Most of us can still recall the days of heavy lab coats with pockets bulging at the seams from the multiple books and manuals that every resident in training carried. Your status in the hierarchy of medicine was often determined not only by the length of your coat but by how few books you had to carry with you. Those days of pocket prolapse are becoming a distant memory as we usher in the era of the Personal Digital Assistant (PDA).
Although physicians’ PDA adoption rate is much faster than the general public the majority still use them simply as a replacement for the Little Black Book. However, the younger generation of physicians are now embracing PDAs not only as planners but as a true medical resource device. A PDA or Smart Phone smaller than your hand can carry dozens of books or even allow you to access the online resources of a medical library via the Internet. The smaller screen size makes reading sizable articles a bit of a pain but is perfect for a quick consultation or to double-check drug dosing. This month in Tech Doc we’ll look at one of top PDA applications in emergency medicine: PEPID.
PEPID has been around for several years now in various forms and on various devices but it has just recently found its way to the iPhone. Up until a year ago the iPhone was a closed platform and as such no outside apps were allowed, so the only way to access PEPID was via the internet which was slow and a major battery drain. A few months ago, however, PEPID became an approved iPhone app, allowing you to install and run it directly off of your iPhone’s RAM, which improved the speed and freed you up from the need for a web connection.
PEPID is, in my opinion, the premier product for emergency medicine on the iPhone. It is the quintessential replacement for an EM pocket manual. PEPID is organized by chapters just as you’d expect from any pocket reference and has a fully searchable database allowing quick access to any topic. But where PEPID really flexes its digital muscle is in the integration of its drug database, medical calculator, drug interactions, medical dictionary, and illustrations. Search for a disease and you will get an indexed page ranging from diagnosis and history to treatment and differential. Within the body all of the drug dosing is hyper-linked so that clicking on it takes you to the appropriate medication with contraindications, precautions, dosing, overdose management, etc. If there is a clinical rule or score associated with the diagnosis, a simple click brings you out to a tool so you can calculate your score and then return to the body with a back click. PEPID also links to evidence-based literature provided through Best Evidence in Emergency Medicine (BEEM). This linking works throughout the product and is what sets PEPID apart from most if not all of its emergency medicine competitors allowing you the ability to diagnose, devise a differential and workup, set up a treatment plan, and finally a disposition, all within the same product.
The illustrations in PEPID range from anatomical to ECG tracings and procedures letting the user compare and contrast the picture with what is in front of them. While this may not be reassuring to the patient it can help tremendously with an uncommon procedure or diagnosis. The illustrations are well done and helpful and the content is fairly extensive (at least by EM standards) including special sections for weapons of mass destruction, disaster medicine, and critical care. Another great item built into PEPID is the drug interaction tool, which allows you to enter multiple medications and then see what interactions might occur with their combination. The latest edition also offers a complaint-oriented differential diagnosis tool (which I have not had time to fully utilize).
With all of its positives PEPID is still not a perfect product. Due to the size of PEPID’s database, searching is a little on the slow side, at least as measured by my personal patience meter. You search by typing one letter at a time and there is about a half-second delay between entering letters. Combine this with the iPhone’s soft keyboard and a simple search can often lead to frustrating and second-wasting mistakes. Also a pro/con of PEPID is that it is a subscription-only product and a little on the spendy side at $240 for 14 months (slightly less per month if you get a longer subscription). The subscription model is great in that PEPID’s frequent updates are automatically offered up to you through the iTunes store, but unlike a hard-copy text, once your subscription is up you can no longer access the product unless you renew. All in all PEPID is THE product to have on your iPhone (or other PDA) when in the ED or stranded on a desert island. Just don’t let your subscription lapse.
Extensive database, nice images, one product to rule them all (this one does about everything)
Cons: Expensive, a tad slow, when your subscription is up your hands are empty
www.pepid.com for more information
Disclosure: Jason Wagner is a content editor for the Thoracic Trauma Chapter of PEPID for which he receives a free subscription to the product