NEED DRUG INFORMATION? There s an app for that

Transcription

1 NEED DRUG INFORMATION? There s an app for that Conor Hanrahan, PharmD, BCPS Drug Information Specialist Intermountain Healthcare conor.hanrahan@imail.org April 16, 2015 DISCLOSURES Conor Hanrahan has no financial or personal relationships to disclose Will not discuss off-label uses OBJECTIVES Explain the role of mobile applications in medical practice. Explain current standards and regulations used to manage mobile medical applications. Describe key critical assessment skills needed to effectively evaluate a drug information resource. Identify mobile drug information applications that are beneficial for pharmacists in their practice setting. 1

2 4/13/15 DISCLAIMERS Mobile apps are changing rapidly Will only discuss apps focused on providing drug information The apps included do not represent an exhaustive list Images courtesy of GROWTH OF MEDICAL APPS Estimated 20,000 to 40,000 medical apps 44-million mobile health app downloads in 2012 Over $1.3 billion in annual revenue Projections 500-million people will use a medical app by 2015 Over $20 billion in mobile health sales by 2017 Student BMJ. 2012;20:e2162. Evid Based Med Jun;18(3):90-2. AAMC Reporter Available from: [click here] 2

3 SCOPE OF MEDICAL APPS Search medication databases View guidelines and consensus statements Educate patients, students, residents, etc. Perform medical calculations Assist with diagnosis and treatment decisions Remotely monitor patients DEVELOPERS OF MEDICAL APPS Individuals (medical and non-medical) Pharmaceutical companies Insurance companies Non-profit and for-profit organizations Governmental bodies BENEFITS Real-time information at the patient s bedside Improved communication Improved efficiency Better clinical decision making Visser BJ, et al. Student BMJ. 2012;20:e2162. Buijink AW, et al. Evid Based Med Jun;18(3):90-2. Mosa AS, et al. BMC Med Inform Decis Mak Jul 10;12:67. 3

4 POTENTIAL DANGERS Inaccurate, misleading, or unreliable information Pfizer rheumatology calculator app recall Apps for melanoma detection Apps for cancer information J Canc Educ. 2013;28: JAMA Dermatol Apr;149(4): Evid Based Med Jun;18(3):90-2. POTENTIAL DANGERS Lack of involvement from medical professionals Opioid conversion apps 52% were not associated with a health care professional 35% did not recommend empiric dose reduction Haffey F, et al. Drug Saf. 2013;36: Buijink AW, et al. Evid Based Med Jun;18(3):90-2. GOVERNMENT OVERSIGHT Limited regulation of medical apps Food and Drug Administration Finalized guidance for mobile medical apps in 2013 Outlines how regulatory authority will be applied Certain apps will be considered a medical device FDA Guidance: Mobile Medical Applications, Available from: [CLICK] 4

5 REGULATED APPS Control other medical devices Display, store, analyze, or transmit patient-specific medical data from another medical device Use attachments, display screens, or sensors to transform the mobile platform into a device Perform patient-specific analyses and provide a patientspecific diagnosis or treatment recommendation FDA Guidance: Mobile Medical Applications, Available from: [CLICK] ENFORCEMENT DISCRETION Provide or facilitate supplemental care by coaching or prompting patients Tools to help patients organize or track health information Provide access to information related to health conditions or treatments Allow patients to communicate medical conditions with providers Perform simple calculations used in clinical practice Enable individuals to interact with electronic health records FDA Guidance: Mobile Medical Applications, Available from: [CLICK] NOT REGULATED BY FDA Electronic copies of medical textbooks, teaching aids, or other reference materials Intended as educational tools for medical training Facilitate patient access or understanding Automate general office operations Not specifically designed for medical purposes FDA Guidance: Mobile Medical Applications, Available from: [CLICK] 5

6 QUESTION 1 Which of the following is an example of a mobile medical app that would require approval as a medical device by FDA? A. An app that provides pharmacists access to treatment guidelines from the American Diabetes Association. B. An app that lets a patient with type I diabetes control the flow rate of his or her insulin pump. C. An app that helps remind a patient to take his or her diabetes medication. D. An app that provides medical residents with general, non-patient specific dosing information for common diabetes medications. A Roadmap for EVALUATING APPS USEFULNESS Can you see it being useful in your daily work? Is it relevant to your scope of practice? Will it make your job easier or more efficient? 6

7 ACCURACY Is the clinical content based on evidence? Is the content referenced? Are the references appropriate? Do you consider the content to be complete and comprehensive? ACCURACY Qx Calculate (QxMD Medical Software) Critical Care Emergencies (Anna Chan) AUTHORITY Are the creators or developers reputable? Are the creators medically trained or content experts in the area? Consider doing a literature search What other apps have they developed? Is their contact information available? 7

8 AUTHORITY Anticoag Evaluator (American College of Cardiology) Coagulate (LJ Cubed Apps) AUTHORITY Can be difficult to find Check the download page or developer page Check within the app OBJECTIVITY Is the content fair and balanced? Does the app show multiple view points? Could the developer be biased? Does the app use clinical data for promotional purposes? 8

9 OBJECTIVITY iclot (Cranworth Medical Ltd.) TIMELINESS Does the clinical content reflect the most recent information? Is the app updated regularly? Manual or automatic updates Version history on download page TIMELINESS Lexicomp (Lexi-Comp, Inc.) Micromedex (Truven Health Analytics) 9

10 FUNCTIONALITY Does the app install, launch, and operate consistently? Does the app freeze? Does material download appropriately? Are there technical glitches? FUNCTIONALITY Pharmacist s Letter (Therapeutics Research Center) DESIGN Does the design add to or hurt functionality? Are graphics, layout, and terminology consistent? Is text sized and spaced appropriately? Are things presented in a clean, uncluttered way? Are buttons easy to understand? 10

11 DESIGN Pharmacist s Letter (Therapeutics Research Center) Medscape (WebMD) SECURITY Is the app free of malicious software? Is there a privacy statement? Is personal information protected? HIPAA compliance? VALUE How much does the app cost? Is the price reasonable compared with other products? Do the overall benefits outweigh the limitations? 11

12 4/13/15 VALUE Tarascon Pharmacopeia (USBMIS, Inc.) Medscape (WebMD) ADDITIONAL RESOURCES imedicalapp.com MedicalAppJournal.com QUESTION 2 You are evaluating a mobile app designed to help you choose an appropriate chemotherapy regimen. Which one of the following apps would be considered the MOST appropriate to use? A. An app developed by an oncology fellow that references national treatment guidelines, but has not been updated since B. An app developed by a computer scientist from the Massachusetts Institute of Technology (MIT), which references various chemotherapy textbooks. C. An app developed by the National Comprehensive Cancer Network (NCCN) that is updated weekly and references current treatment guidelines and primary literature. D. An app that references current treatment guidelines, is updated monthly, but does not provide any information regarding authorship. 12

13 Image: DRUG INFO General Resources OVERVIEW OF APP RESOURCES Lexicomp Micromedex Clin Pharm Epocrates Medscape Skyscape Adult General DI* Pediatric General DI* Drug Interactions Drug Identificaiton IV Compatibility Calculators Toxicology Data storage Device Device Device Device Device** Device Systems * Includes drug dosing, adverse effects, warnings, contraindications, pharmacokinetics, preparations, etc. ** Can also choose to keep data stored on the Internet instead of the device Minimal information included within drug monographs 13

14 APP DRUG MONOGRAPHS Lexicomp Micromedex Clin Pharm Epocrates Medscape Skyscape Uses Dosing Administration Side Effects Cautions Monitoring Interactions MOA ADME Storage Dosage Forms Drug Pricing ADME = absorption, distribution, metabolism, and excretion; MOA = mechanism of action LEXICOMP DATABASES Lexi-Drugs Pediatric & Neonatal Lexi-Drugs Lexi-IV Compatibility Lexi-Interact Lexi-Drug ID Lexi-CALC LEXI-DRUGS 14

15 LEXI-DRUGS Charts and special topics Chemotherapy regimens Black box warnings REMS medication list LEXI-INTERACT Severity, onset, and documentation Summary and detailed discussion Management strategies References available LEXI-IV COMPATIBILITY Based on Trissel s IV-Chek Y-site, syringe, and admixtures Summary of studies Individual drug properties References available 15

16 LEXICOMP PRICING Software packages from $115 to $595 per year Individual databases for $75 each per year LEXICOMP SUMMARY Reputation Strengths Thorough information that is easy to comprehend Comparable with the online database Easy/intuitive interface Limitations Manual updates Some awkward formatting on small screens Expensive Drug Information Drug Interactions IV Compatibility Pediatric Essentials NeoFax Essentials MICROMEDEX APPS 16

17 MICROMEDEX MONOGRAPHS MICROMEDEX INTERACTIONS Severity, onset, and documentation Summary Clinical management Full references not available MICROMEDEX COMPATIBILITY Based on Trissel s 2 IV Compatibility database Y-site and admixtures Study details but no specific references 17

18 MICROMEDEX PRICING Free to institutional/online subscribers (need code) $2.99 to $30 per year for individuals MICROMEDEX SUMMARY Strengths Reputation Inexpensive Easy to use and navigate Automatic updates Limitations Drug information is basic Lacks features found in similar products Separate app for each database CLINICAL PHARMACOLOGY Drugs Interactions 18

19 4/13/15 CLIN PHARM MONOGRAPHS DRUG INTERACTIONS Severity and documentation Summary Clinical management Full references not available CLIN PHARM PRICING Only available to institutional/online subscribers (need to create username and password) 19

20 CLIN PHARM SUMMARY Strengths Very simple interface Detailed drug monographs Reputable reference Free Limitations Missing other databases/ resources Interaction checker helpful, but not as detailed Monographs can be text heavy EPOCRATES RX DATABASES Drugs Interaction Check Pill ID Calculators Drug Tables EPOCRATES DRUGS 20

21 EPOCRATES INTERACTION CHECK Simple interface Minimal information on effect and management No references OTHER NOTABLE RESOURCES Tables and special drug topics Drug manufacturer directory EPOCRATES PRICING Epocrates Rx is free Must register for an account Epocrates Essentials is $160 per year 21

22 EPOCRATES SUMMARY Strengths Very simple interface Several unique resources Free Limitations Drug monographs are basic compared with other products Lacks information on IV administration and compatibility Interaction checker lacks detail and references MEDSCAPE DATABASES Drugs Interaction Checker Calculators MEDSCAPE DRUGS 22

23 MEDSCAPE INTERACTION CHECKER Simple interface Minimal details Vague or no management suggestions No references Free MEDSCAPE PRICING Must register for an account MEDSCAPE SUMMARY Strengths Relatively detailed drug information Monograph information is easy to read Intuitive interface Limitations Little detail in drug interaction checker Content not referenced Advertisements Free 23

24 SKYSCAPE / OMNIO DATABASES SkyscapeRx Interaction Checker Calculator (Archimedes) (ipad) SKYSCAPERX SKYSCAPE INTERACTION CHECKER Uses data from Hansten and Horn s Drug Interactions Often lacks specific management strategies No references 24

25 SKYSCAPE / OMNIO PRICING RxDrugs and Interaction Checker are free Must register for an account Other in-app drug resources can be purchased SKYSCAPE SUMMARY Strengths Relatively detailed drug information Monograph information is easy to read Free Limitations Little information on administration, monitoring, and storage Basic information in drug interaction checker QUESTION 3 You are rounding with your internal medicine team when one of the residents asks you which mobile drug app would be best to use for general drug information on rounds. You correctly tell him which of the following? A. To use Epocrates because it is free and contains detailed information on dosing, adverse effects, and IV administration. B. To use Medscape because it is internally referenced and has supplemental tools, such as an IV compatibility checker. C. To use Micromedex because it contains the same detailed DRUGDEX information found in the online version. D. To use Lexicomp because it contains detailed information, is internally referenced, and has an intuitive user interface. 25

26 4/13/15 OTHER APPS General Drug Information DRUG INFO Infectious Diseases SUMMARY Drug information apps can be an important clinical tool Use and prevalence will continue to increase It is important to critically evaluate apps before using them in clinical practice 26

27 HAVE QUESTIONS? There s probably an app for that too Conor Hanrahan, PharmD, BCPS Drug Information Specialist Intermountain Healthcare conor.hanrahan@imail.org 27