Evaluation of paediatric medicines information content on smartphones & mobile devices

One of the benefits of working at a large university is all of the different faculty you get a chance to work with. In this case, I collaborated with a group led by someone I have immense respect for – Dr. Sandra Benavides. She relayed that, “Medication safety and dosing information is often poorly delineated for paediatric patients as 75% of medications demonstrate insufficient labelling for these two purposes.” [1] So off-label or ‘unlicensed’ use of meds in peds is very common, with accompanying safety problems exacerbated by the more narrow therapeutic window in this population. Since use of clinical decision support tools is one strategy that has demonstrated the ability to help prevent med errors in peds [2] and the use of mobile devices in clinical practice has expanded substantially – we decided to systematically examine the quality of medicines information in a sample of commercially available tools. The article that came out of the study was recently published in Informatics in Primary Care.[3]

Paediatric-specific tools evaluated included: British National Formulary for Children, Harriet Lane Handbook, and Paediatric Lexi-Drugs. Generalist tools included: A to Z Drug Facts, American Hospital Formulary Service Drug Information, Clinical Pharmacology OnHand, Epocrates Rx Pro, Lexi-Drugs, and Thomson Clinical Xpert. 108 questions (e.g., Can the sudden appearance of extrapyramidal symptoms in an 11-month-old infant be attributed to administration of metoclopramide for injection?) were distributed evenly across infant, children and adolescent subgroups. Answers for the evaluative questions were sourced from established sources and (due to the high rate of off-label prescribing for which no conventional source exists) clinical guidelines.

The verdict? “The best performer [Pediatric Lexi-Drug] provided 75.9% of the answers…Databases generally performed less effectively in providing answers sourced from clinical guidelines compared with more conservative sources such as package inserts”. Obviously the article itself goes into much more detail regarding scope and completeness of the tools and their performance based on several criteria. Hopefully the article adds some useful guidance and identifies both strengths and shortcomings with which these increasingly important tools and their nextgens can be improved upon.


1. Benjamin DK, Smith PB, Murphy MD et al. Peerreviewed publication of clinical trials completed for pediatric exclusivity. Journal of the American Medical Association 2006;296:1266–73.
2. Fortescue EB, Kaushal R, Landrigan CP et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics 2003;111:722–9.
3. Benavides S, Polen HH, Goncz CE, Clauson KA. A systematic evaluation of paediatric medicines information content in clinical decision support tools on smartphones and mobile devices. Informatics in Primary Care 2011;19(1):39-46.

Two Billionaires, The White House, The Rockefeller President and mHealth

The title of this post is shorthand for four of the keynote presenters at next week’s mHealth Summit (follow at #mhs10) in Washington DC.  In addition to these four keynotes by Bill Gates (@BillGates), Ted Turner, Aneesh Chopra, and Judith Rodin, there is a great lineup of speakers and moderators.  There is a dizzying array of tracks and talks to choose from, but for me there are a handful that are particularly relevant.  These include  Najeeb Al-Shorbaji, who directs KMS at the World Health Organization, @SusannahFox of Pew Internet & American Life and e-patients.net, who is asking the right questions and always has cool new data right around the corner, Matthew Holt (@boltyboy), who is behind THCB and Health 2.0 [and who will hopefully be bemoaning Chelsea dropping points the Sunday prior], @JoshNesbit whose video about Frontline SMS I regularly use in my informatics course and who presents one of the most compelling cases for mHealth [seriously, you may be dead inside if it doesn’t speak to you on some level].

I am also really eager to hear from @HajovanBeijma from Text to Change and Susan Dentzer, who has been very forward thinking as EIC at Health Affairs, as well as to meet Walter Curioso, whose work I have long admired.  Since some of the biggest issues facing mHealth deal with scalability, policy, and interoperability, the mHealth Summit promises to be particularly useful as this conference brings together most of the stakeholders necessary to enact change.  I am looking forward to it.  I plan to be livetweeting and possibly liveblogging some, but I may very well get caught up in the presentations and discussions so I can’t make any guarantees.


Stargazing at Digital Pharma East

I am really looking forward to the 4th Annual Digital Pharma East coming up on October 18th in Philadelphia.  In addition to presenting, I plan to do some major stargazing while I am there.  I don’t mean ‘star’ in the manner of the cult of celebrity.  I am defining stars as people who have something really valuable and/or interesting to say.  It feels a little mercenary to go with the express intent of cherry picking knowledge from experts given the themes around sharing – but I guess that’s just part of the allure.

I’m also very much looking forward to reconnecting with Berci Mesko (@Berci) who I have not seen in a couple years, talking shop with social media flag bearer Bryan Vartabedian (@Doctor_V) who will likely be pressed for time from Co-chairing the event, having a face-to-face chat with Phil Baumann (@PhilBaumann) whose mind works unlike any other I’ve encountered in this space, meeting Gilles Frydman (@gfry) who is the final piece of the ePatient trinity, as well as Shwen Gwee (@shwen) who has both tweet cred and does great work.

In addition to those folks, I may be most eager to see presentations by representatives from Comscore and Within3, along with Cluetrain Manifesto author Doc Searls and futurist Ian Morrison.  Needless to say, I am planning to see every single presentation on the final day, which is dedicated to mobile/mHealth.  The rest of the time, it’s just a question of which Stream.  Finally, I am curious to see how the unconference activities and #SocPharm sessions play out relative to previous HealthCamp events I’ve seen.

As for me, I’ll be presenting “Social Media Research: Partnering with Academia”.  The link to the slides on the Digital Pharma conference site will be provided here after the presentation and will be available beyond that at SlideShare as per.  I’m curious to see the reception given that the composition of the audience is pretty different than who I have been interacting with recently.  I definitely have a (relatively) longstanding interest in the subject as one of the first articles we published on the topic was “Legal and regulatory risk associated with Web 2.0 adoption by pharmaceutical companies” in the Journal of Medical Marketing.  We’ve also published several other studies on interactions between different healthcare professionals and representatives from Pharma.  Ultimately, I am banking on the fact that I actually do what I will be talking about and have some concrete takeaways for those interested in the topic.  I’m also optimistic that using an audience response system and building in time for discussion will help make it legitimately interactive.  We shall see.

Overall, I am looking forward to reconnecting and making new connections, planting the seeds for future research collaborations, and learning from area experts that are rarely available in this concentration.  I hope to see you there, hear your thoughts, or cross paths via #DigPharm (or whatever the hashtag ends up being)!