Scheduling: Time to take control

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Scheduling: Time to take control

Like many doctors, you often feel the need to be two places at once.

The trick is to avoid scheduling two commitments at the same time. Anyone who has had to manage a busy practice schedule and remember his or her child’s soccer practice knows this can be challenging.

If you’re looking to organize your schedule, the Internet or your personal digital assistant (PDA) may hold the answer. This article will review scheduling solutions and help you decide which is right for your practice.

PDA scheduling-pros and cons

Both Palm and Pocket PC devices offer very good scheduling capabilities; your choice of operating system depends upon whether you need to use Microsoft Outlook. In my view, Palm is simpler and more reliable, whereas I have had more trouble connecting a Pocket PC device to my desktop computer.

Keeping a calendar in a handheld computer can be quite handy. Simply pull out the PDA, click once or twice, and view your daily schedule. Used properly, this can help prevent scheduling conflicts.

This feature, however, may be less helpful if your office staff maintains your schedule. For one, no one else can access the PDA while you’re carrying it. Second, if you do not regularly synchronize your PDA to the office computer, the staffer can make in-office schedule changes that are not recorded on the PDA version, possibly leading to double booking.

To prevent such mixups, assign one office assistant to update your schedule, and allow only that staffer to make changes. Also, be sure to double check the schedule before booking an appointment on your own.

Many major personal information managers such as Microsoft Outlook and Lotus Notes can be synchronized to a handheld. This allows your staff to view and simultaneously edit your schedule in the office, which is then synchronized onto the handheld. What’s more, users who cannot access your computer but have the proper privileges to your information can still connect to your schedule.

If a significant other uses a Palm OS device and you need to coordinate your schedule with his or hers, WeSync provides a solution that synchronizes both schedules via an online server and displays them side by side on your Palm OS PDA. Although WeSync no longer provides tech support for it, the software and service (which PalmOne owns) is still available.

Schedule synchronization between Pocket PC users is tricky: It cannot be done via an Internet server because each device has a one-to-one relationship with Microsoft Outlook, the desktop schedule software.

ManyPartners overcomes this limitation by allowing users to connect two Pocket PC devices to the same desktop scheduling software. Both users then must share information on one profile in Microsoft Outlook and must enter information in a way that avoids confusion, such as “John: doctor’s appointment” and “Mary: lecture on Monday.”)

Making your days colorful

Third-party software can make your calendar easier to use by employing color and icons to designate types of appointments (Table). This software also provides quick access to other information, such as task lists and notes.

For Palm OS devices, products such as Agendus, DateBk5, and Beyond Contacts provide a different and enhanced way to view your data. Similar software for the Pocket PC or Windows Mobile 2003 devices include Ulti-Planner, Pocket Informant, and Agenda Fusion and Agenda Today from DeveloperOne.

Some programs use the PDA’s built-in database while others have a proprietary database. This difference is important because it affects your ability to “beam” information from one device to another. For example, a proprietary database can facilitate data exchange, but only if the user to whom you are sending the data also uses a device with a proprietary database.

Online scheduling

Internet-based scheduling programs can also prevent double-booking. The user enters prospective meeting dates into the online form; the software then checks the dates against the calendar for conflicts and selects the best date. These schedules can also be synchronized to a PDA.

One drawback: changes to the online and PDA schedules must be entered separately, creating the potential for double booking. To avoid this:

 

  • assign one staff member to make schedule changes
  • or use a wireless PDA or one with a built-in cellular phone to allow instant schedule updates and prevent miscommunication.

Appointmentquest.com and scheduling.com-two services geared toward health care providers-provide online schedules, can handle multiple service locations and personnel, and will generate reminders for patients. Scheduling.com also can track multiple types of insurance and can provide billing systems with patient registration information to generate statements.

 

 

Schedule enhancement software options

 

SOLUTIONWEBSITE URLOSCOST
WeSyncwww.wesync.comPalmFree
Beyond Contactswww.dataviz.comPalm$49.95
Agenduswww.iambic.comPalm$25.95 standard
$39.95 professional
DateBK5www.pimlicosoftware.comPalm$24.95
Agenda Fusionwww.developerone.comPocket PC$29.95
Pocket Informantwww.pocketinformant.comPocket PC$24.95
Ulti-Plannerwww.uglybass.com/ultiplannerPocket PC$14.95

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com .

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

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Like many doctors, you often feel the need to be two places at once.

The trick is to avoid scheduling two commitments at the same time. Anyone who has had to manage a busy practice schedule and remember his or her child’s soccer practice knows this can be challenging.

If you’re looking to organize your schedule, the Internet or your personal digital assistant (PDA) may hold the answer. This article will review scheduling solutions and help you decide which is right for your practice.

PDA scheduling-pros and cons

Both Palm and Pocket PC devices offer very good scheduling capabilities; your choice of operating system depends upon whether you need to use Microsoft Outlook. In my view, Palm is simpler and more reliable, whereas I have had more trouble connecting a Pocket PC device to my desktop computer.

Keeping a calendar in a handheld computer can be quite handy. Simply pull out the PDA, click once or twice, and view your daily schedule. Used properly, this can help prevent scheduling conflicts.

This feature, however, may be less helpful if your office staff maintains your schedule. For one, no one else can access the PDA while you’re carrying it. Second, if you do not regularly synchronize your PDA to the office computer, the staffer can make in-office schedule changes that are not recorded on the PDA version, possibly leading to double booking.

To prevent such mixups, assign one office assistant to update your schedule, and allow only that staffer to make changes. Also, be sure to double check the schedule before booking an appointment on your own.

Many major personal information managers such as Microsoft Outlook and Lotus Notes can be synchronized to a handheld. This allows your staff to view and simultaneously edit your schedule in the office, which is then synchronized onto the handheld. What’s more, users who cannot access your computer but have the proper privileges to your information can still connect to your schedule.

If a significant other uses a Palm OS device and you need to coordinate your schedule with his or hers, WeSync provides a solution that synchronizes both schedules via an online server and displays them side by side on your Palm OS PDA. Although WeSync no longer provides tech support for it, the software and service (which PalmOne owns) is still available.

Schedule synchronization between Pocket PC users is tricky: It cannot be done via an Internet server because each device has a one-to-one relationship with Microsoft Outlook, the desktop schedule software.

ManyPartners overcomes this limitation by allowing users to connect two Pocket PC devices to the same desktop scheduling software. Both users then must share information on one profile in Microsoft Outlook and must enter information in a way that avoids confusion, such as “John: doctor’s appointment” and “Mary: lecture on Monday.”)

Making your days colorful

Third-party software can make your calendar easier to use by employing color and icons to designate types of appointments (Table). This software also provides quick access to other information, such as task lists and notes.

For Palm OS devices, products such as Agendus, DateBk5, and Beyond Contacts provide a different and enhanced way to view your data. Similar software for the Pocket PC or Windows Mobile 2003 devices include Ulti-Planner, Pocket Informant, and Agenda Fusion and Agenda Today from DeveloperOne.

Some programs use the PDA’s built-in database while others have a proprietary database. This difference is important because it affects your ability to “beam” information from one device to another. For example, a proprietary database can facilitate data exchange, but only if the user to whom you are sending the data also uses a device with a proprietary database.

Online scheduling

Internet-based scheduling programs can also prevent double-booking. The user enters prospective meeting dates into the online form; the software then checks the dates against the calendar for conflicts and selects the best date. These schedules can also be synchronized to a PDA.

One drawback: changes to the online and PDA schedules must be entered separately, creating the potential for double booking. To avoid this:

 

  • assign one staff member to make schedule changes
  • or use a wireless PDA or one with a built-in cellular phone to allow instant schedule updates and prevent miscommunication.

Appointmentquest.com and scheduling.com-two services geared toward health care providers-provide online schedules, can handle multiple service locations and personnel, and will generate reminders for patients. Scheduling.com also can track multiple types of insurance and can provide billing systems with patient registration information to generate statements.

 

 

Schedule enhancement software options

 

SOLUTIONWEBSITE URLOSCOST
WeSyncwww.wesync.comPalmFree
Beyond Contactswww.dataviz.comPalm$49.95
Agenduswww.iambic.comPalm$25.95 standard
$39.95 professional
DateBK5www.pimlicosoftware.comPalm$24.95
Agenda Fusionwww.developerone.comPocket PC$29.95
Pocket Informantwww.pocketinformant.comPocket PC$24.95
Ulti-Plannerwww.uglybass.com/ultiplannerPocket PC$14.95

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com .

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Like many doctors, you often feel the need to be two places at once.

The trick is to avoid scheduling two commitments at the same time. Anyone who has had to manage a busy practice schedule and remember his or her child’s soccer practice knows this can be challenging.

If you’re looking to organize your schedule, the Internet or your personal digital assistant (PDA) may hold the answer. This article will review scheduling solutions and help you decide which is right for your practice.

PDA scheduling-pros and cons

Both Palm and Pocket PC devices offer very good scheduling capabilities; your choice of operating system depends upon whether you need to use Microsoft Outlook. In my view, Palm is simpler and more reliable, whereas I have had more trouble connecting a Pocket PC device to my desktop computer.

Keeping a calendar in a handheld computer can be quite handy. Simply pull out the PDA, click once or twice, and view your daily schedule. Used properly, this can help prevent scheduling conflicts.

This feature, however, may be less helpful if your office staff maintains your schedule. For one, no one else can access the PDA while you’re carrying it. Second, if you do not regularly synchronize your PDA to the office computer, the staffer can make in-office schedule changes that are not recorded on the PDA version, possibly leading to double booking.

To prevent such mixups, assign one office assistant to update your schedule, and allow only that staffer to make changes. Also, be sure to double check the schedule before booking an appointment on your own.

Many major personal information managers such as Microsoft Outlook and Lotus Notes can be synchronized to a handheld. This allows your staff to view and simultaneously edit your schedule in the office, which is then synchronized onto the handheld. What’s more, users who cannot access your computer but have the proper privileges to your information can still connect to your schedule.

If a significant other uses a Palm OS device and you need to coordinate your schedule with his or hers, WeSync provides a solution that synchronizes both schedules via an online server and displays them side by side on your Palm OS PDA. Although WeSync no longer provides tech support for it, the software and service (which PalmOne owns) is still available.

Schedule synchronization between Pocket PC users is tricky: It cannot be done via an Internet server because each device has a one-to-one relationship with Microsoft Outlook, the desktop schedule software.

ManyPartners overcomes this limitation by allowing users to connect two Pocket PC devices to the same desktop scheduling software. Both users then must share information on one profile in Microsoft Outlook and must enter information in a way that avoids confusion, such as “John: doctor’s appointment” and “Mary: lecture on Monday.”)

Making your days colorful

Third-party software can make your calendar easier to use by employing color and icons to designate types of appointments (Table). This software also provides quick access to other information, such as task lists and notes.

For Palm OS devices, products such as Agendus, DateBk5, and Beyond Contacts provide a different and enhanced way to view your data. Similar software for the Pocket PC or Windows Mobile 2003 devices include Ulti-Planner, Pocket Informant, and Agenda Fusion and Agenda Today from DeveloperOne.

Some programs use the PDA’s built-in database while others have a proprietary database. This difference is important because it affects your ability to “beam” information from one device to another. For example, a proprietary database can facilitate data exchange, but only if the user to whom you are sending the data also uses a device with a proprietary database.

Online scheduling

Internet-based scheduling programs can also prevent double-booking. The user enters prospective meeting dates into the online form; the software then checks the dates against the calendar for conflicts and selects the best date. These schedules can also be synchronized to a PDA.

One drawback: changes to the online and PDA schedules must be entered separately, creating the potential for double booking. To avoid this:

 

  • assign one staff member to make schedule changes
  • or use a wireless PDA or one with a built-in cellular phone to allow instant schedule updates and prevent miscommunication.

Appointmentquest.com and scheduling.com-two services geared toward health care providers-provide online schedules, can handle multiple service locations and personnel, and will generate reminders for patients. Scheduling.com also can track multiple types of insurance and can provide billing systems with patient registration information to generate statements.

 

 

Schedule enhancement software options

 

SOLUTIONWEBSITE URLOSCOST
WeSyncwww.wesync.comPalmFree
Beyond Contactswww.dataviz.comPalm$49.95
Agenduswww.iambic.comPalm$25.95 standard
$39.95 professional
DateBK5www.pimlicosoftware.comPalm$24.95
Agenda Fusionwww.developerone.comPocket PC$29.95
Pocket Informantwww.pocketinformant.comPocket PC$24.95
Ulti-Plannerwww.uglybass.com/ultiplannerPocket PC$14.95

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com .

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

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Spam: Lower your intake

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Spam: Lower your intake

You’re anxiously awaiting an important e-mail from a patient or colleague. You click into your in box, only to find a string of solicitations urging you to refinance your mortgage, buy cheap Viagra, or get rich quick.

Meanwhile, that important message may have been bounced back to the sender and lost.

This is just one way electronic junk mail, or spam, wreaks havoc on millions of e-mail users. If you’re tired of ‘spammers’ feeding you unwanted messages, read on.

Why spam is a problem

Mailing printed advertisements to 20 million people can cost tens of thousands of dollars in postage, mailing lists, and printing. By contrast, a spammer can reach that same audience for a fraction of the cost. Anyone with an Internet service provider (ISP) and a mass-mailing program can flood cyberspace with junk messages.

As a result, users waste precious time and money deleting junk messages by the score. Spam is especially costly to users who pay by the hour for dial-up Internet access.

What’s more, ISPs need to purchase additional processing servers to handle the increase in e-mail volume caused by excessive junk messages. This often leads to rate increases for subscribers with DSL, cable-modem, or other broadband connections.

Fighting back

Federal lawmakers have begun taking aim at unwanted e-mails. The Can Spam Act of 2003, which awaits a Senate vote, would outlaw misleading advertising and mandate a range of requirements on e-solicitors, from inclusion of unsubscribe options on messages to use of functional return e-mail addresses. Violators would face fines of as much as $1 million and/or 1 year in prison.1 Several states, such as Minnesota, also have been considering fines for junk e-mail.2

In the meantime, users can take measures—common-sense and technological—against spam.

Follow these 4 steps

To keep your e-mail address out of spammers’ hands, do not:

 

  1. Open spam messages. Just as traditional junk mail is immediately discarded, spam should be deleted without opening. By clicking anywhere in the body of the junk e-mail, the sender receives a return message that e-mail access is valid, subjecting you to more spam.
  2. Click on the ‘unsubscribe’ link. “Spammers” will not honor this request but will instead store your e-mail address for future reference. For similar reasons, do not reply to the e-mail.
  3. Post your e-mail address on a Web page. Many spammers use programs that “harvest” e-mail addresses. These programs are particularly attracted to Web pages with hyperlinked e-mail addresses.
  4. Use an obvious address. Some spammers use “dictionary spamming” by combining common last names and initials to find new e-mail targets. Try to include unusual numeral and character combinations in your address.

Also, use “jsluo|at|email.com” instead of jsluo@email.com. Replacing @ with |at| prevents mass-mailing programs from automatically harvesting and using that address. However, some novice users may not realize they need to type |at| instead of @ to contact you.

Finally, use an alternate e-mail address for contests and newsletters if you suspect these will open the floodgates for spam.

Fighting spam with technology

Many free Web-based e-mail accounts such as Hotmail or Yahoo allow users to receive and delete e-mail in bulk by checking one box. Most providers also employ proprietary anti-spam software to protect their subscribers and servers.

E-mail clients such as Microsoft Outlook or Outlook Express allow you to set up rules to organize mail. Mail from certain users or with particular subjects can be automatically moved from the in box to designated folders. Messages containing terms such as ‘mortgage’ or ‘improve your sex life’ can be automatically deleted. Certain senders can be sent directly to the trash. Consult the “Help” section of these clients for directions.

Check your “deleted items” box to ensure that your rules are not sending important mail to the trash. Once you know that the rules work, you can automatically delete the files.

An anti-spam program can be added to your mail client (Table). These programs work via a combination of methods:

 

  • The program checks a message’s subject content and source to see if the address matches with a list of known spammers. Most spam has a characteristic style, format and phrasing that programs can spot.
  • Users can “teach” the program which e-mails to block by verifying wanted and unwanted messages. Some programs send an e-mail to the sender requesting verification. Once the sender replies, mail will go through automatically.

But be careful. If you set your filter to get rid of any subject with ‘urgent,’ the filter may block a patient’s urgent message.

Blowing the whistle

 

 

You can also report a spammer to his or her ISP, which in turn may rescind the spammer’s account or assess “cleanup fees.”

Programs such as SpamCop and the Network Abuse Clearinghouse offer reporting/filtering programs that electronically forward spam complaints to ISPs and, in some cases, get a spammer’s address blacklisted, meaning that the user can be denied Internet access through that ISP.

Senders who advertise fraudulent products can also be reported to the Federal Trade Commission. Those who advertise unapproved medical products can be reported to the Food and Drug Administration at (800) 532-4440.

Selected anti-spam programs

 

ProgramURLClientsCost
SpamBayeshttp://spambayes.sourceforge.net/index.htmlMicrosoft Outlook 2000/XPFree
spamassassinhttp://www.spamassasin.orgAny POP clientsFree
SpamCophttp://www.spamcop.netReportingFree
Network Abuse Clearinghousehttp://www.abuse.netReportingFree
MailFrontier Matadorhttp://www.mailfrontier.comMicrosoft Outlook, Outlook Express$29.95
Ellahttp://www.openfieldsoftware.com/Microsoft Outlook 2000/02, Outlook Express 5/6$29.95
InBoxerhttp://www.inboxer.comMicrosoft Outlook 2000/02/XP$29.95
EmailProtecthttp://www.contentwatch.com/email_protect/index.phpAny POP or IMAP e-mail client$39.95
(STEVEN)http://www.softwaredevelopment.net.au/pge_steven.htmAny POP client, Microsoft Outlook and Outlook ExpressFree and $29 registered versions
Vipul’s Razorhttp://razor.sourceforge.net/Requires PERL, software agentsFree
SpamEater Prohttp://www.hms.com/spameater.aspAny POP client$24.95

Related Resources

Spam safety tips. http://www.spamfilterreview.com/spam-saftey-tips.html

Spam Tips and Help. http://spam.abuse.net/userhelp/

Mark R. Senate panel overwhelmingly passes anti-spam bill. dc.internet.com June 19, 2003. Available at: http://dc.internet.com/news/article.php/2224681. Accessed Sept. 5, 2003

Sturdevant C. Can-Spam Act can’t. eWeek June 9, 2003. Available at: http://www.eweek.com/print_article/0,3668,a=43121,00.asp. Accessed Sept. 5, 2003

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

 

1. Can Spam Act. Spam Laws. Available at: http://www.spamlaws.com/federal/108s877.html. Accessed Sept. 5, 2003.

2. Moylan MJ. Minnesota legislature considers fines for junk e-mail. Siliconvalley.com. Available at: http://www.siliconvalley.com/mld/siliconvalley/2751877.htm. Accessed Sept. 9, 2003.

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You’re anxiously awaiting an important e-mail from a patient or colleague. You click into your in box, only to find a string of solicitations urging you to refinance your mortgage, buy cheap Viagra, or get rich quick.

Meanwhile, that important message may have been bounced back to the sender and lost.

This is just one way electronic junk mail, or spam, wreaks havoc on millions of e-mail users. If you’re tired of ‘spammers’ feeding you unwanted messages, read on.

Why spam is a problem

Mailing printed advertisements to 20 million people can cost tens of thousands of dollars in postage, mailing lists, and printing. By contrast, a spammer can reach that same audience for a fraction of the cost. Anyone with an Internet service provider (ISP) and a mass-mailing program can flood cyberspace with junk messages.

As a result, users waste precious time and money deleting junk messages by the score. Spam is especially costly to users who pay by the hour for dial-up Internet access.

What’s more, ISPs need to purchase additional processing servers to handle the increase in e-mail volume caused by excessive junk messages. This often leads to rate increases for subscribers with DSL, cable-modem, or other broadband connections.

Fighting back

Federal lawmakers have begun taking aim at unwanted e-mails. The Can Spam Act of 2003, which awaits a Senate vote, would outlaw misleading advertising and mandate a range of requirements on e-solicitors, from inclusion of unsubscribe options on messages to use of functional return e-mail addresses. Violators would face fines of as much as $1 million and/or 1 year in prison.1 Several states, such as Minnesota, also have been considering fines for junk e-mail.2

In the meantime, users can take measures—common-sense and technological—against spam.

Follow these 4 steps

To keep your e-mail address out of spammers’ hands, do not:

 

  1. Open spam messages. Just as traditional junk mail is immediately discarded, spam should be deleted without opening. By clicking anywhere in the body of the junk e-mail, the sender receives a return message that e-mail access is valid, subjecting you to more spam.
  2. Click on the ‘unsubscribe’ link. “Spammers” will not honor this request but will instead store your e-mail address for future reference. For similar reasons, do not reply to the e-mail.
  3. Post your e-mail address on a Web page. Many spammers use programs that “harvest” e-mail addresses. These programs are particularly attracted to Web pages with hyperlinked e-mail addresses.
  4. Use an obvious address. Some spammers use “dictionary spamming” by combining common last names and initials to find new e-mail targets. Try to include unusual numeral and character combinations in your address.

Also, use “jsluo|at|email.com” instead of jsluo@email.com. Replacing @ with |at| prevents mass-mailing programs from automatically harvesting and using that address. However, some novice users may not realize they need to type |at| instead of @ to contact you.

Finally, use an alternate e-mail address for contests and newsletters if you suspect these will open the floodgates for spam.

Fighting spam with technology

Many free Web-based e-mail accounts such as Hotmail or Yahoo allow users to receive and delete e-mail in bulk by checking one box. Most providers also employ proprietary anti-spam software to protect their subscribers and servers.

E-mail clients such as Microsoft Outlook or Outlook Express allow you to set up rules to organize mail. Mail from certain users or with particular subjects can be automatically moved from the in box to designated folders. Messages containing terms such as ‘mortgage’ or ‘improve your sex life’ can be automatically deleted. Certain senders can be sent directly to the trash. Consult the “Help” section of these clients for directions.

Check your “deleted items” box to ensure that your rules are not sending important mail to the trash. Once you know that the rules work, you can automatically delete the files.

An anti-spam program can be added to your mail client (Table). These programs work via a combination of methods:

 

  • The program checks a message’s subject content and source to see if the address matches with a list of known spammers. Most spam has a characteristic style, format and phrasing that programs can spot.
  • Users can “teach” the program which e-mails to block by verifying wanted and unwanted messages. Some programs send an e-mail to the sender requesting verification. Once the sender replies, mail will go through automatically.

But be careful. If you set your filter to get rid of any subject with ‘urgent,’ the filter may block a patient’s urgent message.

Blowing the whistle

 

 

You can also report a spammer to his or her ISP, which in turn may rescind the spammer’s account or assess “cleanup fees.”

Programs such as SpamCop and the Network Abuse Clearinghouse offer reporting/filtering programs that electronically forward spam complaints to ISPs and, in some cases, get a spammer’s address blacklisted, meaning that the user can be denied Internet access through that ISP.

Senders who advertise fraudulent products can also be reported to the Federal Trade Commission. Those who advertise unapproved medical products can be reported to the Food and Drug Administration at (800) 532-4440.

Selected anti-spam programs

 

ProgramURLClientsCost
SpamBayeshttp://spambayes.sourceforge.net/index.htmlMicrosoft Outlook 2000/XPFree
spamassassinhttp://www.spamassasin.orgAny POP clientsFree
SpamCophttp://www.spamcop.netReportingFree
Network Abuse Clearinghousehttp://www.abuse.netReportingFree
MailFrontier Matadorhttp://www.mailfrontier.comMicrosoft Outlook, Outlook Express$29.95
Ellahttp://www.openfieldsoftware.com/Microsoft Outlook 2000/02, Outlook Express 5/6$29.95
InBoxerhttp://www.inboxer.comMicrosoft Outlook 2000/02/XP$29.95
EmailProtecthttp://www.contentwatch.com/email_protect/index.phpAny POP or IMAP e-mail client$39.95
(STEVEN)http://www.softwaredevelopment.net.au/pge_steven.htmAny POP client, Microsoft Outlook and Outlook ExpressFree and $29 registered versions
Vipul’s Razorhttp://razor.sourceforge.net/Requires PERL, software agentsFree
SpamEater Prohttp://www.hms.com/spameater.aspAny POP client$24.95

Related Resources

Spam safety tips. http://www.spamfilterreview.com/spam-saftey-tips.html

Spam Tips and Help. http://spam.abuse.net/userhelp/

Mark R. Senate panel overwhelmingly passes anti-spam bill. dc.internet.com June 19, 2003. Available at: http://dc.internet.com/news/article.php/2224681. Accessed Sept. 5, 2003

Sturdevant C. Can-Spam Act can’t. eWeek June 9, 2003. Available at: http://www.eweek.com/print_article/0,3668,a=43121,00.asp. Accessed Sept. 5, 2003

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

You’re anxiously awaiting an important e-mail from a patient or colleague. You click into your in box, only to find a string of solicitations urging you to refinance your mortgage, buy cheap Viagra, or get rich quick.

Meanwhile, that important message may have been bounced back to the sender and lost.

This is just one way electronic junk mail, or spam, wreaks havoc on millions of e-mail users. If you’re tired of ‘spammers’ feeding you unwanted messages, read on.

Why spam is a problem

Mailing printed advertisements to 20 million people can cost tens of thousands of dollars in postage, mailing lists, and printing. By contrast, a spammer can reach that same audience for a fraction of the cost. Anyone with an Internet service provider (ISP) and a mass-mailing program can flood cyberspace with junk messages.

As a result, users waste precious time and money deleting junk messages by the score. Spam is especially costly to users who pay by the hour for dial-up Internet access.

What’s more, ISPs need to purchase additional processing servers to handle the increase in e-mail volume caused by excessive junk messages. This often leads to rate increases for subscribers with DSL, cable-modem, or other broadband connections.

Fighting back

Federal lawmakers have begun taking aim at unwanted e-mails. The Can Spam Act of 2003, which awaits a Senate vote, would outlaw misleading advertising and mandate a range of requirements on e-solicitors, from inclusion of unsubscribe options on messages to use of functional return e-mail addresses. Violators would face fines of as much as $1 million and/or 1 year in prison.1 Several states, such as Minnesota, also have been considering fines for junk e-mail.2

In the meantime, users can take measures—common-sense and technological—against spam.

Follow these 4 steps

To keep your e-mail address out of spammers’ hands, do not:

 

  1. Open spam messages. Just as traditional junk mail is immediately discarded, spam should be deleted without opening. By clicking anywhere in the body of the junk e-mail, the sender receives a return message that e-mail access is valid, subjecting you to more spam.
  2. Click on the ‘unsubscribe’ link. “Spammers” will not honor this request but will instead store your e-mail address for future reference. For similar reasons, do not reply to the e-mail.
  3. Post your e-mail address on a Web page. Many spammers use programs that “harvest” e-mail addresses. These programs are particularly attracted to Web pages with hyperlinked e-mail addresses.
  4. Use an obvious address. Some spammers use “dictionary spamming” by combining common last names and initials to find new e-mail targets. Try to include unusual numeral and character combinations in your address.

Also, use “jsluo|at|email.com” instead of jsluo@email.com. Replacing @ with |at| prevents mass-mailing programs from automatically harvesting and using that address. However, some novice users may not realize they need to type |at| instead of @ to contact you.

Finally, use an alternate e-mail address for contests and newsletters if you suspect these will open the floodgates for spam.

Fighting spam with technology

Many free Web-based e-mail accounts such as Hotmail or Yahoo allow users to receive and delete e-mail in bulk by checking one box. Most providers also employ proprietary anti-spam software to protect their subscribers and servers.

E-mail clients such as Microsoft Outlook or Outlook Express allow you to set up rules to organize mail. Mail from certain users or with particular subjects can be automatically moved from the in box to designated folders. Messages containing terms such as ‘mortgage’ or ‘improve your sex life’ can be automatically deleted. Certain senders can be sent directly to the trash. Consult the “Help” section of these clients for directions.

Check your “deleted items” box to ensure that your rules are not sending important mail to the trash. Once you know that the rules work, you can automatically delete the files.

An anti-spam program can be added to your mail client (Table). These programs work via a combination of methods:

 

  • The program checks a message’s subject content and source to see if the address matches with a list of known spammers. Most spam has a characteristic style, format and phrasing that programs can spot.
  • Users can “teach” the program which e-mails to block by verifying wanted and unwanted messages. Some programs send an e-mail to the sender requesting verification. Once the sender replies, mail will go through automatically.

But be careful. If you set your filter to get rid of any subject with ‘urgent,’ the filter may block a patient’s urgent message.

Blowing the whistle

 

 

You can also report a spammer to his or her ISP, which in turn may rescind the spammer’s account or assess “cleanup fees.”

Programs such as SpamCop and the Network Abuse Clearinghouse offer reporting/filtering programs that electronically forward spam complaints to ISPs and, in some cases, get a spammer’s address blacklisted, meaning that the user can be denied Internet access through that ISP.

Senders who advertise fraudulent products can also be reported to the Federal Trade Commission. Those who advertise unapproved medical products can be reported to the Food and Drug Administration at (800) 532-4440.

Selected anti-spam programs

 

ProgramURLClientsCost
SpamBayeshttp://spambayes.sourceforge.net/index.htmlMicrosoft Outlook 2000/XPFree
spamassassinhttp://www.spamassasin.orgAny POP clientsFree
SpamCophttp://www.spamcop.netReportingFree
Network Abuse Clearinghousehttp://www.abuse.netReportingFree
MailFrontier Matadorhttp://www.mailfrontier.comMicrosoft Outlook, Outlook Express$29.95
Ellahttp://www.openfieldsoftware.com/Microsoft Outlook 2000/02, Outlook Express 5/6$29.95
InBoxerhttp://www.inboxer.comMicrosoft Outlook 2000/02/XP$29.95
EmailProtecthttp://www.contentwatch.com/email_protect/index.phpAny POP or IMAP e-mail client$39.95
(STEVEN)http://www.softwaredevelopment.net.au/pge_steven.htmAny POP client, Microsoft Outlook and Outlook ExpressFree and $29 registered versions
Vipul’s Razorhttp://razor.sourceforge.net/Requires PERL, software agentsFree
SpamEater Prohttp://www.hms.com/spameater.aspAny POP client$24.95

Related Resources

Spam safety tips. http://www.spamfilterreview.com/spam-saftey-tips.html

Spam Tips and Help. http://spam.abuse.net/userhelp/

Mark R. Senate panel overwhelmingly passes anti-spam bill. dc.internet.com June 19, 2003. Available at: http://dc.internet.com/news/article.php/2224681. Accessed Sept. 5, 2003

Sturdevant C. Can-Spam Act can’t. eWeek June 9, 2003. Available at: http://www.eweek.com/print_article/0,3668,a=43121,00.asp. Accessed Sept. 5, 2003

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

 

1. Can Spam Act. Spam Laws. Available at: http://www.spamlaws.com/federal/108s877.html. Accessed Sept. 5, 2003.

2. Moylan MJ. Minnesota legislature considers fines for junk e-mail. Siliconvalley.com. Available at: http://www.siliconvalley.com/mld/siliconvalley/2751877.htm. Accessed Sept. 9, 2003.

References

 

1. Can Spam Act. Spam Laws. Available at: http://www.spamlaws.com/federal/108s877.html. Accessed Sept. 5, 2003.

2. Moylan MJ. Minnesota legislature considers fines for junk e-mail. Siliconvalley.com. Available at: http://www.siliconvalley.com/mld/siliconvalley/2751877.htm. Accessed Sept. 9, 2003.

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Prescribing information: Scroll with the changes

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Prescribing information: Scroll with the changes

Today’s physician needs to stay abreast of ever-changing prescribing information. Print and CD-ROM drug guides, long regarded as the gold standard in clinical reference, are constrained by press deadlines and start becoming outdated upon publication.

Electronic drug guides, available online or via handheld computers, are updated regularly and provide real-time developments about drug alerts, safety recalls, and changes in prescribing information.

Online drug guides

Benefits. Drug-drug interactions can be checked with a couple of clicks. By contrast, scanning printed lists of interactions for each medication could cost you valuable time.

Some electronic guides list the medication’s cost and formulary availability in addition to dosing, indication(s), drug mechanism, precautions, and adverse reactions.

Drawbacks. Depending on the type of subscription, access to an online drug reference may be restricted. Many institutions purchase access to online references, which are readily available at any terminal or computer in the hospital network. When attempting to access the resource from an outside computer, however, access is denied.

Some facilities circumvent this problem by providing a proxy server to relay access or use a virtual private network to connect to the hospital network. Individual subscriptions, which provide access via password, do not have this limitation.

The table lists benefits and drawbacks of individual programs.

Drug guides for handhelds

Drug guides for personal digital assistants are more accessible, but many handhelds lack sufficient memory for the guides’ databases and programs.

Some programs, such as the American Hospital Formulary Service guide and Physicians’ Desk Reference, can operate from external memory-such as secure digital or compact flash-thus preserving the limited main memory of most handhelds. In working this way, however, these programs’ databases often cannot be updated automatically and require user intervention.

The handheld’s small screen size is another potential drawback. The better handheld drug guides are designed to maximize limited screen space and promote easy navigation by utilizing hyperlinks to jump to related information or pop up windows to provide additional information. Ideally, content should be succinct yet offer sufficient detail.

How to choose a drug reference guide

Electronic drug reference guides vary greatly in their detail, organization of content, and ease of navigation and downloading. To decide which drug reference guide is right for you, try several demonstration versions:

 

  • Compare different features. Look for sufficient content and intuitive navigation.
  • Find out if pre-made patient education brochures are available for printing.
  • For handheld guides, determine how much memory is required by the program and databases, how often they must be updated, and whether they can be stored on external memory.
  • Ask if discounts are offered for purchases during trade shows or for a combination purchase of the guide’s online and handheld versions.

The following table, which lists quick reviews of reference guide demonstration products, can help you explore the options.

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to: Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Article PDF
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Today’s physician needs to stay abreast of ever-changing prescribing information. Print and CD-ROM drug guides, long regarded as the gold standard in clinical reference, are constrained by press deadlines and start becoming outdated upon publication.

Electronic drug guides, available online or via handheld computers, are updated regularly and provide real-time developments about drug alerts, safety recalls, and changes in prescribing information.

Online drug guides

Benefits. Drug-drug interactions can be checked with a couple of clicks. By contrast, scanning printed lists of interactions for each medication could cost you valuable time.

Some electronic guides list the medication’s cost and formulary availability in addition to dosing, indication(s), drug mechanism, precautions, and adverse reactions.

Drawbacks. Depending on the type of subscription, access to an online drug reference may be restricted. Many institutions purchase access to online references, which are readily available at any terminal or computer in the hospital network. When attempting to access the resource from an outside computer, however, access is denied.

Some facilities circumvent this problem by providing a proxy server to relay access or use a virtual private network to connect to the hospital network. Individual subscriptions, which provide access via password, do not have this limitation.

The table lists benefits and drawbacks of individual programs.

Drug guides for handhelds

Drug guides for personal digital assistants are more accessible, but many handhelds lack sufficient memory for the guides’ databases and programs.

Some programs, such as the American Hospital Formulary Service guide and Physicians’ Desk Reference, can operate from external memory-such as secure digital or compact flash-thus preserving the limited main memory of most handhelds. In working this way, however, these programs’ databases often cannot be updated automatically and require user intervention.

The handheld’s small screen size is another potential drawback. The better handheld drug guides are designed to maximize limited screen space and promote easy navigation by utilizing hyperlinks to jump to related information or pop up windows to provide additional information. Ideally, content should be succinct yet offer sufficient detail.

How to choose a drug reference guide

Electronic drug reference guides vary greatly in their detail, organization of content, and ease of navigation and downloading. To decide which drug reference guide is right for you, try several demonstration versions:

 

  • Compare different features. Look for sufficient content and intuitive navigation.
  • Find out if pre-made patient education brochures are available for printing.
  • For handheld guides, determine how much memory is required by the program and databases, how often they must be updated, and whether they can be stored on external memory.
  • Ask if discounts are offered for purchases during trade shows or for a combination purchase of the guide’s online and handheld versions.

The following table, which lists quick reviews of reference guide demonstration products, can help you explore the options.

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to: Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Today’s physician needs to stay abreast of ever-changing prescribing information. Print and CD-ROM drug guides, long regarded as the gold standard in clinical reference, are constrained by press deadlines and start becoming outdated upon publication.

Electronic drug guides, available online or via handheld computers, are updated regularly and provide real-time developments about drug alerts, safety recalls, and changes in prescribing information.

Online drug guides

Benefits. Drug-drug interactions can be checked with a couple of clicks. By contrast, scanning printed lists of interactions for each medication could cost you valuable time.

Some electronic guides list the medication’s cost and formulary availability in addition to dosing, indication(s), drug mechanism, precautions, and adverse reactions.

Drawbacks. Depending on the type of subscription, access to an online drug reference may be restricted. Many institutions purchase access to online references, which are readily available at any terminal or computer in the hospital network. When attempting to access the resource from an outside computer, however, access is denied.

Some facilities circumvent this problem by providing a proxy server to relay access or use a virtual private network to connect to the hospital network. Individual subscriptions, which provide access via password, do not have this limitation.

The table lists benefits and drawbacks of individual programs.

Drug guides for handhelds

Drug guides for personal digital assistants are more accessible, but many handhelds lack sufficient memory for the guides’ databases and programs.

Some programs, such as the American Hospital Formulary Service guide and Physicians’ Desk Reference, can operate from external memory-such as secure digital or compact flash-thus preserving the limited main memory of most handhelds. In working this way, however, these programs’ databases often cannot be updated automatically and require user intervention.

The handheld’s small screen size is another potential drawback. The better handheld drug guides are designed to maximize limited screen space and promote easy navigation by utilizing hyperlinks to jump to related information or pop up windows to provide additional information. Ideally, content should be succinct yet offer sufficient detail.

How to choose a drug reference guide

Electronic drug reference guides vary greatly in their detail, organization of content, and ease of navigation and downloading. To decide which drug reference guide is right for you, try several demonstration versions:

 

  • Compare different features. Look for sufficient content and intuitive navigation.
  • Find out if pre-made patient education brochures are available for printing.
  • For handheld guides, determine how much memory is required by the program and databases, how often they must be updated, and whether they can be stored on external memory.
  • Ask if discounts are offered for purchases during trade shows or for a combination purchase of the guide’s online and handheld versions.

The following table, which lists quick reviews of reference guide demonstration products, can help you explore the options.

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to: Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

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Cyber self-help

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Cyber self-help

Patients who dread the stigma of in-person psychotherapy are substituting traditional “couch trips” with computer sessions.

Computer-based therapy programs, either online or on CD-ROM or DVD, have become popular adjuncts to traditional therapy for patients with mild depression or anxiety. For example, more than 17,000 users visited the MoodGYM site within 6 months, and more than 20% of these users stayed on the site for 16 minutes or more.1

Computerized psychotherapy has demonstrated numerous benefits in clinical studies and may reduce the time a therapist needs to spend with the patient.

How computer therapy works

Computer-based psychotherapy has its roots in the ELIZA2 program developed in 1966 to study natural language communication between man and machine.3 Users simply write a normal sentence, and ELIZA responds appropriately.

The original ELIZA program, which works via text parsing, is limited in its ability to respond. For example, a user who types in “I feel depressed every day” may repeatedly get a response such as “Are you sure?”

Today’s programs are more sophisticated, utilizing specialized heuristic techniques and semantic databases to produce more natural responses to various expressions. Some programs even have audio and video features.

Most computer-based therapy programs employ a cognitive-behavioral treatment model, similar to that used in print workbooks. Several key concepts are presented, such as the relationship between automatic thoughts and feelings; techniques to control these thoughts are highlighted.

Many programs also use common scales to determine depression or anxiety ratings, thus helping the user choose an appropriate module.

Advantages of computer psychotherapy

Computer-based programs offer patients advantages such as:

 

  • Increased comfort. Without the social cues and dynamics that characterize traditional psychotherapy, some patients may disclose feelings online they would feel uncomfortable sharing in person. Online therapy also is immune to the fatigue, illness, boredom, or exploitation that may occur in a relationship with a therapist.
  • Flexibility. Users can work the program at home, at their convenience and pace. Responses to exercises also can be stored for future reference.
  • Speed of care. Treatment is accessed with minimal delay.
  • A greater sense of empowerment. Whereas patients in traditional therapy often feel dependent upon their therapist for direction, computer-based therapy encourages users to take a more active learning role by choosing where to click and how to respond. Patients feel more in control because they are helping themselves.
  • Cost-effectiveness. Although price varies, some programs cost about the same as one in-person session. Most programs are sold directly to medical practices.

Disadvantages

Some patients will not benefit from self-help. Those with moderate to severe depression or anxiety may be unable to focus on the material, and inability to navigate the program can increase the patent’s despondency or anxiety. Personality type also may predict lack of response to self-help treatment.4

Patients with poor eyesight, deficient reading skills, and limited computer proficiency are not good candidates for online or CD-ROM-based therapy. Also, some computers may not be sufficiently powerful to run some programs, and not all Internet connections are fast enough to post multimedia features.

Clinical effectiveness

In 1990, Selmi et al5 compared a six-session, cognitive-behavioral therapy (CBT) course in CD-ROM with six therapist-administered CBT sessions and a control group. An experimenter assisted with computer operation, and both courses followed an identical treatment model and required homework. Patients in both treatment groups demonstrated significant improvement based on Beck Depression Inventory and Automatic Thoughts Questionnaire scores.

Each group comprised only 12 patients, most of whom were young and well-educated. Still, Selmi et al provided initial evidence of computer-based therapy’s effectiveness and these findings have been replicated in subsequent studies. A meta-analysis of 16 studies6 found that CD-ROM-based and therapist-administered CBT work equally well in clinically depressed and anxious outpatients. More studies are needed to determine optimal levels of therapist involvement.

More research also is needed to gauge the effectiveness of Internet-based therapy programs (Table). Clarke et al randomized 144 out of 299 patients in a nonprofit health maintenance organization to online therapy with the Overcoming Depression on the Internet (ODIN) program or to treatment as usual. The study demonstrated no effect for ODIN, perhaps because of severity of depression or infrequent access to the site.7

Table

Samples of computer-based psychotherapy programs

 

Beating the Blues http://www.ultrasis.co.uk/products/btb/btb.html
BT STEPS http://www.healthtechsys.com/ivr/btsteps/btsteps.html
Behavioral Self-Control
Program for Windows http://www.behaviortherapy.com/software.htm#software
Calipso http://www.calipso.co.uk/mainframe.htm
FearFighter http://www.fearfighter.com
Good Days Ahead http://www.mindstreet.com
MoodGYM http://moodgym.anu.edu.au
Overcoming Depression http://www.maiw.com/main.html
Overcoming Depression on the Internet (ODIN) https://www.kpchr.org/feelbetter/

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

 

1. Christensen H, Griffiths K, Korten A. Web-based cognitive behavior therapy: analysis of site usage and changes in depression and anxiety scores. J Med Internet Res 2002;4(1):e3. Available at: http://www.jmir.org/2002/1/e3/index.htm. Accessed July 1, 2003.

2. ELIZA. Available at: http://www-ai.ijs.si/eliza/eliza.html. Accessed July 1, 2003.

3. ELIZA- a computer program for the study of natural language communication between man and machine. Communications of the Association for Computing Machinery 1966;9(1):35-6.Available at: http://i5.nyu.edu/~mm64/x52.9265/january1966.html. Accessed July 1, 2003.

4. Beutler LE, Engle D, Mohr D, et al. Predictors of differential response to cognitive, experiential, and self-directed psychotherapeutic procedures. J Consult Clin Psychol 1991;59:333-40.

5. Selmi PM, Klein MH, Greist JH, et al. Computer-administered cognitive-behavioral therapy for depression. Am J Psychiatry 1990;147:51-6.

6. Kaltenthaler E, Shackley P, Stevens K, et al. A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety. Health Technol Assess 2002;6(22):1-89.

7. Clarke G, Reid E, Eubanks D, et al. Overcoming Depression on the Internet (ODIN): a randomized trial of an Internet depression skills intervention program. J Med Internet Res 2002;4(3):e14.-Available at: http://www.jmir.org/2002/3/e14/index.htm. Accessed July 1, 2003.

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Article PDF
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Patients who dread the stigma of in-person psychotherapy are substituting traditional “couch trips” with computer sessions.

Computer-based therapy programs, either online or on CD-ROM or DVD, have become popular adjuncts to traditional therapy for patients with mild depression or anxiety. For example, more than 17,000 users visited the MoodGYM site within 6 months, and more than 20% of these users stayed on the site for 16 minutes or more.1

Computerized psychotherapy has demonstrated numerous benefits in clinical studies and may reduce the time a therapist needs to spend with the patient.

How computer therapy works

Computer-based psychotherapy has its roots in the ELIZA2 program developed in 1966 to study natural language communication between man and machine.3 Users simply write a normal sentence, and ELIZA responds appropriately.

The original ELIZA program, which works via text parsing, is limited in its ability to respond. For example, a user who types in “I feel depressed every day” may repeatedly get a response such as “Are you sure?”

Today’s programs are more sophisticated, utilizing specialized heuristic techniques and semantic databases to produce more natural responses to various expressions. Some programs even have audio and video features.

Most computer-based therapy programs employ a cognitive-behavioral treatment model, similar to that used in print workbooks. Several key concepts are presented, such as the relationship between automatic thoughts and feelings; techniques to control these thoughts are highlighted.

Many programs also use common scales to determine depression or anxiety ratings, thus helping the user choose an appropriate module.

Advantages of computer psychotherapy

Computer-based programs offer patients advantages such as:

 

  • Increased comfort. Without the social cues and dynamics that characterize traditional psychotherapy, some patients may disclose feelings online they would feel uncomfortable sharing in person. Online therapy also is immune to the fatigue, illness, boredom, or exploitation that may occur in a relationship with a therapist.
  • Flexibility. Users can work the program at home, at their convenience and pace. Responses to exercises also can be stored for future reference.
  • Speed of care. Treatment is accessed with minimal delay.
  • A greater sense of empowerment. Whereas patients in traditional therapy often feel dependent upon their therapist for direction, computer-based therapy encourages users to take a more active learning role by choosing where to click and how to respond. Patients feel more in control because they are helping themselves.
  • Cost-effectiveness. Although price varies, some programs cost about the same as one in-person session. Most programs are sold directly to medical practices.

Disadvantages

Some patients will not benefit from self-help. Those with moderate to severe depression or anxiety may be unable to focus on the material, and inability to navigate the program can increase the patent’s despondency or anxiety. Personality type also may predict lack of response to self-help treatment.4

Patients with poor eyesight, deficient reading skills, and limited computer proficiency are not good candidates for online or CD-ROM-based therapy. Also, some computers may not be sufficiently powerful to run some programs, and not all Internet connections are fast enough to post multimedia features.

Clinical effectiveness

In 1990, Selmi et al5 compared a six-session, cognitive-behavioral therapy (CBT) course in CD-ROM with six therapist-administered CBT sessions and a control group. An experimenter assisted with computer operation, and both courses followed an identical treatment model and required homework. Patients in both treatment groups demonstrated significant improvement based on Beck Depression Inventory and Automatic Thoughts Questionnaire scores.

Each group comprised only 12 patients, most of whom were young and well-educated. Still, Selmi et al provided initial evidence of computer-based therapy’s effectiveness and these findings have been replicated in subsequent studies. A meta-analysis of 16 studies6 found that CD-ROM-based and therapist-administered CBT work equally well in clinically depressed and anxious outpatients. More studies are needed to determine optimal levels of therapist involvement.

More research also is needed to gauge the effectiveness of Internet-based therapy programs (Table). Clarke et al randomized 144 out of 299 patients in a nonprofit health maintenance organization to online therapy with the Overcoming Depression on the Internet (ODIN) program or to treatment as usual. The study demonstrated no effect for ODIN, perhaps because of severity of depression or infrequent access to the site.7

Table

Samples of computer-based psychotherapy programs

 

Beating the Blues http://www.ultrasis.co.uk/products/btb/btb.html
BT STEPS http://www.healthtechsys.com/ivr/btsteps/btsteps.html
Behavioral Self-Control
Program for Windows http://www.behaviortherapy.com/software.htm#software
Calipso http://www.calipso.co.uk/mainframe.htm
FearFighter http://www.fearfighter.com
Good Days Ahead http://www.mindstreet.com
MoodGYM http://moodgym.anu.edu.au
Overcoming Depression http://www.maiw.com/main.html
Overcoming Depression on the Internet (ODIN) https://www.kpchr.org/feelbetter/

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Patients who dread the stigma of in-person psychotherapy are substituting traditional “couch trips” with computer sessions.

Computer-based therapy programs, either online or on CD-ROM or DVD, have become popular adjuncts to traditional therapy for patients with mild depression or anxiety. For example, more than 17,000 users visited the MoodGYM site within 6 months, and more than 20% of these users stayed on the site for 16 minutes or more.1

Computerized psychotherapy has demonstrated numerous benefits in clinical studies and may reduce the time a therapist needs to spend with the patient.

How computer therapy works

Computer-based psychotherapy has its roots in the ELIZA2 program developed in 1966 to study natural language communication between man and machine.3 Users simply write a normal sentence, and ELIZA responds appropriately.

The original ELIZA program, which works via text parsing, is limited in its ability to respond. For example, a user who types in “I feel depressed every day” may repeatedly get a response such as “Are you sure?”

Today’s programs are more sophisticated, utilizing specialized heuristic techniques and semantic databases to produce more natural responses to various expressions. Some programs even have audio and video features.

Most computer-based therapy programs employ a cognitive-behavioral treatment model, similar to that used in print workbooks. Several key concepts are presented, such as the relationship between automatic thoughts and feelings; techniques to control these thoughts are highlighted.

Many programs also use common scales to determine depression or anxiety ratings, thus helping the user choose an appropriate module.

Advantages of computer psychotherapy

Computer-based programs offer patients advantages such as:

 

  • Increased comfort. Without the social cues and dynamics that characterize traditional psychotherapy, some patients may disclose feelings online they would feel uncomfortable sharing in person. Online therapy also is immune to the fatigue, illness, boredom, or exploitation that may occur in a relationship with a therapist.
  • Flexibility. Users can work the program at home, at their convenience and pace. Responses to exercises also can be stored for future reference.
  • Speed of care. Treatment is accessed with minimal delay.
  • A greater sense of empowerment. Whereas patients in traditional therapy often feel dependent upon their therapist for direction, computer-based therapy encourages users to take a more active learning role by choosing where to click and how to respond. Patients feel more in control because they are helping themselves.
  • Cost-effectiveness. Although price varies, some programs cost about the same as one in-person session. Most programs are sold directly to medical practices.

Disadvantages

Some patients will not benefit from self-help. Those with moderate to severe depression or anxiety may be unable to focus on the material, and inability to navigate the program can increase the patent’s despondency or anxiety. Personality type also may predict lack of response to self-help treatment.4

Patients with poor eyesight, deficient reading skills, and limited computer proficiency are not good candidates for online or CD-ROM-based therapy. Also, some computers may not be sufficiently powerful to run some programs, and not all Internet connections are fast enough to post multimedia features.

Clinical effectiveness

In 1990, Selmi et al5 compared a six-session, cognitive-behavioral therapy (CBT) course in CD-ROM with six therapist-administered CBT sessions and a control group. An experimenter assisted with computer operation, and both courses followed an identical treatment model and required homework. Patients in both treatment groups demonstrated significant improvement based on Beck Depression Inventory and Automatic Thoughts Questionnaire scores.

Each group comprised only 12 patients, most of whom were young and well-educated. Still, Selmi et al provided initial evidence of computer-based therapy’s effectiveness and these findings have been replicated in subsequent studies. A meta-analysis of 16 studies6 found that CD-ROM-based and therapist-administered CBT work equally well in clinically depressed and anxious outpatients. More studies are needed to determine optimal levels of therapist involvement.

More research also is needed to gauge the effectiveness of Internet-based therapy programs (Table). Clarke et al randomized 144 out of 299 patients in a nonprofit health maintenance organization to online therapy with the Overcoming Depression on the Internet (ODIN) program or to treatment as usual. The study demonstrated no effect for ODIN, perhaps because of severity of depression or infrequent access to the site.7

Table

Samples of computer-based psychotherapy programs

 

Beating the Blues http://www.ultrasis.co.uk/products/btb/btb.html
BT STEPS http://www.healthtechsys.com/ivr/btsteps/btsteps.html
Behavioral Self-Control
Program for Windows http://www.behaviortherapy.com/software.htm#software
Calipso http://www.calipso.co.uk/mainframe.htm
FearFighter http://www.fearfighter.com
Good Days Ahead http://www.mindstreet.com
MoodGYM http://moodgym.anu.edu.au
Overcoming Depression http://www.maiw.com/main.html
Overcoming Depression on the Internet (ODIN) https://www.kpchr.org/feelbetter/

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

 

1. Christensen H, Griffiths K, Korten A. Web-based cognitive behavior therapy: analysis of site usage and changes in depression and anxiety scores. J Med Internet Res 2002;4(1):e3. Available at: http://www.jmir.org/2002/1/e3/index.htm. Accessed July 1, 2003.

2. ELIZA. Available at: http://www-ai.ijs.si/eliza/eliza.html. Accessed July 1, 2003.

3. ELIZA- a computer program for the study of natural language communication between man and machine. Communications of the Association for Computing Machinery 1966;9(1):35-6.Available at: http://i5.nyu.edu/~mm64/x52.9265/january1966.html. Accessed July 1, 2003.

4. Beutler LE, Engle D, Mohr D, et al. Predictors of differential response to cognitive, experiential, and self-directed psychotherapeutic procedures. J Consult Clin Psychol 1991;59:333-40.

5. Selmi PM, Klein MH, Greist JH, et al. Computer-administered cognitive-behavioral therapy for depression. Am J Psychiatry 1990;147:51-6.

6. Kaltenthaler E, Shackley P, Stevens K, et al. A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety. Health Technol Assess 2002;6(22):1-89.

7. Clarke G, Reid E, Eubanks D, et al. Overcoming Depression on the Internet (ODIN): a randomized trial of an Internet depression skills intervention program. J Med Internet Res 2002;4(3):e14.-Available at: http://www.jmir.org/2002/3/e14/index.htm. Accessed July 1, 2003.

References

 

1. Christensen H, Griffiths K, Korten A. Web-based cognitive behavior therapy: analysis of site usage and changes in depression and anxiety scores. J Med Internet Res 2002;4(1):e3. Available at: http://www.jmir.org/2002/1/e3/index.htm. Accessed July 1, 2003.

2. ELIZA. Available at: http://www-ai.ijs.si/eliza/eliza.html. Accessed July 1, 2003.

3. ELIZA- a computer program for the study of natural language communication between man and machine. Communications of the Association for Computing Machinery 1966;9(1):35-6.Available at: http://i5.nyu.edu/~mm64/x52.9265/january1966.html. Accessed July 1, 2003.

4. Beutler LE, Engle D, Mohr D, et al. Predictors of differential response to cognitive, experiential, and self-directed psychotherapeutic procedures. J Consult Clin Psychol 1991;59:333-40.

5. Selmi PM, Klein MH, Greist JH, et al. Computer-administered cognitive-behavioral therapy for depression. Am J Psychiatry 1990;147:51-6.

6. Kaltenthaler E, Shackley P, Stevens K, et al. A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety. Health Technol Assess 2002;6(22):1-89.

7. Clarke G, Reid E, Eubanks D, et al. Overcoming Depression on the Internet (ODIN): a randomized trial of an Internet depression skills intervention program. J Med Internet Res 2002;4(3):e14.-Available at: http://www.jmir.org/2002/3/e14/index.htm. Accessed July 1, 2003.

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Writing in the palm of your hand

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Psyber Psychiatry, February. A few voice command programs also are available for Pocket PC devices ARTrecognition, VoiceLookup, PDsay, and VoiceContact allow you to use voice commands to lookup information and launch tasks.

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

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Psyber Psychiatry, February. A few voice command programs also are available for Pocket PC devices ARTrecognition, VoiceLookup, PDsay, and VoiceContact allow you to use voice commands to lookup information and launch tasks.

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Psyber Psychiatry, February. A few voice command programs also are available for Pocket PC devices ARTrecognition, VoiceLookup, PDsay, and VoiceContact allow you to use voice commands to lookup information and launch tasks.

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

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Speeding up your Web Search

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Speeding up your Web Search

Search engines are the express lanes of the Internet. Knowing how to navigate them can help you get exactly the information you need in seconds flat.

This article will address the differences between search engines, offer basic and advanced search methods, and discuss Web search technologies and alternatives.

How search engines work

Search engines employ different methods of finding Web pages and ranking them according to relevance of information requested.1

Search engines such as Google and Altavista gather information by “crawling” or “spidering” through the Web. They check all the pages in a site and then proceed through pages linked to that site. As it progresses, it creates an indexed database of the content of each page it finds. Some search engines index more Web pages than others, while others update their indexes more often.

Many search engines pick up on how often and where the key word appears on a Web page.2 Pages on which key words appear more frequently or near the top usually will be deemed more relevant.

Search engines garner additional listings by charging advertisers to list their Web sites (e.g., a pharmaceutical company’s site promoting a particular drug) among the search results. These listings vary from paid placement, where sites are guaranteed a high ranking, to paid inclusion, by which an advertisement might be listed in more search requests.3

Taken together, these methods can generate millions of search results for a user who enters a broad topic. For example, entering “depression” in the Google search field produces 5,420,000 links ranging from product sites, government agencies and academic departments, to advocacy organizations and patients’ blogs. Unless the page relevant to you happens to be among the top five search results, you will need to refine your search. Fortunately, there are many ways to do this.

Refining your search: Basic tips

Say you’re trying to find this article without a link or a URL. Just follow these simple key word tips.4

 

  • First, try the obvious. Enter Psyber Psychiatry.
  • Use words likely to appear on a site with the information you want (e.g., psychiatry, John Luo).
  • Make key words as specific as possible-for example, Current Psychiatry Psyber vs. Psyber Psychiatry

Google and most search engines assume that you want to find pages with all the words you have entered. Other search engines, such as Teoma, usually generate pages containing all key words preceded by a + (e.g., +Current +Psychiatry will produce a link to this Web site).

If that search produces too many results, you can eliminate sites containing certain key words by inserting a - before the key word (e.g., +current +psychiatry -American -psychology). Your search still may be too broad, however, because the words “current” and “psychiatry” could appear anywhere on the site-including pages you’re trying to rule out. Placing key words within quotation marks (e.g., “Current Psychiatry” “Psyber Psychiatry”) can eliminate still more sites.

Advanced searches

If your search requires even more fine-tuning, consider the following:

Site search. Specifying a site in your query can uncover references to specific topics. For example, enter computers site: www.currentpsychiatry.com in Google to find all pages with computers mentioned on the Current Psychiatry Web site. Other sites such as AltaVista use the term host: instead of site:.

Title search. Every Web page has an HTML title, which is also searched by the spider programs. Because an HTML title usually is indicative of the site’s content, searching through these titles may point to relevant information. Use allintitle: or intitle: to find a site (e.g., intitle:currentpsychiatry).

URL search. Similar to a site and title search, you can also search for words in the URL of a Web page. For example, in Google try entering current inurl:psychiatry or inurl:currentpsychiatry.

Some search engines employ techniques such as “clustering” (prevents a search from finding too many results from the same site), “stemming” (searches for variations of a word), and “find similar” (seeks out other pages with similar information). Some sites offer “related searches” or “search again” options to help users zero in on the desired information.

Confused about which commands and search features work for which search engines? searchenginewatch.com offers a comprehensive list of basic and power search commands, search assistance features, customization and display features, and Boolean commands.

Because Google is the most popular search engine, many search tools have been developed based on the Google engine. Fagan Finder provides a Web-based interface to Google that lets users search by exact phrase, any/all words, subject, author, and many other ways. Visualization technologies such as Touchgraph and Anacubis, both of which are connected to Google, allow searchers to visually explore and navigate relationships between Web sites.

 

 

KartOO is a metasearch engine with visual display interfaces. A metasearch engine uses other search engines to find information. After you enter a search term, KartOO launches the query to a set of search engines, compiles the results, and presents them in a series of interactive maps through a proprietary algorithm. Users can narrow the search by clicking on one of the plus/minus icons and categories between the results.

When all else fails …

If you cannot be bothered with search engine tricks and tools, consider Ask Jeeves, a popular site that uses natural language processing to enter a search request. Users simply phrase and enter a query as it would be phrased in conversation-for example, “What are the side effects of lithium?” Using techniques such as tokenization, stemming, parsing, and semantic analysis, Ask Jeeves attempts to determine the information you desire, and then generates results via the Teoma search engine.

If you’re really strapped for time, you could pay someone to do the searching for you.5 For example, Google Answers allows users to submit a question for between $2.50 and $200. Google’s research team will provide an answer, usually within 24 hours.

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Related Resources

Sullivan D. Articles on searchenginewatch.com:

 

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

 

1. Sullivan D. How search engines work. searchenginewatch.com. Available at: http://www.searchenginewatch.com/webmasters/work.html. Accessed April 7, 2003.

2. Sullivan D. How search engines rank Web pages. searchenginewatch.com. Available at: http://www.searchenginewatch.com/webmasters/rank.html. Accessed April 7, 2003.

3. Sullivan D. Buying your way into search engines. searchenginewatch.com. Available at: http://www.searchenginewatch.com/webmasters/paid.html. Accessed April 7, 2003.

4. The basics of Google search. Available at: http://www.google.com/help/basics.html. Accessed April 7, 2003.

5. Arnoldy B. Paying for answers online. Christian Science Monitor July 22, 2002. Available at: http://www.csmonitor.com/2002/0722/p14s01-wmcn.htm. Accessed April 7, 2003.

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Search engines are the express lanes of the Internet. Knowing how to navigate them can help you get exactly the information you need in seconds flat.

This article will address the differences between search engines, offer basic and advanced search methods, and discuss Web search technologies and alternatives.

How search engines work

Search engines employ different methods of finding Web pages and ranking them according to relevance of information requested.1

Search engines such as Google and Altavista gather information by “crawling” or “spidering” through the Web. They check all the pages in a site and then proceed through pages linked to that site. As it progresses, it creates an indexed database of the content of each page it finds. Some search engines index more Web pages than others, while others update their indexes more often.

Many search engines pick up on how often and where the key word appears on a Web page.2 Pages on which key words appear more frequently or near the top usually will be deemed more relevant.

Search engines garner additional listings by charging advertisers to list their Web sites (e.g., a pharmaceutical company’s site promoting a particular drug) among the search results. These listings vary from paid placement, where sites are guaranteed a high ranking, to paid inclusion, by which an advertisement might be listed in more search requests.3

Taken together, these methods can generate millions of search results for a user who enters a broad topic. For example, entering “depression” in the Google search field produces 5,420,000 links ranging from product sites, government agencies and academic departments, to advocacy organizations and patients’ blogs. Unless the page relevant to you happens to be among the top five search results, you will need to refine your search. Fortunately, there are many ways to do this.

Refining your search: Basic tips

Say you’re trying to find this article without a link or a URL. Just follow these simple key word tips.4

 

  • First, try the obvious. Enter Psyber Psychiatry.
  • Use words likely to appear on a site with the information you want (e.g., psychiatry, John Luo).
  • Make key words as specific as possible-for example, Current Psychiatry Psyber vs. Psyber Psychiatry

Google and most search engines assume that you want to find pages with all the words you have entered. Other search engines, such as Teoma, usually generate pages containing all key words preceded by a + (e.g., +Current +Psychiatry will produce a link to this Web site).

If that search produces too many results, you can eliminate sites containing certain key words by inserting a - before the key word (e.g., +current +psychiatry -American -psychology). Your search still may be too broad, however, because the words “current” and “psychiatry” could appear anywhere on the site-including pages you’re trying to rule out. Placing key words within quotation marks (e.g., “Current Psychiatry” “Psyber Psychiatry”) can eliminate still more sites.

Advanced searches

If your search requires even more fine-tuning, consider the following:

Site search. Specifying a site in your query can uncover references to specific topics. For example, enter computers site: www.currentpsychiatry.com in Google to find all pages with computers mentioned on the Current Psychiatry Web site. Other sites such as AltaVista use the term host: instead of site:.

Title search. Every Web page has an HTML title, which is also searched by the spider programs. Because an HTML title usually is indicative of the site’s content, searching through these titles may point to relevant information. Use allintitle: or intitle: to find a site (e.g., intitle:currentpsychiatry).

URL search. Similar to a site and title search, you can also search for words in the URL of a Web page. For example, in Google try entering current inurl:psychiatry or inurl:currentpsychiatry.

Some search engines employ techniques such as “clustering” (prevents a search from finding too many results from the same site), “stemming” (searches for variations of a word), and “find similar” (seeks out other pages with similar information). Some sites offer “related searches” or “search again” options to help users zero in on the desired information.

Confused about which commands and search features work for which search engines? searchenginewatch.com offers a comprehensive list of basic and power search commands, search assistance features, customization and display features, and Boolean commands.

Because Google is the most popular search engine, many search tools have been developed based on the Google engine. Fagan Finder provides a Web-based interface to Google that lets users search by exact phrase, any/all words, subject, author, and many other ways. Visualization technologies such as Touchgraph and Anacubis, both of which are connected to Google, allow searchers to visually explore and navigate relationships between Web sites.

 

 

KartOO is a metasearch engine with visual display interfaces. A metasearch engine uses other search engines to find information. After you enter a search term, KartOO launches the query to a set of search engines, compiles the results, and presents them in a series of interactive maps through a proprietary algorithm. Users can narrow the search by clicking on one of the plus/minus icons and categories between the results.

When all else fails …

If you cannot be bothered with search engine tricks and tools, consider Ask Jeeves, a popular site that uses natural language processing to enter a search request. Users simply phrase and enter a query as it would be phrased in conversation-for example, “What are the side effects of lithium?” Using techniques such as tokenization, stemming, parsing, and semantic analysis, Ask Jeeves attempts to determine the information you desire, and then generates results via the Teoma search engine.

If you’re really strapped for time, you could pay someone to do the searching for you.5 For example, Google Answers allows users to submit a question for between $2.50 and $200. Google’s research team will provide an answer, usually within 24 hours.

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Related Resources

Sullivan D. Articles on searchenginewatch.com:

 

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Search engines are the express lanes of the Internet. Knowing how to navigate them can help you get exactly the information you need in seconds flat.

This article will address the differences between search engines, offer basic and advanced search methods, and discuss Web search technologies and alternatives.

How search engines work

Search engines employ different methods of finding Web pages and ranking them according to relevance of information requested.1

Search engines such as Google and Altavista gather information by “crawling” or “spidering” through the Web. They check all the pages in a site and then proceed through pages linked to that site. As it progresses, it creates an indexed database of the content of each page it finds. Some search engines index more Web pages than others, while others update their indexes more often.

Many search engines pick up on how often and where the key word appears on a Web page.2 Pages on which key words appear more frequently or near the top usually will be deemed more relevant.

Search engines garner additional listings by charging advertisers to list their Web sites (e.g., a pharmaceutical company’s site promoting a particular drug) among the search results. These listings vary from paid placement, where sites are guaranteed a high ranking, to paid inclusion, by which an advertisement might be listed in more search requests.3

Taken together, these methods can generate millions of search results for a user who enters a broad topic. For example, entering “depression” in the Google search field produces 5,420,000 links ranging from product sites, government agencies and academic departments, to advocacy organizations and patients’ blogs. Unless the page relevant to you happens to be among the top five search results, you will need to refine your search. Fortunately, there are many ways to do this.

Refining your search: Basic tips

Say you’re trying to find this article without a link or a URL. Just follow these simple key word tips.4

 

  • First, try the obvious. Enter Psyber Psychiatry.
  • Use words likely to appear on a site with the information you want (e.g., psychiatry, John Luo).
  • Make key words as specific as possible-for example, Current Psychiatry Psyber vs. Psyber Psychiatry

Google and most search engines assume that you want to find pages with all the words you have entered. Other search engines, such as Teoma, usually generate pages containing all key words preceded by a + (e.g., +Current +Psychiatry will produce a link to this Web site).

If that search produces too many results, you can eliminate sites containing certain key words by inserting a - before the key word (e.g., +current +psychiatry -American -psychology). Your search still may be too broad, however, because the words “current” and “psychiatry” could appear anywhere on the site-including pages you’re trying to rule out. Placing key words within quotation marks (e.g., “Current Psychiatry” “Psyber Psychiatry”) can eliminate still more sites.

Advanced searches

If your search requires even more fine-tuning, consider the following:

Site search. Specifying a site in your query can uncover references to specific topics. For example, enter computers site: www.currentpsychiatry.com in Google to find all pages with computers mentioned on the Current Psychiatry Web site. Other sites such as AltaVista use the term host: instead of site:.

Title search. Every Web page has an HTML title, which is also searched by the spider programs. Because an HTML title usually is indicative of the site’s content, searching through these titles may point to relevant information. Use allintitle: or intitle: to find a site (e.g., intitle:currentpsychiatry).

URL search. Similar to a site and title search, you can also search for words in the URL of a Web page. For example, in Google try entering current inurl:psychiatry or inurl:currentpsychiatry.

Some search engines employ techniques such as “clustering” (prevents a search from finding too many results from the same site), “stemming” (searches for variations of a word), and “find similar” (seeks out other pages with similar information). Some sites offer “related searches” or “search again” options to help users zero in on the desired information.

Confused about which commands and search features work for which search engines? searchenginewatch.com offers a comprehensive list of basic and power search commands, search assistance features, customization and display features, and Boolean commands.

Because Google is the most popular search engine, many search tools have been developed based on the Google engine. Fagan Finder provides a Web-based interface to Google that lets users search by exact phrase, any/all words, subject, author, and many other ways. Visualization technologies such as Touchgraph and Anacubis, both of which are connected to Google, allow searchers to visually explore and navigate relationships between Web sites.

 

 

KartOO is a metasearch engine with visual display interfaces. A metasearch engine uses other search engines to find information. After you enter a search term, KartOO launches the query to a set of search engines, compiles the results, and presents them in a series of interactive maps through a proprietary algorithm. Users can narrow the search by clicking on one of the plus/minus icons and categories between the results.

When all else fails …

If you cannot be bothered with search engine tricks and tools, consider Ask Jeeves, a popular site that uses natural language processing to enter a search request. Users simply phrase and enter a query as it would be phrased in conversation-for example, “What are the side effects of lithium?” Using techniques such as tokenization, stemming, parsing, and semantic analysis, Ask Jeeves attempts to determine the information you desire, and then generates results via the Teoma search engine.

If you’re really strapped for time, you could pay someone to do the searching for you.5 For example, Google Answers allows users to submit a question for between $2.50 and $200. Google’s research team will provide an answer, usually within 24 hours.

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Related Resources

Sullivan D. Articles on searchenginewatch.com:

 

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

 

1. Sullivan D. How search engines work. searchenginewatch.com. Available at: http://www.searchenginewatch.com/webmasters/work.html. Accessed April 7, 2003.

2. Sullivan D. How search engines rank Web pages. searchenginewatch.com. Available at: http://www.searchenginewatch.com/webmasters/rank.html. Accessed April 7, 2003.

3. Sullivan D. Buying your way into search engines. searchenginewatch.com. Available at: http://www.searchenginewatch.com/webmasters/paid.html. Accessed April 7, 2003.

4. The basics of Google search. Available at: http://www.google.com/help/basics.html. Accessed April 7, 2003.

5. Arnoldy B. Paying for answers online. Christian Science Monitor July 22, 2002. Available at: http://www.csmonitor.com/2002/0722/p14s01-wmcn.htm. Accessed April 7, 2003.

References

 

1. Sullivan D. How search engines work. searchenginewatch.com. Available at: http://www.searchenginewatch.com/webmasters/work.html. Accessed April 7, 2003.

2. Sullivan D. How search engines rank Web pages. searchenginewatch.com. Available at: http://www.searchenginewatch.com/webmasters/rank.html. Accessed April 7, 2003.

3. Sullivan D. Buying your way into search engines. searchenginewatch.com. Available at: http://www.searchenginewatch.com/webmasters/paid.html. Accessed April 7, 2003.

4. The basics of Google search. Available at: http://www.google.com/help/basics.html. Accessed April 7, 2003.

5. Arnoldy B. Paying for answers online. Christian Science Monitor July 22, 2002. Available at: http://www.csmonitor.com/2002/0722/p14s01-wmcn.htm. Accessed April 7, 2003.

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Handhelds: A cure for illegible prescriptions?

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Handhelds: A cure for illegible prescriptions?

Those stale jokes about a doctor’s poor penmanship are no laughing matter when it comes to writing prescriptions.

Prescription errors are a common cause of adverse patient events.1 Illegible handwriting can lead to misinterpretations of dosage, drug name, or abbreviations. Imagine the implications for a patient with bipolar depression whose pharmacist interprets “Lamictal” as “Lamisil” on your prescription.

Replacing your Rx pad with a Palm or Pocket PC-both of which have prescription writing, printing, and processing capacities-may help you prevent such errors.

Why a handheld?

Machine-generated text usually is more readable than handwritten copy, but use of handhelds can also make prescription writing more efficient and secure.

A tap on the screen can pull a patient’s name from a database directly into the prescription. With a few more taps, you can access a list of the patient’s current medications and renew them without changes. A drug reference program allows you to check for drug-drug interactions.

To add a prescription, simply type the first letter and choose from a menu of drug names; the program narrows the choices as additional letters are typed.

Prescription-writing programs for handhelds also offer links to health plan formulary databases, so you can immediately find out whether a medication is available to the patient. This can eliminate time-consuming phone calls from the patient or pharmacy and discussions with pharmacy benefits managers. The patient also will appreciate getting needed medications with no hassle.

You can print out the prescription via the handheld’s infrared or wireless port. This will help you prevent forgery, since a printed prescription is harder to forge than a handwritten one. It is extremely difficult to align a printed document in order to add or correct existing text.

By connecting the handheld to your desktop computer, you can fax prescriptions directly to the pharmacy. Entering all prescriptions into the handheld and sending them in bulk at day’s end can save you significant time. To do this, you must create a database of pharmacies used by your patients and enter it into the handheld’s fax software.

Cellular phone networks and wireless Internet access can also facilitate handheld transmissions. Companies offering these options typically have the prescription sent to their electronic warehouses, then to the designated pharmacy. These transmissions are expedient and safe, but users should make sure that they conform to the Health Insurance Portability and Accountability Act of 1996. Users face civil penalties for failure to use these adopted standards and criminal penalties for wrongfully disclosing confidential information. Violators can be fined up to $25,000 and face as much as 10 years in prison.

Caveats

Use of handhelds entails hardware, software, and monthly service costs. Most handhelds cost around $300, with the software and service totaling around $50 per month. Several prescription solutions are on the market (See “Handheld options for writing prescriptions”) and they vary in terms of hardware compatibility, software interface, and mode of transmission. For example, ePhysician is available for Palm OS devices, but transmissions must go to the ePhysician server before they are relayed to the pharmacy. iScribe is available for Palm OS, but prescriptions must be printed on specialized paper with preset perforations.

As mentioned, fax-based transmission lets you send prescriptions en masse, but this makes it difficult to confirm that a particular faxed prescription has been received. Worse still, if the handheld device fails, all prescriptions in storage would be lost. It is better to send fax-based prescriptions as often as possible or back up the information during the day.

Pharmaceutical benefit management organizations have begun purchasing handheld-compatible prescription companies. While this could expedite claims processing for handheld users, tighter controls on out-of-formulary drug use could result. The number and types of prescriptions can be tracked, making it easier for administrators to spot non-formulary prescriptions. The impact this will have on psychiatry remains to be seen.

Finally, because both computer technology and the health care industry are constantly changing, a prescription writing solution can become obsolete within a couple of years. Specifically, when health care companies merge, some products are discontinued. For example, when Salu medical communications purchased ScanRx, the latter company’s software upgrades were stalled and continuity of service to existing customers was broken.

The future

Technology is addressing the need to reduce prescription errors in other ways.

Many hospitals use bar-code scanners attached or built into handhelds to ensure that medications reach the right patients. This capability could one day reach the practice mainstream.

Voice recognition software may one day allow physicians to dictate prescriptions onto the handheld, but will require voice imprint recognition for security.

 

 

Handheld options for writing prescriptions

Palm OS

Bluefish Wireless

iScribe

ePhysician

Palmscription

Pocket PC OS

Scriptlynx

Pocketscript

Allscripts

Doc-U-Scrip

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

Reference

1. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academies Press, 2000:22.

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Those stale jokes about a doctor’s poor penmanship are no laughing matter when it comes to writing prescriptions.

Prescription errors are a common cause of adverse patient events.1 Illegible handwriting can lead to misinterpretations of dosage, drug name, or abbreviations. Imagine the implications for a patient with bipolar depression whose pharmacist interprets “Lamictal” as “Lamisil” on your prescription.

Replacing your Rx pad with a Palm or Pocket PC-both of which have prescription writing, printing, and processing capacities-may help you prevent such errors.

Why a handheld?

Machine-generated text usually is more readable than handwritten copy, but use of handhelds can also make prescription writing more efficient and secure.

A tap on the screen can pull a patient’s name from a database directly into the prescription. With a few more taps, you can access a list of the patient’s current medications and renew them without changes. A drug reference program allows you to check for drug-drug interactions.

To add a prescription, simply type the first letter and choose from a menu of drug names; the program narrows the choices as additional letters are typed.

Prescription-writing programs for handhelds also offer links to health plan formulary databases, so you can immediately find out whether a medication is available to the patient. This can eliminate time-consuming phone calls from the patient or pharmacy and discussions with pharmacy benefits managers. The patient also will appreciate getting needed medications with no hassle.

You can print out the prescription via the handheld’s infrared or wireless port. This will help you prevent forgery, since a printed prescription is harder to forge than a handwritten one. It is extremely difficult to align a printed document in order to add or correct existing text.

By connecting the handheld to your desktop computer, you can fax prescriptions directly to the pharmacy. Entering all prescriptions into the handheld and sending them in bulk at day’s end can save you significant time. To do this, you must create a database of pharmacies used by your patients and enter it into the handheld’s fax software.

Cellular phone networks and wireless Internet access can also facilitate handheld transmissions. Companies offering these options typically have the prescription sent to their electronic warehouses, then to the designated pharmacy. These transmissions are expedient and safe, but users should make sure that they conform to the Health Insurance Portability and Accountability Act of 1996. Users face civil penalties for failure to use these adopted standards and criminal penalties for wrongfully disclosing confidential information. Violators can be fined up to $25,000 and face as much as 10 years in prison.

Caveats

Use of handhelds entails hardware, software, and monthly service costs. Most handhelds cost around $300, with the software and service totaling around $50 per month. Several prescription solutions are on the market (See “Handheld options for writing prescriptions”) and they vary in terms of hardware compatibility, software interface, and mode of transmission. For example, ePhysician is available for Palm OS devices, but transmissions must go to the ePhysician server before they are relayed to the pharmacy. iScribe is available for Palm OS, but prescriptions must be printed on specialized paper with preset perforations.

As mentioned, fax-based transmission lets you send prescriptions en masse, but this makes it difficult to confirm that a particular faxed prescription has been received. Worse still, if the handheld device fails, all prescriptions in storage would be lost. It is better to send fax-based prescriptions as often as possible or back up the information during the day.

Pharmaceutical benefit management organizations have begun purchasing handheld-compatible prescription companies. While this could expedite claims processing for handheld users, tighter controls on out-of-formulary drug use could result. The number and types of prescriptions can be tracked, making it easier for administrators to spot non-formulary prescriptions. The impact this will have on psychiatry remains to be seen.

Finally, because both computer technology and the health care industry are constantly changing, a prescription writing solution can become obsolete within a couple of years. Specifically, when health care companies merge, some products are discontinued. For example, when Salu medical communications purchased ScanRx, the latter company’s software upgrades were stalled and continuity of service to existing customers was broken.

The future

Technology is addressing the need to reduce prescription errors in other ways.

Many hospitals use bar-code scanners attached or built into handhelds to ensure that medications reach the right patients. This capability could one day reach the practice mainstream.

Voice recognition software may one day allow physicians to dictate prescriptions onto the handheld, but will require voice imprint recognition for security.

 

 

Handheld options for writing prescriptions

Palm OS

Bluefish Wireless

iScribe

ePhysician

Palmscription

Pocket PC OS

Scriptlynx

Pocketscript

Allscripts

Doc-U-Scrip

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Those stale jokes about a doctor’s poor penmanship are no laughing matter when it comes to writing prescriptions.

Prescription errors are a common cause of adverse patient events.1 Illegible handwriting can lead to misinterpretations of dosage, drug name, or abbreviations. Imagine the implications for a patient with bipolar depression whose pharmacist interprets “Lamictal” as “Lamisil” on your prescription.

Replacing your Rx pad with a Palm or Pocket PC-both of which have prescription writing, printing, and processing capacities-may help you prevent such errors.

Why a handheld?

Machine-generated text usually is more readable than handwritten copy, but use of handhelds can also make prescription writing more efficient and secure.

A tap on the screen can pull a patient’s name from a database directly into the prescription. With a few more taps, you can access a list of the patient’s current medications and renew them without changes. A drug reference program allows you to check for drug-drug interactions.

To add a prescription, simply type the first letter and choose from a menu of drug names; the program narrows the choices as additional letters are typed.

Prescription-writing programs for handhelds also offer links to health plan formulary databases, so you can immediately find out whether a medication is available to the patient. This can eliminate time-consuming phone calls from the patient or pharmacy and discussions with pharmacy benefits managers. The patient also will appreciate getting needed medications with no hassle.

You can print out the prescription via the handheld’s infrared or wireless port. This will help you prevent forgery, since a printed prescription is harder to forge than a handwritten one. It is extremely difficult to align a printed document in order to add or correct existing text.

By connecting the handheld to your desktop computer, you can fax prescriptions directly to the pharmacy. Entering all prescriptions into the handheld and sending them in bulk at day’s end can save you significant time. To do this, you must create a database of pharmacies used by your patients and enter it into the handheld’s fax software.

Cellular phone networks and wireless Internet access can also facilitate handheld transmissions. Companies offering these options typically have the prescription sent to their electronic warehouses, then to the designated pharmacy. These transmissions are expedient and safe, but users should make sure that they conform to the Health Insurance Portability and Accountability Act of 1996. Users face civil penalties for failure to use these adopted standards and criminal penalties for wrongfully disclosing confidential information. Violators can be fined up to $25,000 and face as much as 10 years in prison.

Caveats

Use of handhelds entails hardware, software, and monthly service costs. Most handhelds cost around $300, with the software and service totaling around $50 per month. Several prescription solutions are on the market (See “Handheld options for writing prescriptions”) and they vary in terms of hardware compatibility, software interface, and mode of transmission. For example, ePhysician is available for Palm OS devices, but transmissions must go to the ePhysician server before they are relayed to the pharmacy. iScribe is available for Palm OS, but prescriptions must be printed on specialized paper with preset perforations.

As mentioned, fax-based transmission lets you send prescriptions en masse, but this makes it difficult to confirm that a particular faxed prescription has been received. Worse still, if the handheld device fails, all prescriptions in storage would be lost. It is better to send fax-based prescriptions as often as possible or back up the information during the day.

Pharmaceutical benefit management organizations have begun purchasing handheld-compatible prescription companies. While this could expedite claims processing for handheld users, tighter controls on out-of-formulary drug use could result. The number and types of prescriptions can be tracked, making it easier for administrators to spot non-formulary prescriptions. The impact this will have on psychiatry remains to be seen.

Finally, because both computer technology and the health care industry are constantly changing, a prescription writing solution can become obsolete within a couple of years. Specifically, when health care companies merge, some products are discontinued. For example, when Salu medical communications purchased ScanRx, the latter company’s software upgrades were stalled and continuity of service to existing customers was broken.

The future

Technology is addressing the need to reduce prescription errors in other ways.

Many hospitals use bar-code scanners attached or built into handhelds to ensure that medications reach the right patients. This capability could one day reach the practice mainstream.

Voice recognition software may one day allow physicians to dictate prescriptions onto the handheld, but will require voice imprint recognition for security.

 

 

Handheld options for writing prescriptions

Palm OS

Bluefish Wireless

iScribe

ePhysician

Palmscription

Pocket PC OS

Scriptlynx

Pocketscript

Allscripts

Doc-U-Scrip

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

Reference

1. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academies Press, 2000:22.

References

Reference

1. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academies Press, 2000:22.

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Handhelds: A cure for illegible prescriptions?

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Handhelds: A cure for illegible prescriptions?

Those stale jokes about a doctor’s poor penmanship are no laughing matter when it comes to writing prescriptions.

Prescription errors are a common cause of adverse patient events.1 Illegible handwriting can lead to misinterpretations of dosage, drug name, or abbreviations. Imagine the implications for a patient with bipolar depression whose pharmacist interprets “Lamictal” as “Lamisil” on your prescription.

Replacing your Rx pad with a Palm or Pocket PC-both of which have prescription writing, printing, and processing capacities-may help you prevent such errors.

Why a handheld?

Machine-generated text usually is more readable than handwritten copy, but use of handhelds can also make prescription writing more efficient and secure.

A tap on the screen can pull a patient’s name from a database directly into the prescription. With a few more taps, you can access a list of the patient’s current medications and renew them without changes. A drug reference program allows you to check for drug-drug interactions.

To add a prescription, simply type the first letter and choose from a menu of drug names; the program narrows the choices as additional letters are typed.

Prescription-writing programs for handhelds also offer links to health plan formulary databases, so you can immediately find out whether a medication is available to the patient. This can eliminate time-consuming phone calls from the patient or pharmacy and discussions with pharmacy benefits managers. The patient also will appreciate getting needed medications with no hassle.

You can print out the prescription via the handheld’s infrared or wireless port. This will help you prevent forgery, since a printed prescription is harder to forge than a handwritten one. It is extremely difficult to align a printed document in order to add or correct existing text.

By connecting the handheld to your desktop computer, you can fax prescriptions directly to the pharmacy. Entering all prescriptions into the handheld and sending them in bulk at day’s end can save you significant time. To do this, you must create a database of pharmacies used by your patients and enter it into the handheld’s fax software.

Cellular phone networks and wireless Internet access can also facilitate handheld transmissions. Companies offering these options typically have the prescription sent to their electronic warehouses, then to the designated pharmacy. These transmissions are expedient and safe, but users should make sure that they conform to the Health Insurance Portability and Accountability Act of 1996. Users face civil penalties for failure to use these adopted standards and criminal penalties for wrongfully disclosing confidential information. Violators can be fined up to $25,000 and face as much as 10 years in prison.

Caveats

Use of handhelds entails hardware, software, and monthly service costs. Most handhelds cost around $300, with the software and service totaling around $50 per month. Several prescription solutions are on the market (See “Handheld options for writing prescriptions”) and they vary in terms of hardware compatibility, software interface, and mode of transmission. For example, ePhysician is available for Palm OS devices, but transmissions must go to the ePhysician server before they are relayed to the pharmacy. iScribe is available for Palm OS, but prescriptions must be printed on specialized paper with preset perforations.

As mentioned, fax-based transmission lets you send prescriptions en masse, but this makes it difficult to confirm that a particular faxed prescription has been received. Worse still, if the handheld device fails, all prescriptions in storage would be lost. It is better to send fax-based prescriptions as often as possible or back up the information during the day.

Pharmaceutical benefit management organizations have begun purchasing handheld-compatible prescription companies. While this could expedite claims processing for handheld users, tighter controls on out-of-formulary drug use could result. The number and types of prescriptions can be tracked, making it easier for administrators to spot non-formulary prescriptions. The impact this will have on psychiatry remains to be seen.

Finally, because both computer technology and the health care industry are constantly changing, a prescription writing solution can become obsolete within a couple of years. Specifically, when health care companies merge, some products are discontinued. For example, when Salu medical communications purchased ScanRx, the latter company’s software upgrades were stalled and continuity of service to existing customers was broken.

The future

Technology is addressing the need to reduce prescription errors in other ways.

Many hospitals use bar-code scanners attached or built into handhelds to ensure that medications reach the right patients. This capability could one day reach the practice mainstream.

Voice recognition software may one day allow physicians to dictate prescriptions onto the handheld, but will require voice imprint recognition for security.

 

 

Handheld options for writing prescriptions

Palm OS

Bluefish Wireless

iScribe

ePhysician

Palmscription

Pocket PC OS

Scriptlynx

Pocketscript

Allscripts

Doc-U-Scrip

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

Reference

1. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academies Press, 2000:22.

Article PDF
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Those stale jokes about a doctor’s poor penmanship are no laughing matter when it comes to writing prescriptions.

Prescription errors are a common cause of adverse patient events.1 Illegible handwriting can lead to misinterpretations of dosage, drug name, or abbreviations. Imagine the implications for a patient with bipolar depression whose pharmacist interprets “Lamictal” as “Lamisil” on your prescription.

Replacing your Rx pad with a Palm or Pocket PC-both of which have prescription writing, printing, and processing capacities-may help you prevent such errors.

Why a handheld?

Machine-generated text usually is more readable than handwritten copy, but use of handhelds can also make prescription writing more efficient and secure.

A tap on the screen can pull a patient’s name from a database directly into the prescription. With a few more taps, you can access a list of the patient’s current medications and renew them without changes. A drug reference program allows you to check for drug-drug interactions.

To add a prescription, simply type the first letter and choose from a menu of drug names; the program narrows the choices as additional letters are typed.

Prescription-writing programs for handhelds also offer links to health plan formulary databases, so you can immediately find out whether a medication is available to the patient. This can eliminate time-consuming phone calls from the patient or pharmacy and discussions with pharmacy benefits managers. The patient also will appreciate getting needed medications with no hassle.

You can print out the prescription via the handheld’s infrared or wireless port. This will help you prevent forgery, since a printed prescription is harder to forge than a handwritten one. It is extremely difficult to align a printed document in order to add or correct existing text.

By connecting the handheld to your desktop computer, you can fax prescriptions directly to the pharmacy. Entering all prescriptions into the handheld and sending them in bulk at day’s end can save you significant time. To do this, you must create a database of pharmacies used by your patients and enter it into the handheld’s fax software.

Cellular phone networks and wireless Internet access can also facilitate handheld transmissions. Companies offering these options typically have the prescription sent to their electronic warehouses, then to the designated pharmacy. These transmissions are expedient and safe, but users should make sure that they conform to the Health Insurance Portability and Accountability Act of 1996. Users face civil penalties for failure to use these adopted standards and criminal penalties for wrongfully disclosing confidential information. Violators can be fined up to $25,000 and face as much as 10 years in prison.

Caveats

Use of handhelds entails hardware, software, and monthly service costs. Most handhelds cost around $300, with the software and service totaling around $50 per month. Several prescription solutions are on the market (See “Handheld options for writing prescriptions”) and they vary in terms of hardware compatibility, software interface, and mode of transmission. For example, ePhysician is available for Palm OS devices, but transmissions must go to the ePhysician server before they are relayed to the pharmacy. iScribe is available for Palm OS, but prescriptions must be printed on specialized paper with preset perforations.

As mentioned, fax-based transmission lets you send prescriptions en masse, but this makes it difficult to confirm that a particular faxed prescription has been received. Worse still, if the handheld device fails, all prescriptions in storage would be lost. It is better to send fax-based prescriptions as often as possible or back up the information during the day.

Pharmaceutical benefit management organizations have begun purchasing handheld-compatible prescription companies. While this could expedite claims processing for handheld users, tighter controls on out-of-formulary drug use could result. The number and types of prescriptions can be tracked, making it easier for administrators to spot non-formulary prescriptions. The impact this will have on psychiatry remains to be seen.

Finally, because both computer technology and the health care industry are constantly changing, a prescription writing solution can become obsolete within a couple of years. Specifically, when health care companies merge, some products are discontinued. For example, when Salu medical communications purchased ScanRx, the latter company’s software upgrades were stalled and continuity of service to existing customers was broken.

The future

Technology is addressing the need to reduce prescription errors in other ways.

Many hospitals use bar-code scanners attached or built into handhelds to ensure that medications reach the right patients. This capability could one day reach the practice mainstream.

Voice recognition software may one day allow physicians to dictate prescriptions onto the handheld, but will require voice imprint recognition for security.

 

 

Handheld options for writing prescriptions

Palm OS

Bluefish Wireless

iScribe

ePhysician

Palmscription

Pocket PC OS

Scriptlynx

Pocketscript

Allscripts

Doc-U-Scrip

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Those stale jokes about a doctor’s poor penmanship are no laughing matter when it comes to writing prescriptions.

Prescription errors are a common cause of adverse patient events.1 Illegible handwriting can lead to misinterpretations of dosage, drug name, or abbreviations. Imagine the implications for a patient with bipolar depression whose pharmacist interprets “Lamictal” as “Lamisil” on your prescription.

Replacing your Rx pad with a Palm or Pocket PC-both of which have prescription writing, printing, and processing capacities-may help you prevent such errors.

Why a handheld?

Machine-generated text usually is more readable than handwritten copy, but use of handhelds can also make prescription writing more efficient and secure.

A tap on the screen can pull a patient’s name from a database directly into the prescription. With a few more taps, you can access a list of the patient’s current medications and renew them without changes. A drug reference program allows you to check for drug-drug interactions.

To add a prescription, simply type the first letter and choose from a menu of drug names; the program narrows the choices as additional letters are typed.

Prescription-writing programs for handhelds also offer links to health plan formulary databases, so you can immediately find out whether a medication is available to the patient. This can eliminate time-consuming phone calls from the patient or pharmacy and discussions with pharmacy benefits managers. The patient also will appreciate getting needed medications with no hassle.

You can print out the prescription via the handheld’s infrared or wireless port. This will help you prevent forgery, since a printed prescription is harder to forge than a handwritten one. It is extremely difficult to align a printed document in order to add or correct existing text.

By connecting the handheld to your desktop computer, you can fax prescriptions directly to the pharmacy. Entering all prescriptions into the handheld and sending them in bulk at day’s end can save you significant time. To do this, you must create a database of pharmacies used by your patients and enter it into the handheld’s fax software.

Cellular phone networks and wireless Internet access can also facilitate handheld transmissions. Companies offering these options typically have the prescription sent to their electronic warehouses, then to the designated pharmacy. These transmissions are expedient and safe, but users should make sure that they conform to the Health Insurance Portability and Accountability Act of 1996. Users face civil penalties for failure to use these adopted standards and criminal penalties for wrongfully disclosing confidential information. Violators can be fined up to $25,000 and face as much as 10 years in prison.

Caveats

Use of handhelds entails hardware, software, and monthly service costs. Most handhelds cost around $300, with the software and service totaling around $50 per month. Several prescription solutions are on the market (See “Handheld options for writing prescriptions”) and they vary in terms of hardware compatibility, software interface, and mode of transmission. For example, ePhysician is available for Palm OS devices, but transmissions must go to the ePhysician server before they are relayed to the pharmacy. iScribe is available for Palm OS, but prescriptions must be printed on specialized paper with preset perforations.

As mentioned, fax-based transmission lets you send prescriptions en masse, but this makes it difficult to confirm that a particular faxed prescription has been received. Worse still, if the handheld device fails, all prescriptions in storage would be lost. It is better to send fax-based prescriptions as often as possible or back up the information during the day.

Pharmaceutical benefit management organizations have begun purchasing handheld-compatible prescription companies. While this could expedite claims processing for handheld users, tighter controls on out-of-formulary drug use could result. The number and types of prescriptions can be tracked, making it easier for administrators to spot non-formulary prescriptions. The impact this will have on psychiatry remains to be seen.

Finally, because both computer technology and the health care industry are constantly changing, a prescription writing solution can become obsolete within a couple of years. Specifically, when health care companies merge, some products are discontinued. For example, when Salu medical communications purchased ScanRx, the latter company’s software upgrades were stalled and continuity of service to existing customers was broken.

The future

Technology is addressing the need to reduce prescription errors in other ways.

Many hospitals use bar-code scanners attached or built into handhelds to ensure that medications reach the right patients. This capability could one day reach the practice mainstream.

Voice recognition software may one day allow physicians to dictate prescriptions onto the handheld, but will require voice imprint recognition for security.

 

 

Handheld options for writing prescriptions

Palm OS

Bluefish Wireless

iScribe

ePhysician

Palmscription

Pocket PC OS

Scriptlynx

Pocketscript

Allscripts

Doc-U-Scrip

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

Reference

1. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academies Press, 2000:22.

References

Reference

1. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academies Press, 2000:22.

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If you cannot type—or don’t like to—read on.

Text-entry advances offer alternatives to traditional keystroking. From voice recognition to online dictation, these options promise increased efficiency and relief from typing-related repetitive stress injuries.

The truth about typing

Few people know that the original typewriter keyboard layout—known as QWERTY, for the row of keys on the upper left-hand side—was designed to decrease typing speed so that the mechanical typewriter’s keys would not jam.1 More recently designed keyboard layouts, such as DVORAK and IDEAL, are reportedly more efficient but are not widely used. It would take months to retrain a typist to work with either keyboard.

Dictation is a well-established alternative to typing, but if the transcriber is not 100% accurate, much time is wasted correcting mistakes, returning the document, and proofreading the corrections.

Voice recognition

Voice recognition technology has been touted as the successor to dictation. With increasing computer power and more sophisticated algorithms to improve recognition, many programs2 can record continuous speech onto a document with approximately 95% accuracy.

Using voice recognition software and hardware to dictate text can save worlds of time compared with typing or writing by hand. But beware: accents and background noise often confound voice-based systems.

What’s more, a voice-recognition package that is suited to medical practice may be considerably more expensive than an entry-level model. Entry-level programs such as ScanSoft Dragon Naturally Speaking and IBM ViaVoice start at less than $100 each, but the medical version of ScanSoft is $1,000. The Trigram Psychiatry Specialty Module, at $300, may be an option. ViaVoice users can get a medical vocabulary module for an additional $142.

Other text-entry solutions

Internet-based dictation is a possible alternative to voice recognition or traditional dictation. Dictaphone’s Physician Workstation, which will reach the market in March, will allow the user to dictate with a specialized microphone linked to the computer or offsite by calling a toll-free telephone number. The computer then sends the voice data securely via the Internet to off-site transcriptionists. The physician logs into the transcript and makes corrections online via a Web browser. The user electronically signs the note to finalize it, and it is automatically delivered to the desired locations.

For a nominal investment in hardware, Physician Workstation can significantly simplify and speed up the transcription process. Dictaphone also provides 24-7 support and maintenance for these services, which cost $86 a month for 500 minutes. The setup has its drawbacks: Dictaphone provides the secure infrastructure and support, but transcription is a separate contracted service at 15.5 cents per line. However, you can select another transcription service to receive your voice files, or you can use Dictaphone’s new voice recognition software (also available in March).

Similarly, other online transcription services, such as HealthScribes and Kinetxhc, allow mobile users to dictate via a telephone, dedicated device, or personal digital assistant (PDA). HealthScribes charges 12.5 cents per line for PDA dictation, plus $45 a month for the software contract. In contrast, Dictaphone offers more services to handle the volume and connectivity of electronic medical records.

Many PDAs are equipped to work like tape recorders: The user talks into a receiver, creates a digital voice file, and sends the file electronically to the transcription/voice recognition service. For example, HealthcareOne provides a solution for the Palm OS based-Handera PDA, and ProVox utilizes Pocket PC OS-based handhelds to deliver dictation to TalkNotes.

In addition to PDA-based entry, TalkNotes can enter information into customized forms. Voice command shortcuts, or macros, can be created to dictate commonly used phrases or norms. TalkNotes goes one step further by automatically pulling patient demographic data into your customized macro. The basic package for an individual user costs $3,900, which includes the desktop and handheld software and creation of specialized dictionaries and voice files.

Although these solutions are costly, they minimize hardware and software investments as well as dependency on a local transcription service. Not to be overlooked is the decreased risk of repetitive stress injury from typing.

Computer-generated documents. The ICANotes system creates medical notes with just a few clicks to reduce text entry. By selecting key words in headings (e.g., “chief complaint”), the program generates approximate “template text” that comprises 80% of the text necessary. Information from previous notes is also brought forward to reduce typing. While generating the note, the program will also determine the appropriate E & M (evaluation and management) and psychotherapy codes based on the entries made.

A basic ICANotes system that creates initial history and assessment reports, progress notes, discharge summaries, and psychotherapy notes can be purchased for $550. Additional modules to produce prescriptions and other notes cost extra. ICANotes will cut out a lot of typing, although the generated text will have a simplistic and repetitive sentence structure.

 

 

Handwriting programs. Although handwriting is obviously much slower than other modes of text entry, it is both silent and within your control, making it perfect for taking notes during medical meetings or sessions with patients.

Seiko’s Smartpad2 System for $150 captures notes and drawings directly into your personal or notebook computer or PDA. This information exists only digitally as a picture, however.

The newly available io personal digital pen from Logitech, at $200, offers another cost-effective handwriting alternative. Instead of a pad underneath to capture pen strokes, a tiny camera in the system captures your pen movements, which are transferred to the computer via a cradle. The drawback is that handwriting recognition is limited.

By using Advanced Recognition Technology’s smARTwriter, printed handwriting can be converted into electronic text, which can be then inserted into any document. The program is affordable ($70) but carries significant drawbacks: Printing may be slow, and handwriting recognition is not 100 % accurate.

The Tablet PC presents a possible all-in-one handwriting solution. New to the market, Tablet PC offers built-in handwriting recognition and conversion, voice recognition, and other rich features. Microsoft adapted the Windows XP operating system for the device, which is manufactured by such vendors as Toshiba, Acer, and Hewlett-Packard. It comes in either a slate or clamshell design; the latter style features an integrated keyboard.

Tablet PCs range in cost from $1,500 to $2,500, and are touted to be as easy to use as Microsoft Windows XP with additional practical features. This is a new product, however, and future versions will offer improved accuracy, hardiness, and longevity.

If you have any questions about these methods or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

1. Hedge A. Choosing a keyboard system. Available at http://ergo.human.cornell.edu/kbdpres/sld001.htm. Accessed Jan. 24, 2003 .

2. CNET software: Voice Recognition Software Reviews. Available at http://www.cnet.com/software/1,11066,0-3227838-1202-0,00.html. Accessed January 27, 2003 .

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If you cannot type—or don’t like to—read on.

Text-entry advances offer alternatives to traditional keystroking. From voice recognition to online dictation, these options promise increased efficiency and relief from typing-related repetitive stress injuries.

The truth about typing

Few people know that the original typewriter keyboard layout—known as QWERTY, for the row of keys on the upper left-hand side—was designed to decrease typing speed so that the mechanical typewriter’s keys would not jam.1 More recently designed keyboard layouts, such as DVORAK and IDEAL, are reportedly more efficient but are not widely used. It would take months to retrain a typist to work with either keyboard.

Dictation is a well-established alternative to typing, but if the transcriber is not 100% accurate, much time is wasted correcting mistakes, returning the document, and proofreading the corrections.

Voice recognition

Voice recognition technology has been touted as the successor to dictation. With increasing computer power and more sophisticated algorithms to improve recognition, many programs2 can record continuous speech onto a document with approximately 95% accuracy.

Using voice recognition software and hardware to dictate text can save worlds of time compared with typing or writing by hand. But beware: accents and background noise often confound voice-based systems.

What’s more, a voice-recognition package that is suited to medical practice may be considerably more expensive than an entry-level model. Entry-level programs such as ScanSoft Dragon Naturally Speaking and IBM ViaVoice start at less than $100 each, but the medical version of ScanSoft is $1,000. The Trigram Psychiatry Specialty Module, at $300, may be an option. ViaVoice users can get a medical vocabulary module for an additional $142.

Other text-entry solutions

Internet-based dictation is a possible alternative to voice recognition or traditional dictation. Dictaphone’s Physician Workstation, which will reach the market in March, will allow the user to dictate with a specialized microphone linked to the computer or offsite by calling a toll-free telephone number. The computer then sends the voice data securely via the Internet to off-site transcriptionists. The physician logs into the transcript and makes corrections online via a Web browser. The user electronically signs the note to finalize it, and it is automatically delivered to the desired locations.

For a nominal investment in hardware, Physician Workstation can significantly simplify and speed up the transcription process. Dictaphone also provides 24-7 support and maintenance for these services, which cost $86 a month for 500 minutes. The setup has its drawbacks: Dictaphone provides the secure infrastructure and support, but transcription is a separate contracted service at 15.5 cents per line. However, you can select another transcription service to receive your voice files, or you can use Dictaphone’s new voice recognition software (also available in March).

Similarly, other online transcription services, such as HealthScribes and Kinetxhc, allow mobile users to dictate via a telephone, dedicated device, or personal digital assistant (PDA). HealthScribes charges 12.5 cents per line for PDA dictation, plus $45 a month for the software contract. In contrast, Dictaphone offers more services to handle the volume and connectivity of electronic medical records.

Many PDAs are equipped to work like tape recorders: The user talks into a receiver, creates a digital voice file, and sends the file electronically to the transcription/voice recognition service. For example, HealthcareOne provides a solution for the Palm OS based-Handera PDA, and ProVox utilizes Pocket PC OS-based handhelds to deliver dictation to TalkNotes.

In addition to PDA-based entry, TalkNotes can enter information into customized forms. Voice command shortcuts, or macros, can be created to dictate commonly used phrases or norms. TalkNotes goes one step further by automatically pulling patient demographic data into your customized macro. The basic package for an individual user costs $3,900, which includes the desktop and handheld software and creation of specialized dictionaries and voice files.

Although these solutions are costly, they minimize hardware and software investments as well as dependency on a local transcription service. Not to be overlooked is the decreased risk of repetitive stress injury from typing.

Computer-generated documents. The ICANotes system creates medical notes with just a few clicks to reduce text entry. By selecting key words in headings (e.g., “chief complaint”), the program generates approximate “template text” that comprises 80% of the text necessary. Information from previous notes is also brought forward to reduce typing. While generating the note, the program will also determine the appropriate E & M (evaluation and management) and psychotherapy codes based on the entries made.

A basic ICANotes system that creates initial history and assessment reports, progress notes, discharge summaries, and psychotherapy notes can be purchased for $550. Additional modules to produce prescriptions and other notes cost extra. ICANotes will cut out a lot of typing, although the generated text will have a simplistic and repetitive sentence structure.

 

 

Handwriting programs. Although handwriting is obviously much slower than other modes of text entry, it is both silent and within your control, making it perfect for taking notes during medical meetings or sessions with patients.

Seiko’s Smartpad2 System for $150 captures notes and drawings directly into your personal or notebook computer or PDA. This information exists only digitally as a picture, however.

The newly available io personal digital pen from Logitech, at $200, offers another cost-effective handwriting alternative. Instead of a pad underneath to capture pen strokes, a tiny camera in the system captures your pen movements, which are transferred to the computer via a cradle. The drawback is that handwriting recognition is limited.

By using Advanced Recognition Technology’s smARTwriter, printed handwriting can be converted into electronic text, which can be then inserted into any document. The program is affordable ($70) but carries significant drawbacks: Printing may be slow, and handwriting recognition is not 100 % accurate.

The Tablet PC presents a possible all-in-one handwriting solution. New to the market, Tablet PC offers built-in handwriting recognition and conversion, voice recognition, and other rich features. Microsoft adapted the Windows XP operating system for the device, which is manufactured by such vendors as Toshiba, Acer, and Hewlett-Packard. It comes in either a slate or clamshell design; the latter style features an integrated keyboard.

Tablet PCs range in cost from $1,500 to $2,500, and are touted to be as easy to use as Microsoft Windows XP with additional practical features. This is a new product, however, and future versions will offer improved accuracy, hardiness, and longevity.

If you have any questions about these methods or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

If you cannot type—or don’t like to—read on.

Text-entry advances offer alternatives to traditional keystroking. From voice recognition to online dictation, these options promise increased efficiency and relief from typing-related repetitive stress injuries.

The truth about typing

Few people know that the original typewriter keyboard layout—known as QWERTY, for the row of keys on the upper left-hand side—was designed to decrease typing speed so that the mechanical typewriter’s keys would not jam.1 More recently designed keyboard layouts, such as DVORAK and IDEAL, are reportedly more efficient but are not widely used. It would take months to retrain a typist to work with either keyboard.

Dictation is a well-established alternative to typing, but if the transcriber is not 100% accurate, much time is wasted correcting mistakes, returning the document, and proofreading the corrections.

Voice recognition

Voice recognition technology has been touted as the successor to dictation. With increasing computer power and more sophisticated algorithms to improve recognition, many programs2 can record continuous speech onto a document with approximately 95% accuracy.

Using voice recognition software and hardware to dictate text can save worlds of time compared with typing or writing by hand. But beware: accents and background noise often confound voice-based systems.

What’s more, a voice-recognition package that is suited to medical practice may be considerably more expensive than an entry-level model. Entry-level programs such as ScanSoft Dragon Naturally Speaking and IBM ViaVoice start at less than $100 each, but the medical version of ScanSoft is $1,000. The Trigram Psychiatry Specialty Module, at $300, may be an option. ViaVoice users can get a medical vocabulary module for an additional $142.

Other text-entry solutions

Internet-based dictation is a possible alternative to voice recognition or traditional dictation. Dictaphone’s Physician Workstation, which will reach the market in March, will allow the user to dictate with a specialized microphone linked to the computer or offsite by calling a toll-free telephone number. The computer then sends the voice data securely via the Internet to off-site transcriptionists. The physician logs into the transcript and makes corrections online via a Web browser. The user electronically signs the note to finalize it, and it is automatically delivered to the desired locations.

For a nominal investment in hardware, Physician Workstation can significantly simplify and speed up the transcription process. Dictaphone also provides 24-7 support and maintenance for these services, which cost $86 a month for 500 minutes. The setup has its drawbacks: Dictaphone provides the secure infrastructure and support, but transcription is a separate contracted service at 15.5 cents per line. However, you can select another transcription service to receive your voice files, or you can use Dictaphone’s new voice recognition software (also available in March).

Similarly, other online transcription services, such as HealthScribes and Kinetxhc, allow mobile users to dictate via a telephone, dedicated device, or personal digital assistant (PDA). HealthScribes charges 12.5 cents per line for PDA dictation, plus $45 a month for the software contract. In contrast, Dictaphone offers more services to handle the volume and connectivity of electronic medical records.

Many PDAs are equipped to work like tape recorders: The user talks into a receiver, creates a digital voice file, and sends the file electronically to the transcription/voice recognition service. For example, HealthcareOne provides a solution for the Palm OS based-Handera PDA, and ProVox utilizes Pocket PC OS-based handhelds to deliver dictation to TalkNotes.

In addition to PDA-based entry, TalkNotes can enter information into customized forms. Voice command shortcuts, or macros, can be created to dictate commonly used phrases or norms. TalkNotes goes one step further by automatically pulling patient demographic data into your customized macro. The basic package for an individual user costs $3,900, which includes the desktop and handheld software and creation of specialized dictionaries and voice files.

Although these solutions are costly, they minimize hardware and software investments as well as dependency on a local transcription service. Not to be overlooked is the decreased risk of repetitive stress injury from typing.

Computer-generated documents. The ICANotes system creates medical notes with just a few clicks to reduce text entry. By selecting key words in headings (e.g., “chief complaint”), the program generates approximate “template text” that comprises 80% of the text necessary. Information from previous notes is also brought forward to reduce typing. While generating the note, the program will also determine the appropriate E & M (evaluation and management) and psychotherapy codes based on the entries made.

A basic ICANotes system that creates initial history and assessment reports, progress notes, discharge summaries, and psychotherapy notes can be purchased for $550. Additional modules to produce prescriptions and other notes cost extra. ICANotes will cut out a lot of typing, although the generated text will have a simplistic and repetitive sentence structure.

 

 

Handwriting programs. Although handwriting is obviously much slower than other modes of text entry, it is both silent and within your control, making it perfect for taking notes during medical meetings or sessions with patients.

Seiko’s Smartpad2 System for $150 captures notes and drawings directly into your personal or notebook computer or PDA. This information exists only digitally as a picture, however.

The newly available io personal digital pen from Logitech, at $200, offers another cost-effective handwriting alternative. Instead of a pad underneath to capture pen strokes, a tiny camera in the system captures your pen movements, which are transferred to the computer via a cradle. The drawback is that handwriting recognition is limited.

By using Advanced Recognition Technology’s smARTwriter, printed handwriting can be converted into electronic text, which can be then inserted into any document. The program is affordable ($70) but carries significant drawbacks: Printing may be slow, and handwriting recognition is not 100 % accurate.

The Tablet PC presents a possible all-in-one handwriting solution. New to the market, Tablet PC offers built-in handwriting recognition and conversion, voice recognition, and other rich features. Microsoft adapted the Windows XP operating system for the device, which is manufactured by such vendors as Toshiba, Acer, and Hewlett-Packard. It comes in either a slate or clamshell design; the latter style features an integrated keyboard.

Tablet PCs range in cost from $1,500 to $2,500, and are touted to be as easy to use as Microsoft Windows XP with additional practical features. This is a new product, however, and future versions will offer improved accuracy, hardiness, and longevity.

If you have any questions about these methods or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

1. Hedge A. Choosing a keyboard system. Available at http://ergo.human.cornell.edu/kbdpres/sld001.htm. Accessed Jan. 24, 2003 .

2. CNET software: Voice Recognition Software Reviews. Available at http://www.cnet.com/software/1,11066,0-3227838-1202-0,00.html. Accessed January 27, 2003 .

References

1. Hedge A. Choosing a keyboard system. Available at http://ergo.human.cornell.edu/kbdpres/sld001.htm. Accessed Jan. 24, 2003 .

2. CNET software: Voice Recognition Software Reviews. Available at http://www.cnet.com/software/1,11066,0-3227838-1202-0,00.html. Accessed January 27, 2003 .

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If you cannot type—or don’t like to—read on.

Text-entry advances offer alternatives to traditional keystroking. From voice recognition to online dictation, these options promise increased efficiency and relief from typing-related repetitive stress injuries.

The truth about typing

Few people know that the original typewriter keyboard layout—known as QWERTY, for the row of keys on the upper left-hand side—was designed to decrease typing speed so that the mechanical typewriter’s keys would not jam.1 More recently designed keyboard layouts, such as DVORAK and IDEAL, are reportedly more efficient but are not widely used. It would take months to retrain a typist to work with either keyboard.

Dictation is a well-established alternative to typing, but if the transcriber is not 100% accurate, much time is wasted correcting mistakes, returning the document, and proofreading the corrections.

Voice recognition

Voice recognition technology has been touted as the successor to dictation. With increasing computer power and more sophisticated algorithms to improve recognition, many programs2 can record continuous speech onto a document with approximately 95% accuracy.

Using voice recognition software and hardware to dictate text can save worlds of time compared with typing or writing by hand. But beware: accents and background noise often confound voice-based systems.

What’s more, a voice-recognition package that is suited to medical practice may be considerably more expensive than an entry-level model. Entry-level programs such as ScanSoft Dragon Naturally Speaking and IBM ViaVoice start at less than $100 each, but the medical version of ScanSoft is $1,000. The Trigram Psychiatry Specialty Module, at $300, may be an option. ViaVoice users can get a medical vocabulary module for an additional $142.

Other text-entry solutions

Internet-based dictation is a possible alternative to voice recognition or traditional dictation. Dictaphone’s Physician Workstation, which will reach the market in March, will allow the user to dictate with a specialized microphone linked to the computer or offsite by calling a toll-free telephone number. The computer then sends the voice data securely via the Internet to off-site transcriptionists. The physician logs into the transcript and makes corrections online via a Web browser. The user electronically signs the note to finalize it, and it is automatically delivered to the desired locations.

For a nominal investment in hardware, Physician Workstation can significantly simplify and speed up the transcription process. Dictaphone also provides 24-7 support and maintenance for these services, which cost $86 a month for 500 minutes. The setup has its drawbacks: Dictaphone provides the secure infrastructure and support, but transcription is a separate contracted service at 15.5 cents per line. However, you can select another transcription service to receive your voice files, or you can use Dictaphone’s new voice recognition software (also available in March).

Similarly, other online transcription services, such as HealthScribes and Kinetxhc, allow mobile users to dictate via a telephone, dedicated device, or personal digital assistant (PDA). HealthScribes charges 12.5 cents per line for PDA dictation, plus $45 a month for the software contract. In contrast, Dictaphone offers more services to handle the volume and connectivity of electronic medical records.

Many PDAs are equipped to work like tape recorders: The user talks into a receiver, creates a digital voice file, and sends the file electronically to the transcription/voice recognition service. For example, HealthcareOne provides a solution for the Palm OS based-Handera PDA, and ProVox utilizes Pocket PC OS-based handhelds to deliver dictation to TalkNotes.

In addition to PDA-based entry, TalkNotes can enter information into customized forms. Voice command shortcuts, or macros, can be created to dictate commonly used phrases or norms. TalkNotes goes one step further by automatically pulling patient demographic data into your customized macro. The basic package for an individual user costs $3,900, which includes the desktop and handheld software and creation of specialized dictionaries and voice files.

Although these solutions are costly, they minimize hardware and software investments as well as dependency on a local transcription service. Not to be overlooked is the decreased risk of repetitive stress injury from typing.

Computer-generated documents. The ICANotes system creates medical notes with just a few clicks to reduce text entry. By selecting key words in headings (e.g., “chief complaint”), the program generates approximate “template text” that comprises 80% of the text necessary. Information from previous notes is also brought forward to reduce typing. While generating the note, the program will also determine the appropriate E & M (evaluation and management) and psychotherapy codes based on the entries made.

A basic ICANotes system that creates initial history and assessment reports, progress notes, discharge summaries, and psychotherapy notes can be purchased for $550. Additional modules to produce prescriptions and other notes cost extra. ICANotes will cut out a lot of typing, although the generated text will have a simplistic and repetitive sentence structure.

 

 

Handwriting programs. Although handwriting is obviously much slower than other modes of text entry, it is both silent and within your control, making it perfect for taking notes during medical meetings or sessions with patients.

Seiko’s Smartpad2 System for $150 captures notes and drawings directly into your personal or notebook computer or PDA. This information exists only digitally as a picture, however.

The newly available io personal digital pen from Logitech, at $200, offers another cost-effective handwriting alternative. Instead of a pad underneath to capture pen strokes, a tiny camera in the system captures your pen movements, which are transferred to the computer via a cradle. The drawback is that handwriting recognition is limited.

By using Advanced Recognition Technology’s smARTwriter, printed handwriting can be converted into electronic text, which can be then inserted into any document. The program is affordable ($70) but carries significant drawbacks: Printing may be slow, and handwriting recognition is not 100 % accurate.

The Tablet PC presents a possible all-in-one handwriting solution. New to the market, Tablet PC offers built-in handwriting recognition and conversion, voice recognition, and other rich features. Microsoft adapted the Windows XP operating system for the device, which is manufactured by such vendors as Toshiba, Acer, and Hewlett-Packard. It comes in either a slate or clamshell design; the latter style features an integrated keyboard.

Tablet PCs range in cost from $1,500 to $2,500, and are touted to be as easy to use as Microsoft Windows XP with additional practical features. This is a new product, however, and future versions will offer improved accuracy, hardiness, and longevity.

If you have any questions about these methods or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

1. Hedge A. Choosing a keyboard system. Available at http://ergo.human.cornell.edu/kbdpres/sld001.htm. Accessed Jan. 24, 2003 .

2. CNET software: Voice Recognition Software Reviews. Available at http://www.cnet.com/software/1,11066,0-3227838-1202-0,00.html. Accessed January 27, 2003 .

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If you cannot type—or don’t like to—read on.

Text-entry advances offer alternatives to traditional keystroking. From voice recognition to online dictation, these options promise increased efficiency and relief from typing-related repetitive stress injuries.

The truth about typing

Few people know that the original typewriter keyboard layout—known as QWERTY, for the row of keys on the upper left-hand side—was designed to decrease typing speed so that the mechanical typewriter’s keys would not jam.1 More recently designed keyboard layouts, such as DVORAK and IDEAL, are reportedly more efficient but are not widely used. It would take months to retrain a typist to work with either keyboard.

Dictation is a well-established alternative to typing, but if the transcriber is not 100% accurate, much time is wasted correcting mistakes, returning the document, and proofreading the corrections.

Voice recognition

Voice recognition technology has been touted as the successor to dictation. With increasing computer power and more sophisticated algorithms to improve recognition, many programs2 can record continuous speech onto a document with approximately 95% accuracy.

Using voice recognition software and hardware to dictate text can save worlds of time compared with typing or writing by hand. But beware: accents and background noise often confound voice-based systems.

What’s more, a voice-recognition package that is suited to medical practice may be considerably more expensive than an entry-level model. Entry-level programs such as ScanSoft Dragon Naturally Speaking and IBM ViaVoice start at less than $100 each, but the medical version of ScanSoft is $1,000. The Trigram Psychiatry Specialty Module, at $300, may be an option. ViaVoice users can get a medical vocabulary module for an additional $142.

Other text-entry solutions

Internet-based dictation is a possible alternative to voice recognition or traditional dictation. Dictaphone’s Physician Workstation, which will reach the market in March, will allow the user to dictate with a specialized microphone linked to the computer or offsite by calling a toll-free telephone number. The computer then sends the voice data securely via the Internet to off-site transcriptionists. The physician logs into the transcript and makes corrections online via a Web browser. The user electronically signs the note to finalize it, and it is automatically delivered to the desired locations.

For a nominal investment in hardware, Physician Workstation can significantly simplify and speed up the transcription process. Dictaphone also provides 24-7 support and maintenance for these services, which cost $86 a month for 500 minutes. The setup has its drawbacks: Dictaphone provides the secure infrastructure and support, but transcription is a separate contracted service at 15.5 cents per line. However, you can select another transcription service to receive your voice files, or you can use Dictaphone’s new voice recognition software (also available in March).

Similarly, other online transcription services, such as HealthScribes and Kinetxhc, allow mobile users to dictate via a telephone, dedicated device, or personal digital assistant (PDA). HealthScribes charges 12.5 cents per line for PDA dictation, plus $45 a month for the software contract. In contrast, Dictaphone offers more services to handle the volume and connectivity of electronic medical records.

Many PDAs are equipped to work like tape recorders: The user talks into a receiver, creates a digital voice file, and sends the file electronically to the transcription/voice recognition service. For example, HealthcareOne provides a solution for the Palm OS based-Handera PDA, and ProVox utilizes Pocket PC OS-based handhelds to deliver dictation to TalkNotes.

In addition to PDA-based entry, TalkNotes can enter information into customized forms. Voice command shortcuts, or macros, can be created to dictate commonly used phrases or norms. TalkNotes goes one step further by automatically pulling patient demographic data into your customized macro. The basic package for an individual user costs $3,900, which includes the desktop and handheld software and creation of specialized dictionaries and voice files.

Although these solutions are costly, they minimize hardware and software investments as well as dependency on a local transcription service. Not to be overlooked is the decreased risk of repetitive stress injury from typing.

Computer-generated documents. The ICANotes system creates medical notes with just a few clicks to reduce text entry. By selecting key words in headings (e.g., “chief complaint”), the program generates approximate “template text” that comprises 80% of the text necessary. Information from previous notes is also brought forward to reduce typing. While generating the note, the program will also determine the appropriate E & M (evaluation and management) and psychotherapy codes based on the entries made.

A basic ICANotes system that creates initial history and assessment reports, progress notes, discharge summaries, and psychotherapy notes can be purchased for $550. Additional modules to produce prescriptions and other notes cost extra. ICANotes will cut out a lot of typing, although the generated text will have a simplistic and repetitive sentence structure.

 

 

Handwriting programs. Although handwriting is obviously much slower than other modes of text entry, it is both silent and within your control, making it perfect for taking notes during medical meetings or sessions with patients.

Seiko’s Smartpad2 System for $150 captures notes and drawings directly into your personal or notebook computer or PDA. This information exists only digitally as a picture, however.

The newly available io personal digital pen from Logitech, at $200, offers another cost-effective handwriting alternative. Instead of a pad underneath to capture pen strokes, a tiny camera in the system captures your pen movements, which are transferred to the computer via a cradle. The drawback is that handwriting recognition is limited.

By using Advanced Recognition Technology’s smARTwriter, printed handwriting can be converted into electronic text, which can be then inserted into any document. The program is affordable ($70) but carries significant drawbacks: Printing may be slow, and handwriting recognition is not 100 % accurate.

The Tablet PC presents a possible all-in-one handwriting solution. New to the market, Tablet PC offers built-in handwriting recognition and conversion, voice recognition, and other rich features. Microsoft adapted the Windows XP operating system for the device, which is manufactured by such vendors as Toshiba, Acer, and Hewlett-Packard. It comes in either a slate or clamshell design; the latter style features an integrated keyboard.

Tablet PCs range in cost from $1,500 to $2,500, and are touted to be as easy to use as Microsoft Windows XP with additional practical features. This is a new product, however, and future versions will offer improved accuracy, hardiness, and longevity.

If you have any questions about these methods or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

If you cannot type—or don’t like to—read on.

Text-entry advances offer alternatives to traditional keystroking. From voice recognition to online dictation, these options promise increased efficiency and relief from typing-related repetitive stress injuries.

The truth about typing

Few people know that the original typewriter keyboard layout—known as QWERTY, for the row of keys on the upper left-hand side—was designed to decrease typing speed so that the mechanical typewriter’s keys would not jam.1 More recently designed keyboard layouts, such as DVORAK and IDEAL, are reportedly more efficient but are not widely used. It would take months to retrain a typist to work with either keyboard.

Dictation is a well-established alternative to typing, but if the transcriber is not 100% accurate, much time is wasted correcting mistakes, returning the document, and proofreading the corrections.

Voice recognition

Voice recognition technology has been touted as the successor to dictation. With increasing computer power and more sophisticated algorithms to improve recognition, many programs2 can record continuous speech onto a document with approximately 95% accuracy.

Using voice recognition software and hardware to dictate text can save worlds of time compared with typing or writing by hand. But beware: accents and background noise often confound voice-based systems.

What’s more, a voice-recognition package that is suited to medical practice may be considerably more expensive than an entry-level model. Entry-level programs such as ScanSoft Dragon Naturally Speaking and IBM ViaVoice start at less than $100 each, but the medical version of ScanSoft is $1,000. The Trigram Psychiatry Specialty Module, at $300, may be an option. ViaVoice users can get a medical vocabulary module for an additional $142.

Other text-entry solutions

Internet-based dictation is a possible alternative to voice recognition or traditional dictation. Dictaphone’s Physician Workstation, which will reach the market in March, will allow the user to dictate with a specialized microphone linked to the computer or offsite by calling a toll-free telephone number. The computer then sends the voice data securely via the Internet to off-site transcriptionists. The physician logs into the transcript and makes corrections online via a Web browser. The user electronically signs the note to finalize it, and it is automatically delivered to the desired locations.

For a nominal investment in hardware, Physician Workstation can significantly simplify and speed up the transcription process. Dictaphone also provides 24-7 support and maintenance for these services, which cost $86 a month for 500 minutes. The setup has its drawbacks: Dictaphone provides the secure infrastructure and support, but transcription is a separate contracted service at 15.5 cents per line. However, you can select another transcription service to receive your voice files, or you can use Dictaphone’s new voice recognition software (also available in March).

Similarly, other online transcription services, such as HealthScribes and Kinetxhc, allow mobile users to dictate via a telephone, dedicated device, or personal digital assistant (PDA). HealthScribes charges 12.5 cents per line for PDA dictation, plus $45 a month for the software contract. In contrast, Dictaphone offers more services to handle the volume and connectivity of electronic medical records.

Many PDAs are equipped to work like tape recorders: The user talks into a receiver, creates a digital voice file, and sends the file electronically to the transcription/voice recognition service. For example, HealthcareOne provides a solution for the Palm OS based-Handera PDA, and ProVox utilizes Pocket PC OS-based handhelds to deliver dictation to TalkNotes.

In addition to PDA-based entry, TalkNotes can enter information into customized forms. Voice command shortcuts, or macros, can be created to dictate commonly used phrases or norms. TalkNotes goes one step further by automatically pulling patient demographic data into your customized macro. The basic package for an individual user costs $3,900, which includes the desktop and handheld software and creation of specialized dictionaries and voice files.

Although these solutions are costly, they minimize hardware and software investments as well as dependency on a local transcription service. Not to be overlooked is the decreased risk of repetitive stress injury from typing.

Computer-generated documents. The ICANotes system creates medical notes with just a few clicks to reduce text entry. By selecting key words in headings (e.g., “chief complaint”), the program generates approximate “template text” that comprises 80% of the text necessary. Information from previous notes is also brought forward to reduce typing. While generating the note, the program will also determine the appropriate E & M (evaluation and management) and psychotherapy codes based on the entries made.

A basic ICANotes system that creates initial history and assessment reports, progress notes, discharge summaries, and psychotherapy notes can be purchased for $550. Additional modules to produce prescriptions and other notes cost extra. ICANotes will cut out a lot of typing, although the generated text will have a simplistic and repetitive sentence structure.

 

 

Handwriting programs. Although handwriting is obviously much slower than other modes of text entry, it is both silent and within your control, making it perfect for taking notes during medical meetings or sessions with patients.

Seiko’s Smartpad2 System for $150 captures notes and drawings directly into your personal or notebook computer or PDA. This information exists only digitally as a picture, however.

The newly available io personal digital pen from Logitech, at $200, offers another cost-effective handwriting alternative. Instead of a pad underneath to capture pen strokes, a tiny camera in the system captures your pen movements, which are transferred to the computer via a cradle. The drawback is that handwriting recognition is limited.

By using Advanced Recognition Technology’s smARTwriter, printed handwriting can be converted into electronic text, which can be then inserted into any document. The program is affordable ($70) but carries significant drawbacks: Printing may be slow, and handwriting recognition is not 100 % accurate.

The Tablet PC presents a possible all-in-one handwriting solution. New to the market, Tablet PC offers built-in handwriting recognition and conversion, voice recognition, and other rich features. Microsoft adapted the Windows XP operating system for the device, which is manufactured by such vendors as Toshiba, Acer, and Hewlett-Packard. It comes in either a slate or clamshell design; the latter style features an integrated keyboard.

Tablet PCs range in cost from $1,500 to $2,500, and are touted to be as easy to use as Microsoft Windows XP with additional practical features. This is a new product, however, and future versions will offer improved accuracy, hardiness, and longevity.

If you have any questions about these methods or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure:

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References

1. Hedge A. Choosing a keyboard system. Available at http://ergo.human.cornell.edu/kbdpres/sld001.htm. Accessed Jan. 24, 2003 .

2. CNET software: Voice Recognition Software Reviews. Available at http://www.cnet.com/software/1,11066,0-3227838-1202-0,00.html. Accessed January 27, 2003 .

References

1. Hedge A. Choosing a keyboard system. Available at http://ergo.human.cornell.edu/kbdpres/sld001.htm. Accessed Jan. 24, 2003 .

2. CNET software: Voice Recognition Software Reviews. Available at http://www.cnet.com/software/1,11066,0-3227838-1202-0,00.html. Accessed January 27, 2003 .

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