memory all the information needed in everyday practice. The handheld provides a critical mass of information that is relevant, quickly accessible and in a coherent format. 3.3. Benefits for training: Providing reference texts and resources in an easily accessible format will support the learning of clinicians. 3.4 Benefits for management: It has been suggested that as many as every 15th doctor is employed because other colleagues are looking for paper bound information! Handheld computers transfers this “dead” administrative time into active patient related activities. The Commission for Health Improvement (CHI) may see that Handheld computers will reduce the hospital’s risk profile by providing clinical information at the point of need. 4. Project team The project team comprises: Project Manager: Claire Honeybourne, Library Services Manager, LGH Project team: Linda Ward, Clinical Librarian, LGH Sarah Sutton, Clinical Librarian Clinical Sciences Library, LRI (University of Leicester). 5. Work plan overview 5.1 Phase one of the trial used OVID@Hand, a product from Ovid technologies developed using the CogniQ platform from Unbound Medicine. The product has both a handheld component and a web-based “personal library” delivering some content to the users PDA and linking that content back to the larger OVID resources on the web. Users require access to a PC with a USB port and connection to the Internet and a handheld computer with a palm operating system. Apart from OVID, users were given the opportunity to download other free material from the web. As the library has a subscription to Micromedex the users downloaded the mobile version of Micromedex. All the users loaded Clinical Evidence and the free BMJ journals provided by CogniQ and as other Internet freeware was identified the websites were added to the library palm webpage. Fifteen participants completed phase one of the trial. For further details of the products included in the trial see Appendix 1 5.2 Phase two of the trial used Medhand International’s Dr Companion™ UK. UK recognised information sources are pre-loaded and stored on a secure digital (SD) card that plugs into the handheld computer and leaves the internal memory free 4
  5. 5. for the users own data and applications. Users do not need access to a PC or the web to use this tool. The handheld computer requires a palm operating system. Information sources loaded onto the beta version of this card were the BNF, Swedish Drug Interaction Module, Oxford Handbook of Clinical Medicine and Oxford Concise Medical Dictionary, Whittaker’s Instant Pictorial Anatomy, EBM Guidelines with links to Cochrane reviews, NICE guidelines, OPSC IV (classification of surgical procedures), eMedicines Compendium (full encyclopaedia of drugs registered in the UK), medical calculators from MedCalc, and the Leicestershire Prescribing Guide. In addition to Drs Companion, the GP was given access to the primary care patient information system, EMIS for the palm: PalmGP. This provides mobile patient record viewing & consultation recording with access to the full, up-to-date patient record on the Palm. All current & past drug lists, immunisations, allergies and attachments (e.g. radiographs) are synchronised to the palm and a secure log-on / auto lockout is in operation. Users require access to a PC with a USB port and the local EMIS system and a handheld computer with a palm operating system. Eleven participants completed phase two of the trial 5.3 Phase three of the trial began in August 2004 with 53 junior doctors undertaking the new Foundation Year training programme being issued with a Palm Tungsten E and Drs Companion on SD card. Foundation Year 1 will retain the handheld for the two years of their training. Foundation Year 2 will retain the handheld for the one year of their training programme. 6. Project initiation 6.1 The 50 junior doctors across the Leicestershire, Northamptonshire and Rutland (LNR) Strategic Health Authority (SHA) will be issued a handheld computer and SD card with Drs Companion at the Foundation Year Induction session. 6.2 The Baseline Data Questionnaire includes multiple-choice, Likert-type scale, and open-ended items and will be administered during the August 2004 Foundation Year Induction. 6.3 The project manager will meet with the participants to ensure that the software has been loaded correctly and provide guidance in how to use the palmtops. 6.4 The project manager will organise a series of training sessions to ensure that the participants are getting the most out of the software. 6.5. Drs Companion Software Company will attend a training session in October to provide further training to the participants. 6.6 The Knowledge in the palm of your hands website will provide a medium to deliver documentation relating to the project and links to help pages and email support. 6.7 A discussion list for the Foundation Year doctors will aid peer support in utilising the hardware and software. 7 Evaluation 7.1 Baseline Data Questionnaire. This questionnaire included multiple-choice, Likert- type scale, and open-ended items to identify participants’ prior use of handheld computers, information retrieval functions they perform and which of these functions they would like to transfer to the handheld computer. 7.2 End of phase Questionnaire incorporating baseline data questions plus specific questions about each resource used. 8. Communication plan 8.1 The project manager will make contact with the participants on a monthly basis. 8.2 The website will provide a constant link to participants and manage general problems and documentation requirements. 8.3 Participants will be able to discuss the project amongst themselves through an e- discussion group. 8.4 The project manager will liaise with Gail Rose at LNR postgraduate deanery to ensure that the deanery and colleagues at Strategic Health Authority are informed of the developments. 5
  6. 6. 8.5 The findings of the trial will be disseminated to colleagues at workshops, seminars and conferences. 8.6 The findings of the trial will be published in peer-reviewed journals. 9. Timetable Date Phase 3 FY1 issued with handheld computers, Drs Companion software, hire form, baseline data questionnaire 5 August 2004 FY2 issued with handheld computers, Drs Companion software, hire form, baseline data questionnaire 6 August 2004 Website updated with Foundation Year material 12 August 2004 Discussion list set up for participants 12 August 2004 HandBase version of PDP designed to monitor learning needs DatePak investigated to manage training dates for Foundation programme All participants met by Project manager for initial set-up 31st August 2004 Presentation to Health Libraries Group Conference Belfast 7th September 2004 Drs Companion visit for training session mid October 2004 1st interim project report to Postgraduate Dean February 2005 Decision on whether to extend the project March 2005 2nd interim project report to Postgraduate Dean July 2005 Final report to Postgraduate Dean July 2006 6
  7. 7. Appendix 1 Resources included in the trial phase 1& 2 Phase 1: OVID@Hand software Features Content Channels A to Z Drug Facts is an ideal resource for students and practicing clinicians. Using either the alphabetical or therapeutic class index, quickly access 700 full drug monographs, covering over 3500 new and orphan drugs. Monographs are divided into pharmacological and patient care considerations, and include indications, dosages, and side effects. Drug Interaction Facts Module contains all of the drug-drug and drug-food interaction information busy clinicians need. This sophisticated multi-check module covers more than 20,000 brand and generic drugs and more than 70 therapeutic classes. Lippincott’s Nursing Drug Guide is a must have for all student and practicing nurses in classroom and clinical settings, including home care. Using either the alphabetical or therapeutic class index, user can access 900 full drug monographs, covering over 3600 medications. Each monograph provides Medweaver Disease Profiles, users get immediate access to over 700 profiles of diseases and conditions, providing information on etiology, symptoms, associated terms & conditions and physical findings all on the handheld Access to Medline Journal Table of Contents with abstracts: AACN Clinical Issues: Advanced Practice in Acute & Critical Care AIDS Alcoholism: Clinical & Experimental Research Alzheimer Disease & Associated Disorders American Heart Journal American Journal of Cardiology American Journal of Clinical Oncology American Journal of Dermatopathology American Journal of Forensic Medicine & Pathology American Journal of Infection Control American Journal of Medicine American Journal of Nursing American Journal of Obstetrics & Gynecology American Journal of Physical Medicine & Rehabilitation American Journal of Physical Medicine & Rehabilitation American Journal of Psychiatry American Journal of Public Health American Journal of Surgery American Journal of Surgical Pathology American Journal of the Medical Sciences Anesthesia & Analgesia Anesthesiology Annals of Emergency Medicine Annals of Internal Medicine Annals of Surgery Annals of Surgical Oncology Anti-Cancer Drugs Applied Immunohistochemistry Archives of Dermatology Archives of General Psychiatry Arteriosclerosis, Thrombosis & Vascular Biology ASAIO Journal 7
  8. 8. Behavioural Pharmacology BJU International – Supplement BJU International Blood Coagulation & Fibrinolysis Blood Pressure Monitoring BMJ British Heart Journal British Journal of Dermatology, Supplement British Journal of Dermatology British Journal of Haematology Supplement British Journal of Haematology British Journal of Psychiatry British Journal of Surgery – Supplement British Journal of Surgery British Journal of Urology – Supplement British Journal of Urology Cancer Nursing Chest Circulation Research Circulation Clinical Journal of Pain Clinical Journal of Sport Medicine Clinical Neuropharmacology Clinical Nuclear Medicine Clinical Obstetrics & Gynecology Clinical Orthopaedics & Related Research Clinical Pharmacology & Therapeutics CMAJ: Canadian Medical Association Journal Computers in Nursing Cornea Coronary Artery Disease Critical Care Medicine Current Opinion in Anaesthesiology Current Opinion in Clinical Nutrition & Metabolic Care Current Opinion in Critical Care Current Opinion in Endocrinology & Diabetes Current Opinion in Gastroenterology Current Opinion in Hematology Current Opinion in Infectious Diseases Current Opinion in Lipidology Current Opinion in Nephrology & Hypertension Current Opinion in Neurology Current Opinion in Obstetrics & Gynecology Current Opinion in Oncology Current Opinion in Ophthalmology Current Opinion in Organ Transplantation Current Opinion in Orthopedics Current Opinion in Otolaryngology & Head & Neck Surgery Current Opinion in Pediatrics Current Opinion in Psychiatry Current Opinion in Pulmonary Medicine Current Opinion in Rheumatology Current Opinion in Urology Diabetes Diagnostic Molecular Pathology Ear & Hearing Epidemiology European Journal of Cancer Prevention European Journal of Gastroenterology & Hepatology Fertility & Sterility 8
  9. 9. Gastroenterology Nursing Genetics in Medicine Gut Health Physics Heart & Lung: Journal of Acute & Critical Care Heart Hypertension International Anesthesiology Clinics International Journal of Gynecological Pathology International Journal of Pharmaceutical Medicine International Ophthalmology Clinics Investigative Radiology JAMA Journal for Nurses in Staff Development – JNSD Journal of Acquired Immune Deficiency Syndromes Journal of Advanced Nursing Journal of Allergy & Clinical Immunology Journal of Assisted Reproduction & Genetics Journal of Bone & Joint Surgery - American Volume Journal of Bone & Joint Surgery - American Volume Journal of Bone & Joint Surgery - British Volume Journal of Cardiopulmonary Rehabilitation Journal of Cardiovascular Pharmacology Journal of Cerebral Blood Flow & Metabolism Journal of Clinical Endocrinology & Metabolism Journal of Clinical Gastroenterology Journal of Clinical Investigation Journal of Clinical Neurophysiology Journal of Clinical Nursing Journal of Clinical Oncology Journal of Clinical Pathology-Clinical Molecular Pathology Edition Journal of Clinical Pathology Journal of Clinical Psychopharmacology Journal of Computer Assisted Tomography Journal of ECT Journal of Endodontics Journal of Family Practice Journal of General Internal Medicine Journal of Hypertension Journal of Immunotherapy Journal of Infusion Nursing Journal of Intravenous Nursing Journal of Investigative Dermatology. Symposium Proceedings Journal of Investigative Dermatology Journal of Medical Microbiology Journal of Nervous & Mental Disease Journal of Neurology, Neurosurgery & Psychiatry Journal of Neurosurgical Anesthesiology Journal of Nursing Administration Journal of Nursing Staff Development Journal of Occupational & Environmental Medicine Journal of Orthopaedic Trauma Journal of Pediatric Gastroenterology & Nutrition Journal of Pediatric Hematology/Oncology Journal of Pediatric Orthopedics Journal of Pediatrics Journal of Spinal Disorders Journal of the American Academy of Child & Adolescent Psychiatry Journal of Thoracic Imaging Journal of Trauma-Injury Infection & Critical Care 9
  10. 10. Journal of Urology Journal of Vascular & Interventional Radiology Kidney International – Supplement Kidney International Laboratory Investigation Laryngoscope Lippincott's Case Management Mayo Clinic Proceedings MCN, American Journal of Maternal Child Nursing Medical Care Medicine & Science in Sports & Exercise Medicine Melanoma Research Menopause Modern Pathology Molecular Pathology Nature Neurology Neurosurgery Nuclear Medicine Communications Nurse Educator Nursing Case Management Nursing Management Nursing Research Nursing Standard Obstetrical & Gynecological Survey Ophthalmic Plastic & Reconstructive Surgery Optometry & Vision Science Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, & Endodontics Outcomes Management for Nursing Practice Pancreas Pediatric Emergency Care Pediatric Infectious Disease Journal Pediatric Research Pharmacogenetics Plastic & Reconstructive Surgery Psychiatric Genetics Psychological Medicine Psychosomatic Medicine QJM Sexually Transmitted Diseases SGIM Forum Soil Science Spine Stroke Surgical Laparoscopy, Endoscopy & Percutaneous Techniques Therapeutic Drug Monitoring Thorax Topics in Magnetic Resonance Imaging Transplantation ConiQ software PDAs The CogniQ software delivers to your handheld: 1) quick-reference sections of Clinical Evidence: Clinical evidence provides brief summaries of the state of evidence on certain topic areas. Topic areas are selected based on research3 that identified important clinical questions. The 3 Ely JW, Osheroff JA, Ebell MJ, et al. Analysis of questions asked by family doctors regarding patient care. BMJ 1999;319:358-361. 10
  11. 11. team at BMJ then searches for and summarise the best available evidence to answer these questions. Clinical evidence is up-to-date, quantified and referenced. 2)and the latest table of contents and abstracts from the BMJ and BMJ Specialist Journals: Thorax Heart Archives of Diseases in Childhood BMJ Gut Journal of Clinical Pathology Western Journal of Medicine Quality in Health Care British Journal of Sports Medicine British Journal of Ophthalmology You can request the full text for content of interest; on synchronization, the requests are sent to your personal library on the web where you can link to the full text of Clinical Evidence and BMJ journals as well as perform sophisticated searches of MEDLINE. CogniQ is compatible with Palms only, but will be available for Pocket PCs soon. Micromedex provides a mobile section of its databases: The Drug information component includes dosing, drug interactions, adverse effects, administration, how supplied, pregnancy warnings, lactation, indications, contraindications, therapeutic class, and brand information. No charge to subscribers! The Alternative Medicine information module includes dosing, administration, how supplied, indications, contraindications, adverse effects, drug interactions, therapeutic class, pregnancy, and lactation for herbals, vitamins, minerals and other dietary supplements. The Acute Care information component includes treatment, diagnosis, and key point information. The Toxicology information module includes clinical effect, treatment, and range of toxicity information Phase two: Dr Companion beta version. Drs Companion, apart from providing the world’s largest reference database for PDA’s, is helping Trusts to get started by converting their local guidelines, recommended drug list and other information into the Dr Companion architecture. The Drs Companion includes: BNF, an encyclopaedia of drug interactions, Oxford Handbook of Clinical Medicine, Oxford Handbook of Clinical Specialties. Oxford Concise Medical Dictionary, Whitaker’s Instant Pictorial Anatomy, EBM-Guidelines with treatment recommendations directly linked to Cochrane and other Sources, NHS NICE Guidelines, ICD 10 with direct links to and from DSM IV TR Quick Reference, Classification of Surgical Procedures (OPSC IV), Medical Calculators module (approximately 70), eMC Medicines Compendium, (the full encyclopaedia with most of the drugs registered in UK, Document Companion This is a full system for document deployment where multiple users can maintain and distribute hierarchic documents with full pictures and table support from a server or individual computers over a network or by e-mail. Examples include Lecture Notes, Administrative Routines, On-call Schedules, Specific Department Related Procedures Local documents including the University Hospitals of Leicester Junior Doctor handbooks and the Leicestershire Prescribing Guide. 11
  12. 12. PalmGP – EMIS. primary care patient information system, EMIS for the palm: PalmGP. This provides mobile patient record viewing & consultation recording with access to the full, up-to-date patient record on the Palm. All current & past drug lists, immunisations, allergies and attachments (e.g. radiographs) are synchronised to the palm and a secure log-on / auto lockout is in operation. Users require access to a PC with a USB port and the local EMIS system and a handheld computer with a palm operating system. 12