The brave new world of on-line drug information

As the field of on-line information continues to bear fruit, the harvest is particularly rich in drug information available for pharmacists. The databases offer information that ranges from frequently asked questions, drug-drug interactions, and formulary advisories to disease management guidelines and ways that pharmacists can assist in patient resuscitation.

Two of the major players are Lexi-Comp, Inc. and Thomson Micromedex. ASHP also has a plethora of software available for purchase on-line.

"Thomson Micromedex has a number of [on-line drug information] products that are valuable to pharmacists," said Gina Moore, Pharm.D., MBA, in an e-mail. "From counseling patients on their medicines to answering complex drug information questions in a hospital setting, Micromedex provides the tools needed for pharmacists to do their jobs." She is the director of product development at Thomson Micromedex.

Some of the brands of information products include Drugdex, DrugReax, IV Index, Clinical Calculators, Kinetidex, and Formulary Advisor. These databases answer several questions regarding pharmaceutical products, including general drug information and dosage recommendations, drug interaction identification and management, and compatibility guidelines for intravenous formulations.

In addition, Formulary Advisor "provides pharmacists a tool to manage their formulary and provide clinicians information on therapeutic substitutions," Moore said. To further help with decisions regarding cost, Micromedex has produced monographs for pharmacy and therapeutic (P&T) committees to guide them in deciding which drugs to carry on their formulary, she said.

One area that is particularly strong for Micromedex is its group of disease information databases, which offer guidelines on disease management, Moore said. "As more pharmacists get involved in disease management, this information will be increasingly crucial," she said. Therefore, the company has documented an increasing number of pharmacists using the disease information databases, she said.

Like Micromedex, a new group of products by Lexi-Comp Online has several databases, said Daniel Krinsky, M.S., R.Ph. "Lexi-Comp Online has been shown to be the most accurate interactive on-line drug information product on the market," he said. Krinsky is the director of Lexi-Comp's department of business partnering and academic and retail pharmacy sales. Lexi-Comp Online is a web-based library of reference publications housed on Lexi-Comp's servers.

"We have 14 unique databases and three unique applications," Krinsky said in a phone interview. "The databases offer general drug information and drug information for specific subpopulations, such as pediatric and geriatric patients. In addition, there are databases on infectious diseases, laboratory tests, chemical agents, and guidelines for clinicians."

Lexi-Comp Online also has a database specifically targeted to pharmacists, Lexi-Drugs Online, which has information on 1,600 generic drugs and 8,000 brand-name drugs. The brand names are available for the products' Canadian, Mexican, and international markets, he said.

"Our drug information is in a point-of-care format that offers 55 fields of information," he said. "Among these are dosing, contraindications, side effects, and compatibility." In addition to pharmacist-targeted information, Lexi-Drugs Online also makes available patient education information and patient advisory leaflets, which can be downloaded and printed for distributing to patients. The patient advisories are available for adult and pediatric patients and come in 18 different languages, based on the 2000 U.S. census data.

One database that can be helpful to pharmacists working with people who do not know which medications they are using is Lexi-Drugs ID, Krinsky said. "This database allows pharmacists to search through images of solid dosage forms and identify the drug in question," he said. He noted that the updates on the information occur virtually daily. Particularly with their Special Alert feature, as well as updates on patient safety and Food & Drug Administration black-box warnings, the updates can give pharmacists up-to-date information "to take into consideration before filling a prescription," he said.

Applications

The products that both companies offer are available in both handheld and desktop applications. "The majority of our drug information products have a complete desktop solution, as well as summary documents and tools available for mobile devices," Moore said.

Lexi-Comp handheld products include software that is installed on a desktop computer and downloaded to a PDA. The desktop, said Krinsky, "serves as a conduit from our server to the subscriber's [handheld device]," he said. "Once installed, the software works for both Palm OS and Pocket PC devices."

Both companies view on-line drug information as an area of growth. Lexi-Comp is continuing to refine and extend its products, and Micromedex has several products in the pipeline, Moore said. "Later this year, we will release a laboratory information database, as well as several other products for the handheld," she said.

Subscriptions

Both companies offer their services on a subscription basis. However, both Moore and Krinsky said that the range of services and products means, conversely, that the subscription costs also vary widely. "Our subscription costs vary greatly based on what the hospital has available bedside, what databases are subscribed to, and whether the system is a stand-alone application or available hospitalwide," Moore said. "All mobile downloads are provided free of charge to subscribers."

Krinsky said that subscribing hospitals or institutions would have either multiple subscriptions or a blanket subscription for the entire system. "Subscribing institutions can also create their own links to on-line reference information and, in so doing, reduce subscription costs," he said. A standard subscription for an individual pharmacy is $450 per year, while institutions' subscriptions and tailored demands can cost several thousand dollars.