Point of-Care Resources & Tools SC

HealthCare Informatics: The big picture

1

Exercises for Practice
• Diagnosis: What is the sensitivity, specificity and LR
for procalcitonin in acute infections?
• Prevention: Starting a patient on Aspirin: Who should
be offered a Proton Pump Inhibitor?

• Risk assessment: How to assess for a DVT risk?
• Risk assessment: How to assess the severity of acute
pancreatitis?

• Quality Improvement: What is the role of Point-ofCare computer reminders in improving patient care?

• Therapy: An 8 year old girl who is 60 pounds
(27.2 kg) has moderate dehydration. What
should her maintenance fluids in mL per 24
hours be?
• Therapy: Anti-coagulation in patients with
cerebral hemorrhage?
• Risk assessment: Calculate your own ATPIII 10
year risk for heart disease based on your age,
gender, cholesterol and smoking status.
Session 5

3

• Medication Side-Effect: A basic metabolic
panel reveals that a 30 year old man suffering
from bipolar disorder has a serum calcium
level of 12.9 mg/dL. He is taking lithium and
valproate. Could his medications be a factor?
• Therapy: A patient was admitted with an
ulcer related upper GI hemorrhage. Outline a
management plan and timing of endoscopy.
• Therapy: Nebulized epinephrine or steroids for
croup in children—are they recommended?

4

• You have a male 42 yr old present in the ER with a severe
headache, nausea, myalgia, malaise, prostration. This
just started suddenly a day or so ago. Physical exam
reveals generalized macules that are red, fever, skin
erythema, generalized papules that are small red, rash on
his palms and soles of his feet. He thinks he has had
insect bites while camping recently.
• What could this be?
– http://www.ddderm.blogspot.com/

• Calculators: What is the predicted peak flow
for a 60 year old woman with asthma? She is
5’2”.
• Drug Interaction: A patient on carbamazepine
for epilepsy is due to be started on
ciprofloxacin..any problem?
• Patient Education: an obese patient (BMI 32.6)
is due to start on olanzapine—what advice
should she receive?
Session 5

6

• Patient Education: A patient with AF is due to
start warfarin..he is requesting to know more?
• Prognosis: A 40 year old woman has just had a
mastectomy. She had a grade 1 tumor, no
lymph nodes and no lymphatic or vascular
invasion. What is her Breast Cancer
Recurrence risk?

Session 5

7

• Calculate your own Body Mass Index, Ideal Body
Weight, Basal Energy Expenditure, and Body Surface
Area.
• 81 year old female with long standing diabetes, and
hypertension. Her BP is usually 140-150/85-90. Her
ideal body weight is 74 kg. Laboratory tests: serum
creatinine 112 umol/dl, Hgb A1C 7.8, liver function
tests normal. What is her creatinine clearance?

Session 5

8

• A basic metabolic panel reveals that a 30 year
old woman recovering from trauma has a
serum chloride level of 108.9 mEq/L. She is
taking ASA. Could her medications be a
factor?

Session 5

9

• In acute respiratory distress syndrome, during the
exudative phase, what findings appear on a chest xray?
• What is the mortality rate for Rocky Mountain
Spotted Fever?

• A 65 year old woman is worried that she may get
Parkinson’s Disease because her father was
diagnosed with it when he was 65. He was a heavy
smoker. She does not smoke or drink alcohol or
coffee. What do you tell her?
• What is the prognosis for a 60 y/o female with Stage
IV metastatic breast cancer?

• A 45 year old man has been a smoker for over
20 years is worried that he might have
diabetes mellitus because his father had it. He
does not think anyone else in his family has
ever been diagnosed with it. He is 6 feet tall
and weighs 250 pounds. What is his Diabetes
risk score? You will first need to determine his
body mass index.
Session 5

12

HEALTH CARE LITERACY IS ESSENTIAL TO
THE MEDICAL TEAM
Every organization can
benefit from speeding up
its information
metabolism.
This metabolism is the
process by which content
is produced and
consumed.

Point-of Care Resources & Tools:
Implementing Evidence &
Transforming Healthcare Provision
Dr. Imad Salah Ahmed Hassan MD FACP FRCPI MSc MBBS
Consultant Physician & Pulmonologist
Chairman, Knowledge Translation Committee
Department of Medicine
KAMC
Riyadh
Kingdom of Saudi Arabia

The Patient Journey: Chances of Error?
Treatment
Medication and prescriptions

Symptoms
and history
Body physical
examination findings

Advice and education
Hypotheses,
Self management and
health issues
home monitoring
Chronic
(problems and
Conventional medical summary
Prevention
Well-being and fitness, and
disease
diagnoses), rehabilitation after illness
risks
screening,
management
population health
Tests and investigations
measures
Care planning
Social welfare, culture, religion,
attitudes, expectations, hopes,
fears

Procedures and operations

Communication, team-based collaboration
Consent, permissions, disclosures, complaints

Protocols, guidelines, care
pathways

Is there a clear need for change:
Characteristics of current Heath care? T/F
1. High Efficiency & Productivity

2. Contained Healthcare Costs
3. Guaranteed Good Clinical Outcomes
4. High Patient Care Quality (No Medical Errors)
5. No Unnecessary & Duplicate Tests
6. High Patient Satisfaction

7. High Patient Engagement
8. Comprehensive Dual Preventive as well as Therapy Inputs

Patient Safety & Quality Gaps
Acknowledged

• “98,000 Hospital
Patients Die Yearly
Because of Adverse
Events” (IOM, 1999)

• “Virtually Every Patient
Experiences a Gap Between
the Best Evidence and the
Care They Receive” (IOM,
2001)

Medical errors kill enough
people to fill four jumbo jets a
week!!!!

KNOWLEDGE IS ESSENTIAL TO HEALING

New & Old Knowledge

What to Do?

Errors

Summary:
Access to Evidence-Based Information
• Push
• Pull

System
Summaries

Synopses
Synthesis
Studies

• Prompt…..some labs and eMRs with a credible evidencebased pedigree
2009

eHealth & mHealth
 eHealth
 eHealth is a broad term
for healthcare practice
which is supported by
electronic processes and
communication.
 The term can encompass
a range of services that
are at the edge of
medicine/healthcare and
information technology.

 mHealth
 Mobile Health
 Mobile technologies such
as mobile phones to
collect and access health
information.

Health Informatics
The intersection of information science,
computer science, and health care.
It deals with the resources, devices and
methods required to optimize the acquisition,
storage, retrieval and use of information in
health.

Why Health Informatics?
Health Informatics provides information to
make decisions
Better information leads to better decisions
leading to better outcomes
Health care, management, planning and policy
all need good information

Point-of-Care Resources & Tools:
POCR&T
• Definition
• Its’ Place: Where in Knowledge Translation
Science
• Uses:
– Evidence-based Knowledge Acquisition
– Decision Making
• Diagnosis
• Therapy

– Patient Centered-Care and Education
– Resident/Student education

• Examples

What are Point-of-Care R &T?
• Point-of-care resources and tools are those
research and reference utilities that a clinician
can employ immediately at the point-of-care
with a patient: (Clinic, ward, home, ER etc) .
• They are often easy to use and contain filtered
information.
• Most of the evidence-based point-of-care tools
include levels of evidence, rating scales or grade
recommendations as well as citations back to the
original research studies, systematic reviews, or
guidelines.

POCR&T
Aim:
Identify useful resources to answer clinical questions
quickly –
• Use the differential diagnosis tools
• Locate disease quick references
• Use online and PDA Calculators
– Medical equation
– Clinical rules, decision support

• Find laboratory information
• Use resources with students

Pre-requisites
For the
Effective Use
of POCR&Ts

Computer
Literacy

EBM Literacy

Resource/Tool:
Technical
Proficiency in its
'Use

Evidence-based Practice
Ask clinical

Acquire the

questions

best evidence

Assess
effectiveness,
efficiency of
EBM process

5A’s !!

Appraise
the evidence

Apply
evidence to
Your patient

Secrets of Literature Searching
• Know how to ask a question
– Foreground: Diagnosis, Therapy, Prognosis
– Background: Epidemiology, Etiology,
Pathophysiology etc

• Know where to look: Time is money!
– EBM resources:
• Primary literature
• Secondary literature

– Other resources: Decision Support, Quality
Improvement, Patient Education etc

Ask Clinical Questions: PICO
Components of Clinical Questions
Patient/
Population

Intervention/
Exposure

Comparison

Outcome

In patients with
acute MI

does early treatment with a statin

compared to
placebo

decrease cardiovascular mortality?

In women with
suspected
coronary disease

what is the
accuracy of
exercise ECHO

compared to
exercise
ECG

for diagnosing
significant
CAD?

In postmenopausal
women

does hormone
replacement
therapy

compared to no
HRT

increase the
risk of
breast cancer?

• Strategies for Literature Searching:
 Strategy 1:
Background Knowledge: Textbooks/eTextbooks e.g. emedicine

 Strategy 2:
Foreground Knowledge: Primary Literature/Original Studies=
Pubmed

• Strategies for Literature Searching:
• Strategy 3:
Foreground Knowledge: Secondary Literature/Pre-appraised
Literature
• Focused/Specific
• Broad/General Topic

•

Diagnosis e.g.
– Troponin in ACS
– Uric acid in Pre-eclampsia

•

Therapy e.g.
– Misoprostol for PPH
– Statins for
hypercholesterolemia
– Specific procedure

Systematic
Review
Sites
Technology
Assessment
Sites

Guidelines

Evidence Based eTextbooks

Broad/General Topic
Management of PPH
Management of hypertension Guidelines
Management of Fetal Respiratory
Distress Syndrome
Evidence
Based
Management of cancer pain

eTextbooks
On-line
eTextbooks

The Effectiveness of Mobile-Health Technologies to Improve
Health Care Service Delivery Processes: A Systematic Review
and Meta-Analysis. Caroline Free et al. Published January 15, 2013
• Background: Mobile health interventions could have beneficial
effects on health care delivery processes. We aimed to conduct a
systematic review of controlled trials of mobile technology
interventions to improve health care delivery processes.
• Conclusions:
1. The results for health care provider support interventions on
diagnosis and management outcomes are generally consistent
with modest benefits.
2. Trials using mobile technology-based photos reported reductions
in correct diagnoses when compared to the gold standard.
3. SMS appointment reminders have modest benefits and may be
appropriate for implementation. High quality trials measuring
clinical outcomes are needed.

Point-R &T: Where in the
Implementation Pyramid?

?

5S Information Resources: Information in top 4 are used
Computerized Decision
Support System (CDSS)

Systems
Evidence based textbooks :UpTo
POCRaTs

Summaries
Synopses
Syntheses

Studies

Date, DynaMed, ACP PIER, BMJ Clinical
Evidence

Evidence based journals
EBM, EBN, EBMH, ACP J club

Systematic Review
Cochrane reviews

Original articles:
BMJUpdates, PubMed
Clinical Queries

Haynes, R. (2006, November). Of studies, syntheses, synopses, summaries, and systems: the 5S evolution of information services for
2009
NCKUFM-YCY
evidence-based health care decisions. ACP Journal Club, 145(3), A8-A9.

Hierarchy of Evidence-Based
Implementation Tools: POCR&T are at the TOP
The Implementation
Pyramid
Interventions
of variable
effectiveness
•Audit and
feedback
•Use of local
opinion leaders
•Local consensus
processes
(ownership)
•Patient mediated
interventions

Consistently effective
interventions
•Educational outreach visits

•Reminders (manual or
computerized)
•Multifaceted interventions*
•Interactive educational
meetings (workshops)
•Financial Incentives

Interventions that have little or no effect
•Educational materials (Printed practice guidelines,
audiovisual materials, and electronic publications)
•Didactic educational meetings (such as lectures)

* (a combination that includes two or more of the following: audit and feedback, reminders, local consensus
processes, or marketing)

5S Information Resources
Computerized Decision
Support System (CDSS)

Systems
Evidence based textbooks :UpTo
POCRaTs

Summaries
Synopses
Syntheses

Studies

Date, DynaMed, ACP PIER, BMJ Clinical
Evidence

Evidence based journals
EBM, EBN, EBMH, ACP J club

Systematic Review
Cochrane reviews

Original articles:
BMJUpdates, PubMed
Clinical Queries

Haynes, R. (2006, November). Of studies, syntheses, synopses, summaries, and systems: the 5S evolution of information services for
2009
NCKUFM-YCY
evidence-based health care decisions. ACP Journal Club, 145(3), A8-A9.

Clinical Workflow: Where Do P-o-C R &
T fit?

P-o-C R & Ts Fit in all Steps.
40

Clinical Workflow: Where Do P-o-C R &
T fit?
Point-of-Care Resources and
Tools are Reminder and
Decision Making Utilities
for Enhancing the Practice
of Evidence-Based Medicine
(Knowledge Translation)

P-o-C R & Ts Fit in all Steps.

The Reminder Systems at the Point-of Care:
The P-o-C R & T
Computerized
Decision
Support
Systems

Integrated Care
Pathways,
Protocols and
Order Sets
Best
Available
Evidence

Point-of-Care
Educational
Resources
(Healthcare Provider &
Patient)

Cognitive
Reminders

EBM-based Summaries (regularly updated
e-text books)

General Characteristics
• Searchable Up-to-Date Medical Databases

• Clinically organized summaries and reference tools
integrating evidence-based and practical information
for decision-making in clinical practice: support in
making diagnoses, creating treatment plans, and
determining prognoses.

General Characteristics
• Variable:
• Diagnosis/Differential Diagnosis aids, Laboratory
Reference Values, Decision Trees, Procedures,
Calculators/Unit and Dose Converters, Drug
Reference/Interactions, Videos and Images, Patient
Information, Links to EBM websites, PDA/Online,
emailing facility, notes entry, feedback etc.

DynaMed

http://www.dynamicmedical.com/

Essential Evidence Plus (formerly
InfoRetriever)

http://www.essentialevidenceplus.c

First Consult

http://www.firstconsult.com/

UpToDate

http://www.uptodate.com/

Clinical Evidence

http://clinicalevidence.bmj.com/ceweb/index
.jsp

ACP PIERS

http://pier.acponline.org/index.html

PEPID

om/

http://www.pepid.com/

ClinicalKey

http://info.clinicalkey.com/

JBI COnNECT (Clinical Online Network of
Evidence for Care and Therapeutics)

http://connect.jbiconnectplus.org/Default.asp
x

Nursing Reference Centre

http://www.ebscohost.com/nursing/products
/nursing-reference-center

Clinical Knowledge Summaries (CKS) :National
Library for Health (Free*)

http://cks.library.nhs.uk/

Clin-eguide (Wolters-Kluwer Ovid)

http://www.clineguide.com/MarketingSiteMa
p.aspx

OvidMD™

http://login.ovidmd.ovid.com/login.aspx?disa
bleIP=

PEMSoft (Pediatrics)

http://www.pemsoft.com/

ProQuest Nursing & Allied Health Source

http://www.proquest.com/enUS/products/default.shtml

Rehabilitation Reference Center™ (RRC)

http://www.ebscohost.com/pointOfCare/rrcabout

Thomson Clinical Xpert

http://truvenhealth.com/your_healthcare_foc
us/hospital_management_decisions/

ZynxEvidence website

http://www.zynxhealth.com/Solutions/ZynxE
vidence.aspx

Epocrates (Free*)

http://www.epocrates.com/online

eMedicine (FREE)

http://emedicine.medscape.com/

VisualDx
With over 25000 images representing more
than 1200 pediatric & adult conditions,
VisualDx allows physicians to search by
diagnosis, build a patient-specific differential,
or look up drug-induced adverse reactions by
medication.

http://www.visualdx.com/features/mobileaccess

Resource

Rx

DxPlain Online

DDx

Dx LAB Calcs

X

Epocrates Essentials PDA

X

Epocrates Online

X

UpToDate

X

X

X

X

X

PEPID Online and PDA

X

X

X

X

X

Dynamed Online and PDA

X

X

Harrison's Practice Online and PDA

X

X

Essential Evidence Plus Online and PDA

X

Pediatric Care Online Online

X

X*

X

X

X

X

X

X

Online

X

X

X

X

Point of Care Clinical Resources:
Systematic Reviews & CATs Websites

Cochrane:

http://www3.interscience.wiley.com/cgibin/mrwhome/106568753/HOME

Database of Systematic Reviews of
effectiveness DARE:

http://www.crd.york.ac.uk/crdweb/

Pubmed Systematic Reviews:

http://www.ncbi.nlm.nih.gov/pubmed/clinical

AHRQ EPC Evidence Reports: Agency for http://www.ahrq.gov/CLINIC/epcquick.htm
Healthcare Research and Quality:
Best BETs:

http://bestbets.org/database/browse-bets.php

Attract:

http://www.attract.wales.nhs.uk/

• JAMAevidence
• The JAMAevidence mobile view features a
portion of the site's content optimized for mobile
browsers.
• They are:
“Quick Reference" pocket cards from Users'
Guides to the Medical Literature”
"Make the Diagnosis" sections from The Rational
Clinical Examination

Clinical Pathways & Protocols

NICE Pathways: guidance at your
fingertips- www.nice.org.uk

http://pathways.nice.org.uk/

Society of Hospital Medicine:
http://www.hospitalmedicine.org/

http://www.hospitalmedicine.org/Content/Navi
gationMenu/QualityImprovement/QIClinicalTools
/Quality_Improvement.htm

ICSI Institute for Clinical Systems
Improvements: http://www.icsi.org/in
dex.aspx
(Order Sets)

https://www.icsi.org/guidelines__more/search_r
esults__browsing/?catalog_search_panel_query=1&cat
alog_search_panel_label_ids%5B%5D=98&catalo
g_search_panel_label_ids%5B%5D=99&catalog_s
earch_panel_label_ids%5B%5D=102&catalog_se
arch_panel_label_ids%5B%5D=141&catalog_sear
ch_panel_label_ids%5B%5D=101#results_header

Decision Tools

Point of For Clinical Resources: Decision Tools
Resources Care EBM Knowledge Translation

Decision Support
Systems
Software to aid clinical decision-making:
characteristics of patient are matched to knowledge base,
recommendations are presented to the clinician/patient.
(Sim et al, JAMIA, 2001)

Objectives:







Diagnostic support
Drug dosing
Preventive care reminders/risk assessment
Disease management (Diabetes, Hypertension, AIDS, Asthma)
Test ordering
Drug prescription

CDSS - Benefits
• Improve patient safety
– Reduce medical errors
– Improved medication and test ordering

• Improve quality of care
– Application of Clinical Pathways and Guidelines
– Evidence based Medicine
– Improved Clinical documentation
– Increase quality time for direct patient care

• Improve efficiency in Healthcare delivery
– Reduce costs, reduce test duplication, decrease
adverse events
61

CDSS:
Computerized Physician Order Entry
• Growing evidence that CPOE reduce medical
errors and adverse drug events.
Effects of Computerized Physician Order Entry and Clinical Decision Support
Systems on Medication Safety Rainu Kaushal,MD,MPH et al Arch Intern
Med. 2003
http://archinte.ama-assn.org/cgi/content/full/163/12/1409
Effects of Computerized Clinical Decision Support Systems on Practitioner Performance
and Patient Outcomes
Garg et al JAMA. 2005
http://jama.ama-assn.org/cgi/content/full/293/10/1223

62

Opposing views…
• CPOE facilitate medication error ‘risks’, create new
errors.
Role of Computerized Physician Order Entry Systems in Facilitating Medication
Errors. Ross Koppel,PhD et al. JAMA. 2005

Computer Technology and Clinical Work Robert L. Wears et. al.
JAMA. 2005;293:1261-1263

.


63

CDSS TYPES based on their USAGE
• Knowledge-based systems
 Alerts and reminders (in real-time)
 Diagnostic assistance (some with likelihood input)
 Therapy critiquing, interactions and planning
 Prescribing decision support systems
 Information retrieval (selects best resource)
 Image recognition and interpretation
 Early warning systems
• Expert laboratory information systems (Interpretation)
• Machine learning systems (futuristic learning expert
system)

Point of Care Clinical Resources: Decision Tools
• Isabel:

http://www.isabelhealthcare.com/home/defa
ult

•Open Clinical:

http://www.openclinical.org/dss.html

• DXplain:

http://dxplain.org/dxp/dxp.pl
Calculators, Conversions and Scoring Tools

Skyscape:
http://www.skyscape.com/Windows/Archime
des360BySpecialty.aspx
•Emergency Medicine on the Web: Best
viewed on Internet Explorer not Google
Chrome.

http://www.ncemi.org/

MedicineWorld.Org:

http://medicineworld.org/online-medicalcalculators.html

•Clinical Decision Making Calculators:

http://www.fammed.ouhsc.edu/robhamm/cd
mcalc.htm

Types of Calculators
• Medical equation calculations
– i.e. body mass index, dosage calculator, unit
converter – emphasis Patient Safety
– Largely free online and for PDA
• MedMath and MedCalc

• Clinical rules, decision trees or criteria
calculators
– i.e. Ottowa ankle rule, NIH Stroke Score,
diagnostic likelihood calculator, mortality
calculator, CURb-65, Killip Class, Ranson’s, APGAR
et
Session 5

68

EPR

HealthCare Informatics: The big picture

69

The ATHENA/EON
Hypertension-Management SystSoftware to aid clinical decision-making; characteristics of patient are matched to knowledge base,
recommendations are presented to the clinician/patient
(Sim et al, JAMIA, 2001)

Patient Education

Patient Education:
Multiple Tools

Point of Care Clinical Resources: Patient Education
WebMD:

http://www.webmd.com/

PubMed Health:

http://www.ncbi.nlm.nih.gov/pubmedhealth/s/
diseases_and_conditions/a/

MedlinePlus:

http://www.nlm.nih.gov/medlineplus/

NHS Choices:

http://www.nhs.uk/Conditions/Pages/hub.aspx

The NNT:

•http://www.medicine.ox.ac.uk/bandolier/ban
d50/b50-8.html
•http://www.thennt.com/
•http://www.nntonline.net/visualrx/v3/display.
aspx

King Abdullah Encyclopedia:

http://www.kaahe.org/ar/

• WebMD Mobile
WebMD Mobile provides consumers with reliable,
timely, and accurate health information on the go. It
includes the award-winning WebMD Symptom
Checker, a comprehensive drug, supplement and
vitamin treatment database, as well as essential first
aid information.http://www.webmd.com/
• MedlinePlus
MedlinePlus is the National Institutes of Health's Web
site for patients and their families. Produced by the
National Library of Medicine, it brings information
about diseases, conditions, and wellness issues in lay
language.

• drawMD is a free app for the iPad to enhance doctor-patient
communication by offering interactive visual guides as a tool for explaining
complex issues and possible medical and surgical solutions.
• Select one of the detailed anatomic images from the 10 medical
specialties or upload your own, and then sketch, stamp, or type directly on
the images. Â The images and stamps are tailored to each specialty and
allow you to explain treatments and procedures in a personalized, easily
understood way. Then, share those images and notes with the patient and
retain them as a record of the consultation.
• With drawMD, patients better understand Â conditions and procedures,
while the time required for the consultation is reduced. Simple, visuallyoriented consultations are more understandable for patients, and can
provide the context that is used to improve and engagement and
satisfaction.
• More information about the app is available
fromhttp://www.drawmd.com/. The app is available for download from
the AppStore.

Health Care Literacy Around the World

Explaining NNT to Patients: http://www.nntonline.net/visualrx/

Patient-Centered Shared Decision Making
Mayo Clinic:
http://shareddecisions.mayoclinic.org/
Diabetes:
http://shareddecisions.mayoclinic.org/files/2011/08/Diabetes_Medication_Cho
ice.pdf

Patient Decision Aids
http://decisionaid.ohri.ca/AZlist.html

Shared Decision Making Resources
• DHMC Center for Shared Decision Making
– http://www.dhmc.org/dept/csdm

• Ottawa Health Research Institute
– http://decisionaid.ohri.ca/index.html

• Healthwise Preferred Care
– http://www.healthwise.net/preferredcare

• WebMD
– http://www.webmd.com/

• Foundation for Informed Medical Decision Making
– http://www.informedmedicaldecisions.org

• Health News Review
– http://www.healthnewsreview.org

Use of DDx Tools with Students
• During presentation of Patient with acute
problem
• Ask student for DDx
• Tell student to use DxPlain, Epocrates Sx,
which they have, or PEPID and name other
possibilities

Session 4

83

83

SOFTWARE PUBLISHERS
•

•
•
•

•

Apps for Healthcare Professionals Collection
Apple's App Store has put together a collection to make it easier for healthcare
professionals to find apps for their mobile devices. It includes six categories:
reference apps, educational apps, EMR & patient monitoring apps, imaging apps,
point of care apps, and personal care apps (which is actually aimed for consumers.)
See the link above for a review by iMedicalApps.
Medical Wizards
Software for medical professionals by medical professionals. Not free.
QxMD
Authored by clinician experts, QxMD’s authoritative free and inexpensive mobile
apps are relied upon by physicians, nurses and other health care professionals.
Skyscape - 25% discount
- Skyscape offers medical references for mobile devices.
- Available for Windows Mobile, Palm, iPhone, BlackBerry, Android.
- In collaboration with the University of Calgary Libraries, Skyscape now offers a
25% discount on the purchase of Skyscape resources for mobile devices.
Unbound Medicine
Unbound Medicine offers medical references for purchase for mobile devices.

• Discussions

• Questions

85

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