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A database is the computer equivalent of a filing cabinet full of forms. Like a filing cabinet, a database can store a lot of information, and by using forms, the information is structured, which paves the way for statistical analysis and audits.
A database on a handheld computer has many advantages over a filing cabinet. First, you can carry all the forms you need. This is great for audits, because you can enter data about patients at any time, including while you are with the patient during the ward round or when you can get hold of the patient's notes from the consultant's secretary.
Second, you can carry all the information you have filled out in the past. Not only is the handheld device orders of magnitude smaller than a filing cabinet, the sorting and searching tools are very fast. For example, if you have a list of patients, it only takes a few seconds to sort it by each patient's name and then to sort it again by consultant's name. You can quickly search for a patient whose date of birth is before a certain year and whose blood results are within a certain range.
Finally, you can share the information with colleagues. Beaming makes this quick and easy to do as you meet with colleagues during the day. It takes more effort and expertise to do this with synchronization, but it means you can get the information without needing a face-to-face meeting.
Many database programs are available to choose from. For the palm powered devices, you can use Pilot-DB [http://pilot-db.sourceforge.net/], which is free of charge but lacks encryption and is not very user friendly. JFile is well worth the US$25 [www.land-j.com], as is Sprint DB Pro for pocket personal computers [www.kaione.com].
For most users, however, HanDBase is the most appropriate database software. First, it is available for both palm powered and pocket PC devices, which makes sharing data with your colleagues easier. Second, it has the most example databases available, both free of charge and for sale, which means that you can use someone else's work rather than design your own database forms.
Freshly installed database software has no forms for you to enter data, so you must either spend the time creating your own forms or use someone else's. Many doctors prefer creating a form that is perfectly suited to their habits and work, and this has its advantages. For the novice user, however, creating a form can be daunting. Furthermore, it is more efficient to use someone else's work and customize it than to create a brand new form. Finally, standardization can be a good thing, especially if you would like to share data with colleagues. In other words, if you use a different form to your colleagues, you cannot share the data in each other's forms.
This is why so many medical institutions make database forms available to their members. For example, the Association of Surgeons of Great Britain and Ireland [www.asgbi.org.uk] has created a surgical logbook built on HanDBase, which you can download free of charge from [www.surgeonslog.com]. What is particularly impressive is the ability to transfer the data from your handheld computer to the association's website so you can back up and view it over the web.
The Royal College of Anaesthetists' logbook is available at [www.logbook.org.uk] and is also built on HanDBase. The author's own website [www.handheldsfordoctors.com/databases] makes other databases that you can customize and share with colleagues available free of charge. The next few examples will use the surgical logbook HanDBase database from this site.
To open HanDBase on pocket PCs, tap on the ‘Start’ icon, then ‘Program Files’ and then the icon labelled ‘HanDBase’. On palm powered machines, tap on the ‘Home’ icon and then the icon labelled ‘HanDBase’. You will see a list of the databases you have installed. Tap on ‘Surgical logbook’ for this example (Figure 1).
For security, this database is encrypted. The default password is blank, so just tap the ‘OK’ button, but you will have to change this when you finish entering data.
You will see a list of column headings across the top, including ID, Date, Patient ID, DOB, Sex and Age. As you add data about your operations, a row will appear for each operation (Figure 2).
To enter data:
In each database, the records usually are listed in the order you entered them. To choose a different method, tap on a column name. For example, to sort by date, with the latest operations appearing at the top:
You can sort using multiple criteria. For example, to sort your operations first by your role and then by the date of the operation:
Filtering allows you to find a particular group of patients. For example, to find all the patients between the age of 30 and 40 years who had diabetes in their past medical history:
The list of operations now will include only those that meet the criteria of these filters.
To remove the filter:
The list will return to showing all of the operations.
You can do simple statistical analyses of your data. To find the average age of your patients on a palm powered device, tap on the ‘Menu’ icon. Then, on this device or a pocket PC:
You will see the average age to the right of ‘Average’, as well as the minimum (‘Min value’) and maximum (‘Max value’) ages. The ‘Sum’ is not useful in this case, but it would be important for adding up the cost column in a database that tracked the purchases made by your department.
It is technically fairly easy to design your own database, but coming up with a good design can be hard. It certainly takes experience and a little thinking in advance. It is worth trying the example databases with your patients for a few days to note which parts of the design you would like to change.
To change the design of an existing database on your pocket PCs, tap on the ‘Start’ icon, then on ‘Program Files’ and then on the icon labelled ‘HanDBase’. On a palm powered device, tap on the ‘Home’ icon and then the icon labelled ‘HanDBase’. Then:
You will see a list of fields. Each field is the equivalent of a column heading that you see when listing the records in your database. Tap on the field that you want to edit. For example, if you tap on ‘DOB’ from the surgical logbook database, you can see that its ‘Field Type’ is ‘Date’ (Figure 3). This means that changing the value of this date in a record will bring up a calendar.
If you had selected ‘Text’ instead, you would have to write ‘01/26/1976’ for a patient' whose date of birth is 26 January 1976. This might seem faster, but it means that running the filters feature is practically useless for ‘DOB’. You will not be able to filter patients born before 1975, for example, as the database does not treat ‘DOB’ as a date.
Similarly, the ‘Age’ field is an integer, which means that the database treats it as a whole number. This is useful because the surgical logbook database will prevent you writing ‘67.5’ or ‘67a’ by mistake, which keeps your data clean. It also means you can see the sum of that field's data when you run a report on the database.
As you can see, designing a database can be complicated at the start. Fortunately, HanDBase's website has excellent explanations of all of the field types, as well as excellent tutorials that walk you through setting up your own database [www.ddhsoftware.com/support.html]. The RSM course that we run every year [www.handheldsfordoctors.com/rsm] also provides hands-on training.
You can share data between databases. To beam from your pocket PCs, tap on the ‘Start’ icon, then on ‘Program Files’ and then on the icon labelled ‘HanDBase’. On a palm powered device, tap on the ‘HJome’ icon and then the icon labelled ‘HanDBase’. Then:
To share the information without beaming, you will need the help of a computer professional who will need to set up your institution's network. If you have access to such a professional, it is worth using their expertise to design the database in the first place.
The databases described in this chapter are quick to set up and affordable to buy for a small number of devices, but they do have limits for large teams and amounts of data. In such cases, you should consider more professional databases like Satellite Forms [www.satelliteforms.net]. A computer professional can use this to quickly design a sophisticated user interface, including calculations that are triggered by the data you enter. This is how Dr Anatole Menon-Johansson designed a database to guide HIV therapy [www.vcpda.com]. After filling out a long form about each patient's health and viral load, the clinician receives advice about the next appropriate prescription.
This is the second in a series of extracts from a forthcoming book by A Al-Ubaydli and C Paton [www.rsmpress.co.uk/bkpda.htm].