Epocrates Essentials: is the expanded product an improvement?

Journal of Family Practice, Jan, 2005 by Gary N. Fox, Kaleem U. Gill, R.E. Music

Epocrates (www2.epocrates.com) is a well-known drug database for handheld personal digital assistants (PDA). Since its introduction about 5 years ago, Epocrates has mushroomed. The latest, most complete PDA version is Epocrates Essentials. System requirements for Essentials are listed in Table 1. Table 2 compares Epocrates' stand-alone components for PDAs with its latest "fully bundled" Essentials program. In this article we review the Palm-OS version only; a Pocket PC version was launched in November.

Essentials, which adds sections on diagnoses and laboratory values to Epocrates Pro, is a valuable tool, especially for medical trainees and allied health professionals. In our opinion, though, Epocrates Pro is still the gem in the Epocrates suite of offerings. To recommend Essentials to experienced clinicians as enthusiastically as we do Epocrates Pro, we will need to see further refinement of the diagnosis and lab sections.

* SETTING BASIC PREFERENCES AND LEARNING NAVIGATION

Essentials' on-screen presentation (Figure 1) is a series of tabs across the top, allowing users to select with a stylus tap the component of interest: drugs (Rx), diagnoses (Dx), laboratory values (Lab), infectious diseases (ID), Tables, and Tools.

[FIGURE 1 OMITTED]

Rx, Dx, ID, and Lab are integrated with hyperlinks. For example, if a user starts in Lab with "BNP"--which is also listed alphabetically under "brain natriuretic peptide" and "B-type natriuretic peptide"--its interpretation section lists causes of a high test result, including congestive heart failure, renal failure, and medications. For each of these causes, users can hyperlink to the corresponding monograph in the Dx or Rx section. After viewing the monograph, tapping the "back arrow" returns users to "BNP." Tables and Tools are independent components not linked with the others.

Epocrates extensively employs scrolling alphabetic pick lists. As each successive letter of a word is selected, users see the alphabetic listing scroll to the corresponding section. In many sections, users can add their own annotations ("Notes").

"Preferences" allows users to select a preferred starting tab and, for each section, a preferred opening view. For example, a user might choose to open on the "Rx" screen, the alphabetic drug list (or the "by class" drug list), and--once a drug monograph is selected--an opening view of adult dosing (or pediatric dosing or contraindications, and so on).

* MAJOR INFORMATION HEADINGS Drugs (Rx)

The "killer app" of Epocrates has been (see JFP 2001; 50:807, 811-813), and still is, its extraordinarily friendly point-of-care drug database. Epocrates Pro lists not only most prescription drugs used in primary care (more than 3000) but also the more common herbal/alternative preparations (more than 400) and some common nonprescription products (eg, dextromethorphan, pseudoephedrine).

Ease in writing prescriptions. With the scrolling alphabetic pick list and well-laid design, users can enter the first few letters of a drug name and, with a couple of stylus taps, access sufficient information to complete a prescription. Useful elements include medication forms, adult and pediatric dosages, frequency, timing, renal and hepatic dosage adjustments, pregnancy class, a synopsis of adverse reactions, how supplied, and cost, plus "Notes" for user annotations.

Identifying drug-drug interactions. Users can enter multiple drugs into a list and run a paired drug-drug interaction check for a multitude of agents. For each identified interaction, users can elect to see a sentence or 2 of detail.

Viewing health plan formularies. Epocrates supports a number of formularies. To be listed, health plans pay a fee that covers incorporating the formulary into Epocrates and keeping it updated. Users select which formularies to download. With each formulary selected, a drug's formulary status (eg, "Tier 1," or "preferred," and so on) becomes clearly visible on screen. There is even a utility to find preferred or covered alternatives for non-formulary drugs (Figure 2). Users also have a "No Formulary Selected" option.

[FIGURE 2 OMITTED]

Reviewing approved and nonapproved uses. Epocrates lists FDA-approved indications for each drug, each listing followed by dosage, because dosage my vary by indication (eg, higher doses of antiviral drugs for herpes zoster than herpes simplex). Some common but not FDA-approved uses for medications are listed and are marked by an asterisk to identify this status.

Searching drug classes. As an alternative to the alphabetic drug listing, users can choose (via 1 tap) to list drugs "by class." When using the latter, users successively drill down to find the drug of interest. For example, first choosing "Gastrointestinal" and then "PPI" (proton pump inhibitors) generates a list of available PPIs.

Calculating pediatric dosages. From the pediatric dosing section in Rx, users can hyperlink to a drug dose calculator (Figure 3). The user enters a choice of dosage (mg/kg/d), the patient's weight (in pounds or kilograms), and the dosing frequency (and, if an oral liquid, the concentration), then presses "Calculate" and a per dose amount in mg (or mL if liquid) appears. For example, choosing "amoxicillin," then "peds dosing," then tapping any of the highlighted dose listings produces the dosage calculation screen. Further selecting "PO Liq[uid]" allows entry of "mg" per "ml"; mg/kg/d; kg; and dosage frequency.