Apps for physicians and patients

Some of the apps in this issue’s Tech Notes are great for both sets of users.

By Iltifat Husain, M.D. | Fall 2019 | Tech Notes

 

In this edition of Tech Notes, the apps I cover are geared more toward the geriatric patient population. Two of the apps featured in this column are from large government agencies, and both have done a fantastic job leveraging their resources to create slick apps that will help their patient populations.

Price: Free. iPhone, iPad: apple.co/2N4YAGn Android: Not available.

The Frailty App

Even those not in medicine know that people age differently. Everyone has their example of an 85-year-old patient who can run circles around a 65-year-old. So when you’re trying to assess a patient’s vulnerability to poor outcomes or ability to thrive, you can’t just use a patient’s age. There are now several frailty assessment tools that exist, and we’ve even highlighted them before in Tech Notes.

This particular app and protocol are from a group of Canadian providers in Halifax who have pioneered what they call the Palliative and Therapeutic Harmonization (PATH) assessment. The app they have released, called The Frailty App, can be used not only by providers, but also by family and friends.

Overall, I’m impressed by the types of questions in the algorithm for PATH’s frailty assessment tool. These questions touched on cognitive questions, social and interpersonal questions, physical ability questions and more. They did not just focus on the patient’s functional ability.

Antidepressant Proposer

Price: Free. iPhone, iPad: apple.co/2J4D1jO Android: Not available.

The Antidepressant Proposer app was created by Theodore Huzyk, M.D., a psychiatry resident from the University of Southern California, to help those prescribing gain a better familiarity with antidepressants. Huzyk makes it clear the tool is for educational purposes, and not meant to be an authoritative clinical decision-making tool.

Antidepressant Proposer assigns scores for 32 different antidepressants based on 20 different commonly encountered patient factors and drug measures.

When you open the app, you are given three screens: side effects, special populations and Cipriani 2018 measures. Within the side effects section, you are given options such as anticholinergic, drowsiness and more. You can toggle to desire or avoid.

In this way, the app combines patient factors and drug side effects with results from medical literature to create a unique list of drug options based on your inputs. Once you have answered all the questions, the list of drug options are presented in a ranked fashion.

Medicare: What’s Covered 

Price: Free. iPhone, iPad: apple.co/2KFAuzK Android: bit.ly/2NeBFIQ

Medicare: What’s Covered is the official Medicare app from the United States government to help you understand the health coverage offered by Medicare Part A (hospital insurance) and Part B (medical insurance).

Kudos to the development team; the Medicare app is slick, easy to use and packed with information.

Some of the key questions this app can help answer are: How much will I pay for prescription drugs included in Medicare Part B coverage? Does the part B deductible apply to cardiac rebab? What percent of the Medicare approved amount will I need to pay for colorectal cancer screening?

Notably though, there are key things the application does not cover, such as information on Medicare Advantage Plans, Medigap, and other Medicare health plans.

The most glaring omission was that CPT code searches and reimbursements are not covered at all.

Overall, this is a fantastic app to further understand what Medicare covers, especially when it comes to preventive services.

NHS 24 MSK Help

Price: Free. iPhone, iPad: apple.co/2X41RFm Android: bit.ly/2X3b7K5

NHS 24 MSK, from the National Health Service in the U.K., provides quality videos and materials to help patients with musculoskeletal conditions. The app includes several MSK conditions commonly seen in primary care, urgent care and emergency medicine settings.

When you open the app, you are presented with three buttons: exercises, self help and reminders. The exercises section is where a bulk of the time is spent, and where the app truly shines.

For example, click on the neck section to find exercises and videos for how to help whiplash.

This is one of those apps that can be used by both providers and patients. Providers can use it to review and educate their patients on the different types of physical therapy exercises their patients can do at home. Patients can use the calculators and questionnaires to create custom therapies. There is even a calendar section that patients can use to remind themselves to do their exercises, take their medication and keep track of their appointments. 

 

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3 new medical apps

These innovative apps help clinicians and patients evaluate risk and remember treatment.

By Iltifat Husain, M.D. | Summer 2019 | Tech Notes

 

Price: Free. iPhone, iPad: apple.co/2HqXAYO Android: bit.ly/2TGxgAa

Pediatric Asthma Risk Score

The Pediatric Asthma Risk Score (PARS) medical app was created out of Cincinnati Children’s Hospital Medical Center. PARS is a continuous scoring system for predicting asthma risk in young children.

The app asks you to answer six questions related to the patient’s past medical history and demographics. Based on these answers, it assigns a PARS score. Based on the PARS score, you are given the probability of the patient developing asthma by the age of 7.

The score was published in the Journal of Allergy and Clinical Immunology in December 2018, and was shown to be better than the Asthma Predictive Index (API) in children with mild to moderate asthma.

One of the main reasons I am featuring this medical app is because it’s a great example of how researchers can take published research and transform it into an easy-to-use app that can be accessed by any clinician. Traditionally, you would have to read the actual published article to access the guidelines and scoring criteria. By making this into an app, clinicians will be more inclined to download and use the tool.

Price: Free iPhone, iPad: apple.co/2HoyRUU Android: bit.ly/2XRhQZ1

PneumoRecs VaxAdvisor

Remembering vaccination guidelines and making sure your patient is up to date on key vaccines isn’t always easy—especially when it comes to the pneumococcal vaccines. These guidelines have undergone updates in recent years, making keeping track of when to administer them a bit more confusing.

There are several medical apps dedicated to helping providers remember when patients should receive their pneumococcal vaccines and the types to administer. However, it’s nice to see the CDC finally getting into the fray and releasing their own dedicated app to help clinicians with this, especially since they created the guidelines.

The PneumoRecs VaxAdvisor was created by the CDC in collaboration with the Georgia Tech Research Institute. The app provides easy-to-use, patient-specific pneumococcal vaccination guidance. Simply enter the patient’s age, pneumococcal vaccination history and underlying medical conditions.

The app is particularly useful in the pediatric patient population of less than 2 years of age (PCV13). The app gives specific recommendations on the numbers of doses of PCV13 and the specific intervals the vaccinations should be given. For clinicians in the primary care setting, this is a must-have app when evaluating if a patient is up to date on their vaccinations.

Price: Free. iPhone, iPad: apple.co/2TrLAxm Android: Not available

PE & DVT dx tool

I have featured several apps by Joshua Steinberg, M.D., in the past—and this one gets a great update.

The PE & DVT dx tool app incorporates a clinician’s pretest probability via the Wells DVT score to help make decisions on whether or not to order a D-dimer or imaging. The app offers one algorithm for DVT diagnosis and two algorithms for PE diagnosis.

The app makes it easy to go through these algorithms based on what you’re evaluating and gives the option to view the algorithms on one page via a large diagram. The new addition is the evaluation of a pulmonary embolism in a pregnant patient. This is based on a study published in the Annals of Internal Medicine in October 2018, by Righini M, et al., “Diagnosis of Pulmonary Embolism During pregnancy: A multicenter Prospective Management Outcome Study.”

As usual, Steinberg does a great job of providing all the references, as well as detailed explanations.

 

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Medical societies win with apps

Two associations release helpful apps—and another that you may want to share with patients.

By Iltifat Husain, M.D. | Spring 2019 | Tech Notes

 

In this edition of Tech Notes, I will cover three recently released medical apps. Two of them are from medical societies and provide great value to their members. Both of those are free to download and critical for their particular specialties.

I’ll also dive into the difference between an FDA “approved” medical app and an FDA “cleared” medical app, and how the FDA has opened up a new regulatory pathway for medical apps that allows them to market their treatment benefits in a way that was not possible before.

Price: Free. iPhone, iPad: apple.co/2Brt7oC. Android: bit.ly/2A5bqeO.

ACOG District II Safe Motherhood Initiative

There has been a lot of unfortunate news recently on how maternal mortality in the United States after childbirth has been increasing. The increase has been dramatic and has been highlighted in many mainstream news publications, with some numbers showing an almost doubling of maternal deaths per 100,000 live births since 1987.

Although the dramatic increase might make researchers think the underlying pathology has changed, it hasn’t. There are still three main causes of maternal mortality worldwide and in the United States: postpartum hemorrhage, severe hypertension of pregnancy, and venous thromboembolism.

The Safe Motherhood Initiative (SMI) is a project of the American College of Obstetricians and Gynecologists (ACOG) District II. SMI started in 2013 and works with over 10,000 health care providers and 118 birthing facilities to help develop a standard approach to handling obstetric emergencies associated with maternal mortality and morbidity.

The application itself contains position statements, guidelines, checklists, algorithms and teaching slides. You are able to highlight and bookmark key bundles and checklists. An interesting feature of the app is the ability to leave feedback. If you click the star icon within a document, you are able to give ratings on the actual content. There is an additional section for leaving detailed text feedback.

My only criticism of the app is in the lack of conversion of the PDF files. The actual content is presented in PDF forms. While the PDFs themselves are relatively easy to read on a mobile device, it would have been much better to convert the PDFs into a native iOS or Android format for reading.

Overall, it’s great to see ACOG’s District II take on such an important task and help standardize management of the main causes of maternal mortality.

Price: Free. iPhone, iPad: apple.co/2A3YOEx. Android: bit.ly/2BBbHWX.

Pedi Crisis 2.0

The Society for Pediatric Anesthesia (SPA) created Pedi Crisis 2.0, a medical app that has peer-reviewed algorithms for treating 26 pediatric crisis situations. Not only is there specific treatment advice, but the application also contains checklists and differentials.

Pedi Crisis allows you to enter the weight of the pediatric patient you’re taking care of, then gives you specific dosing advice throughout the app. The application has a really interesting user interface, with a host of hyperlinks throughout that allow you to jump around the pediatric crisis situations.

A lot of thought went into the user interface, shown in the “phone numbers” section. Instead of just having a blank screen for providers to input key numbers, the application gives you specific sections and categories for the phone numbers, such as “code team,” “blood bank,” “ECMO” and more.

Almost all medical societies have algorithms and treatment plans they give guidance on, and it would be great to see more of them getting into the mobile space by providing value add mobile apps such as Pedi Crisis.

Price: $79.99 billed annually, or $9.99 per month billed monthly. iPhone, iPad: apple.co/2USSUiD. Android: bit.ly/2Ciuesz.

Natural Cycles

Natural Cycles is the first FDA-cleared mobile medical application that can be used as a method of contraception to prevent pregnancy. It’s important to note the mobile application isn’t “approved,” but “cleared.” This means the FDA is allowing the application to market this specific medical use.

Why does the FDA stamp matter here? The story is actually pretty interesting. The FDA reviewed the Natural Cycles app through the new de novo premarket review pathway. This is a regulatory pathway for novel, low-to-moderate risk devices of a new type.

This now allows mobile medical apps to go through the FDA’s 510(k) process, allowing them to obtain marketing authorization for their claims.

Natural Cycles contains an algorithm that calculates the days of the month a woman is likely to be fertile based on daily body temperature readings and menstrual cycle information. This is a type of contraception referred to as fertility awareness. The daily body temperature reading is based on a basal body temperature, which is the lowest body temperature attained during rest (immediately after awakening).

The Natural Cycles app algorithm was originally created by nuclear physicist Elina Berglund Scherwitzl, a Nobel Prize winner. The app launched in 2014, and there have been several studies performed that test the efficacy of the application and algorithm. Overall, this is definitely an interesting medical application with solid research to back it up. The app claims to be 93 percent effective under typical use, meaning that 7 out of 100 women get pregnant during one year of use—so there are definitely several cases of unintended pregnancy.

There is a subset of women who are interested in non-hormonal methods of contraception, and this app could be appealing to them, as long as it’s made clear to patients that it’s not superior to traditional methods and that unintended pregnancy can occur.

Iltifat Husain, M.D., is editor-in-chief and founder of iMedicalApps.com, the leading physician publication on digital medicine. He’s also assistant professor of emergency medicine and director of medical app curriculum at Wake Forest School of Medicine.

 

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CDC releases two new apps

These free apps are instrumental to physicians.

By Iltifat Husain, M.D. | Tech Notes | Winter 2019

 

In this edition of Tech Notes, I will cover three recently released medical apps. They’re all from venerable institutions, and they’re all free to download.

CDC Anticoagulation Manager

Price: Free. Apple: apple.co/2NqlRBE

Price: Free. Apple: apple.co/2NqlRBE

I’ve always been a fan of apps produced by the CDC. Even though I know they produce quality apps, I was pleasantly surprised when they recently released the Anticoagulation Manager.

There are already several other anticoagulation management medical apps available. However, the CDC’s app surpasses both.

One of my favorite parts of the app is that, instead of just presenting the data, it gives you three of the most often-encountered clinical scenarios: Do you want to start a patient on anticoagulation; switch the patient’s current regime; or reverse a patient’s anticoagulation.

Over the past few years, the usage of NOACs has increased tremendously for common conditions such as a-fib, and the app takes this into account.

Where the CDC’s app really shines, though, is in its ability to help through various “tricky” clinical scenarios, such as what to do for patients who are pregnant or have chronic kidney disease.

The app doesn’t go into granular details, but rather mentions key papers that explain the reasoning in more detail. It would have been helpful for the development team to include hyperlinks to PubMed instead of having to do manual searches of the papers listed.

The CDC specified that this app was developed through a collaborative effort with the Georgia Institute of Technology. This is notable, as most of the CDC’s other apps don’t announce a collaboration. (That also might explain why the user interface is my favorite out of all the CDC’s apps.) My only frustration is that it isn’t available on Android yet.

MD Anderson’s QuitMedKit

Price: Free. iPhone, iPad: apple.co/2wVFTul Android: bit.ly/2wSz9MX

Price: Free. iPhone, iPad: apple.co/2wVFTul Android: bit.ly/2wSz9MX

MD Anderson, the venerable cancer treatment center, is upping its focus on prevention by releasing a round of new tobacco and nicotine cessation apps.

The apps released recently are Vaper Chase and QuitMedKit. The original QuitMedKit was released more than four years ago, but it has been completely been revamped and re-released. Vaper Chase is an interesting medical app game for patients that explains the dangers of new and emerging tobacco products.

QuitMedKit is based on the 2008 clinical guidelines for tobacco cessation from the U.S. Department of Health and Human Services. The guidelines also include first-line medications that help with increasing long-term smoking abstinence rates.

For those who counsel patients on tobacco cessation and want an easy-to-digest format for viewing evidence-based recommendations, this app is key.

Prior apps released by MD Anderson have been updated infrequently. I’m hoping that’s not the case with this one.

CDC Cause of Death Reference Guide

Free. Apple: apple.co/2CHl630. Android: bit.ly/2QebXl5

Free. Apple: apple.co/2CHl630. Android: bit.ly/2QebXl5

There’s another recently launched CDC app that provides significant utility—this one for physicians who work in inpatient settings and have to complete a death certificate when a patient dies.

I remember that, when I was a resident, this was the line always fraught with debate, as there were often multiple morbidities and pathologies that contributed to death, but you have to list one main cause.

The CDC wants to educate providers about how to fill this section out correctly because they track causes of death nationally and release the data to the public.

These reports also shape how grants and research funding can be allocated by the NIH and other foundations. For example, if there’s a sudden uptick in a cause of death from a particular pathology or region, there would be more research funding granted to explore further and come up with a solution.

Overall, the app is a great resource if you want to make sure you’re completing a death certificate accurately.

Iltifat Husain, M.D., is editor-in-chief and founder of the website iMedicalApps.com, the leading physician publication on digital medicine. He’s also assistant professor of emergency medicine and director of medical app curriculum at Wake Forest School of Medicine. Learn more about our contributors on page 20.

 

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The best patient education app

The app I most recommend helps patients understand if early breast cancer screening will benefit them—or not.

By Iltifat Husain, M.D. | Fall 2018 | Tech Notes

 

In this edition of Tech Notes, we’ll cover two applications, each made by venerable medical institutions. Though one of the apps I write about, from the American College of Cardiology, is great, my favorite is from a collaboration between Weill Cornell Medicine and Memorial Sloan Kettering Cancer Center. They’ve produced the best patient education app I have ever reviewed or used—no exaggeration.

WCM BSD

Price: Free. Apple: apple.co/2MzeAfw

Price: Free. Apple: apple.co/2MzeAfw

I’ve reviewed and downloaded thousands of medical applications since 2009, when I wrote my first article on iMedicalApps.com. I’ve never said this statement about a medical app before, but I’ll say it now: The WCM BSD application is the best patient education app that has ever been created.

It takes a ridiculously complex and sensitive issue, breast cancer screening before the age of 50, and does what no one could do for years: explain it to patients in an uncondescending and educational way that just makes sense.

When the U.S. Preventive Services Task Force (USPSTF) released their draft report of breast cancer screen recommendations in 2009, they advised women to start getting mammograms at age 50 rather than 40, and recommended that screening happen every two years instead of yearly.

This caused a huge uproar and an absolute frenzy in the media because it was a drastic change from recommendations that had been made by other groups. Further, the way it was explained at the time by the USPSTF was not ideal. The USPSTF struggled to explain the real harms vs. the nominal benefits of early screening in the majority of the population—a population that tends to believe that early screening is always a good thing.

The USPSTF recommendation also made it seem like breast cancer screening should never happen before the age of 50. It didn’t consider the risks and benefits of screening from an individual patient’s perspective and experience.

In 2016, the USPSTF updated their recommendations to include the following Grade C recommendation: “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.”

This recommendation is difficult for patients and physicians to manage because it’s hard during a 10- to 15-minute office visit to truly explain and understand the patient’s risk, context and values.

Enter the WCM BSD app, a collaboration between Weill Cornell Medicine and Memorial Sloan Kettering Cancer Center.

WCM BSD is a tool to help patients and their physicians decide how often they should have screening mammograms performed.

Some of the key questions the app is designed to answer include:

  • Should you have screening mammograms in your 40s or wait until you are 50?
  • Should you have a mammogram every year, or every other year?

The app also helps patients see their own personal risk of breast cancer and learn the benefits and harms of screening mammograms.

After a patient enters responses to a series of 11 questions, the application displays the patient’s overall risk factor as a pictograph. This type of visual representation is much easier to understand than percentages or statements, such as “your chance of developing breast cancer in the next 5 years is 0.7%.” The app also explains what a screening mammogram is and how it is performed.

An important part of the app is the “benefits and harms” section. The general public has a good understanding of the benefits of screening mammograms, but often doesn’t realize there can be serious harms, such as false results that cause unnecessary biopsies, or diagnoses of slow growing breast cancers that end up getting treatment but wouldn’t have changed overall morbidity or mortality.

One of the most interesting parts of the application is the section that shows how well mammograms perform in women with similar profiles. Here, users can see—with another pictograph—how many cases of breast cancer are caught by early screening compared to how many screenings return false positives.

The USPSTF’s recommendation to take a patient’s values into account isn’t easy; the WCM BSD app handles this well. With their answers to eight statements, patients can help physicians better understand their opinions and feelings about early breast cancer screening. This truly empowers the patient.

Clinicians with patients in their 40s who are considering mammograms should tell those patients to download the app and schedule a follow-up appointment to discuss the results. There’s also an online version of the decision tool if patients don’t want to use the app: bsd.med.cornell.edu.

My only negative comment about the app is it isn’t available for Android phones—yet.

TreatHF

The American College of Cardiology was one of the first medical societies to start launching medical apps for smartphones. Their more than 20 medical apps in the Apple App Store alone range from medical calculators to clinical decision support tools. Almost all of their apps are free to use, and they are a great resource for both cardiologists and primary care physicians managing patients with cardiovascular disease.

TreatHF is an app from the ACC that focuses on helping providers manage patients who have heart failure. (This app addresses patients with reduced ejection fraction (HFrEF), not patients with preserved ejection fraction (HFpEF).)

TreatHF is based on the ACC’s Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment and the 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.

The app starts the heart failure assessment by asking NYHA classification, LVEF range, types of medications the patient is and isn’t on, renal/hepatic function status, and age.

From there, TreatHF gives advice related to the patient, such as medication change suggestions and even titrations of key medications. Medications and classes of key medications, specific dosing and frequency are all included in the suggestions.

The last section of the app, “therapies,” contains sections such as “guiding principles for treatment,” further information on classes of medications, considerations for ICD placement and more.

The app’s user interface is clean and simple to use. TreatHF does a great job of using bullet points and dropdown menus to present a wealth of information in an easy-to-digest manner.

Iltifat Husain, M.D., is editor-in-chief and founder of iMedicalApps.com, the leading physician publication on digital medicine. He’s also assistant professor of emergency medicine and director of medical app curriculum at Wake Forest School of Medicine. Learn more about our contributors on page 20.

 

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Evidence-based apps for physicians

These apps put help for specific conditions at physician fingertips—and patient bedsides.

By Iltifat Husain, M.D. | Summer 2018 | Tech Notes

 

Each of the apps in this article help clinicians practice evidence-based medicine at the point of care and in clinic and hospital settings.

Frailty Tool

Price: Free Apple: apple.co/2DQtNDn Android: bit.ly/2EGQ6x4

Price: Free Apple: apple.co/2DQtNDn Android: bit.ly/2EGQ6x4

As cardiac procedures such as transcatheter aortic valve replacement (TAVR) have become more popular in the elderly, it has become even more critical to determine which patients are at a higher risk for mortality and disability following the procedure.

Since TAVR and aortic valve replacements (AVR) performed on the very elderly are still relatively new, integration of consensus algorithms and scores has been suboptimal.

In order to solve this problem, researchers published the FRAILTY-AVR Study last year in the Journal of the American College of Cardiology. Researchers wanted to compare seven different frailty scales in order to predict poor outcomes following AVR in the elderly. The Essential Frailty Toolset (EFT) was found to be the more predictive for one-year mortality and disability.

This toolset is now easy to access through the Frailty Tool, an app developed by physician Jonathan Afilalo, the first author of the FRAILTY-AVR study.

The EFT is relatively easy to use, having only four main components that can essentially be performed at a patient’s bedside (as long as you have key lab values).

It’s important to note the Frailty Tool app isn’t exclusive for TAVR and AVR procedures. The frailty app can be utilized for other procedures or simply to assess frailty in your elderly patient.

GOLD 2017 Pocket Guide

Price: $2.99 Apple: apple.co/2ul4auC Android: bit.ly/2pGRb19

Price: $2.99 Apple: apple.co/2ul4auC Android: bit.ly/2pGRb19

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is a global initiative and organization that works with health professionals and public health officials to improve prevention and treatment of COPD. They focus on evidence-based strategies for COPD management.

When GOLD released its 2017 Pocket Guide, they also released an accompanying medical app. The comprehensive app covers the whole spectrum of COPD, from definition and diagnosis to management of stable COPD versus acute exacerbations.

This isn’t the first COPD application that has been available to download, but it’s the first one that is completely comprehensive and focused on COPD. The GOLD 2017 Pocket Guide has everything in one app.

The app is relatively easy to navigate and lets you favorite high-usage tools for quick access, such as the ABCD assessment tool, CAT assessment and mMRC dyspnea scale.

The only concern with the GOLD 2017 Pocket Guide is that their last app didn’t receive frequent updates.

EBM Stats Calc

Price: Free Apple: apple.co/2IQFSvI

Price: Free Apple: apple.co/2IQFSvI

Joshua Steinberg, M.D., is back at it with another great application: EBM Stats Calc. Those who read this column know we feature Steinberg’s medical apps frequently. We find them to provide a great deal of functionality while being simple to use. EBM Stats Calc is another one of his apps that fits the bill.

Steinberg wants EBM Stats Calc to help clinicians and educators do more effective clinical reasoning by helping with the math. The app:

  • Calculates the number needed to treat from event rates
  • Calculates post-test probability from sensitivity, specificity and likelihood ratios
  • Demonstrates diagnostic principles to learners dynamically

Iltifat Husain, M.D., is editor-in-chief and founder of iMedicalApps.com, the leading physician publication on digital medicine. He’s also assistant professor of emergency medicine and director of medical app curriculum at Wake Forest School of Medicine. Learn more about our contributors on page 20.

 

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4 free apps to download today

A long-overdue addition to the app store—and a good example of how a practice can develop an app of great value.

By Iltifat Husain, M.D. | Spring 2018 | Tech Notes

 

Young hipster using a mobile phone

These four great medical apps have all recently been developed and released. They’re all free to download, and they all come from great sources. One application in particular has long been overdue to make an entrance in the app store, and you’re sure to be excited to download it and give it a try.

Choosing Wisely

Price: Free. Apple: apple.co/2tYQfVK. Android: Not available at this time.

Price: Free. Apple: apple.co/2tYQfVK. Android: Not available at this time.

The Choosing Wisely app is a collaboration between the American Board of Internal Medicine (ABIM) and Consumer Reports—and finally brings the popular Choosing Wisely recommendations to mobile form via a smartphone app.

Most physicians are aware of Choosing Wisely, a campaign created in collaboration between ABIM, other medical societies and Consumer Reports to help promote conversations between clinicians and their patients when it comes to ordering tests and procedures. The crux of the campaign is to reduce unnecessary medical testing and procedures, while also improving health outcomes.

The Choosing Wisely campaign has gotten a lot of attention in the media because of the number of medical societies involved, the evidence behind the recommendations, and how the recommendations are easily presented in one easy-to-access area not only for clinicians, but also for patients.

This ease of access is why I have been puzzling that it took this long for the campaign to make it to mobile form—but it’s better late than never, and the app is a welcome addition to the medical app store.

When you open the Choosing Wisely app, you are immediately prompted to select “For Patients” or “For Clinicians.” In the physician section, along with key recommendations and literature citations, the app has patient-specific handouts and sharing functions that make it easier to explain to patients why a certain test or procedure isn’t recommended at the time.

It’s great to have an application to help patients understand the guidelines their physician is using. It’s important that patients realize that following guidelines and evidence-based care is how tests and procedures should be ordered—not in a haphazard manner that can cause unintended consequences.

My biggest issue with the app is that it’s not available on the Android platform yet. That will hopefully change soon.

Pneumonia Guide

Pneumonia Guide is by the prolific physician app developer Joshua Steinberg, M.D., whom we’ve featured before. His medical apps are truly created “by physicians, for physicians,” and they are simple and easy to use.

Though Steinberg’s Pneumonia Guide app has been around for years, it has undergone a significant update centered around recent changes in pneumonia guidelines by the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA).

Once you select the type of pneumonia (the app has pediatric pneumonia recommendations as well), you are presented with a page that lists diagnostic testing that should and shouldn’t be considered, antibiotic choices, assessing clinical response, and recommendations on management of overall care.

The app makes distinctions between IV and PO antibiotics and outpatient and inpatient settings. There is a calculator section as well to help physicians with risk stratification.

Price: Free. Apple: apple.co/2BaINPc. Android: Not available.

Pregnancy Passport from P&M

Price: Free. Apple: apple.co/2iQGANR. Android: bit.ly/2BCugwg

Price: Free. Apple: apple.co/2iQGANR. Android: bit.ly/2BCugwg

Pregnancy Passport was developed by the Physicians and Midwives Collaborative Practice, a team of OB/GYNs and midwives who practice across five centers across Northern Virginia. The app is a great example of how a practice can promote itself by providing a great smartphone app experience that’s not only for their patients, but for patients in general.

Though the app itself does have specific features made just for patients of the Physicians and Midwives practice, it’s packed full of great patient education content that any pregnant patient would find useful.

There are sections related to many chief complaints encountered in pregnancy. Key timers included in the app are kick counts and a contractions timer. A great feature of this app that many other patient-centered pregnancy apps don’t include is a postpartum and newborn care section.

Practice-specific apps rarely have patient portals and simply include information on the medical practice, which don’t make them useful. However, this app does a great job of promoting their practice by creating a medical application that provides real value.

If you’re thinking of making a practice-specific app, look at the Pregnancy Passport app as a model application.

CKD Care

The CKD Care app by the National Kidney Foundation calculates eGFR, adjusted eGFR, and other related information.

The app allows you to enter in key demographic information, insert key lab values, and get eGFR and adjusted eGFR values. Interestingly, while you are entering in the data, you are at times prompted with pop-ups that explain why the patient should see a nephrologist based on the values that you enter.

You are given a differential diagnosis as well as the actual values, which is one of the main features that separates this app from those that have come before.

Click through the differential list to get a nice condensed version of the condition. Some of the content within the differentials can also link out to UpToDate.

Overall, this medical app is a nice addition by the National Kidney Foundation into the app store and provides value by providing a great differential list based on the values that you get for eGFR and adjusted eGFR.

Price: Free. Apple: apple.co/2BSRyK8. Android: bit.ly/2juOGzT

Iltifat Husain, M.D., is editor-in-chief and founder of iMedicalApps.com, the leading physician publication on digital medicine. He’s also assistant professor of emergency medicine and director of medical app curriculum at Wake Forest School of Medicine.

 

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7 new apps for physicians to try

From guidelines for cancer patients to neurosurgery simulation, these apps—all free—help physicians through a variety of training and practice decisions.

By Iltifat Husain, M.D. | Tech Notes | Winter 2018

 

Women using a smartphone in the display and technology advances in stores. Take your screen to put on advertising.

From guidelines for cancer patients to neurosurgery simulation, these apps—all free—help physicians through a variety of training and practice decisions.

Usually, I use Tech Notes to cover three recently released apps in depth. But over the last few months, we’ve seen a flurry of interesting medical apps released. This time, instead of discussing three apps in detail, I’ll give you a summary of seven interesting, free medical apps that were released in the last few months.

Dx Challenge

Dx Challenge, from the University of Pennsylvania, gives you a case-based presentation of a patient and tests your responses. You have a limited amount of time to respond to the questions, and a limited number of attempts. The interesting thing about the app is that you actually can collect an honorarium for getting the answers right. The challenges and cases are live and only available for a limited time. This is the only medical app I know of that actually pays you for getting medical questions correct.

iTunes: appstore.com/dxchallenge

CorticoCalc

CorticoCalc

The CorticoCalc app helps you determine the appropriate topical steroid and coverage. The app would be useful not only for dermatologists, but also for pediatricians and primary care physicians. One of the best features of this app is the ability to separate pediatric cases from adult ones—there is a separate decision tree for patients 0 to 3 years old and those who are older.

Once you select the appropriate age, the app guides you through selecting the amount of coverage, such as right arm, and then gives steroid recommendations.

ASCO Guidelines

The ASCO Guidelines app from the American Society of Clinical Oncology helps clinicians with a range of management questions and treatment guidelines for their cancer patients. The app has point-of-care decision-making tools and is kept up to date when new evidence becomes available.

iTunes: itunes.apple.com/app/asco-guidelines/id1238827183?uo=5&at=10l9yE

Prescription Check by Warby Parker

Prescription Check by Warby ParkerPrescription Check by Warby Parker is an app that enables you to take a vision test at home and get a prescription for glasses. Simply by using a smartphone and laptop, you’re able to get a prescription assigned to you, approved by an optometrist. The key though is you don’t get a comprehensive medical eye exam, simply a prescription.

Warby Parker makes it clear their technology isn’t meant to replace visits to your eye doctor, but you can imagine there is concern by medical professionals.

The American Optometric Association (AOA) has submitted complaints about this technology to the FDA, and they are concerned that this type of technology will lead to harm by causing fewer patients to get medical eye screening exams.

The main reason I mention this medical app is because these types of eye prescription apps are gaining traction, and the technology itself is innovative. As medical professionals, we should know that we might have patients using these types of apps and should be ready to answer questions that patients have about their safety and use.

PsychoPharm Research

PsychoPharm Research was created by noted medical app developer Joongheum Park, M.D., who is an internal medical physician. Park has created several notable medical apps, and this current one provides an interactive version of medical decision support trees for psychopharmacology.

It should be noted that medication decision support trees have backing from a venerable institution. They are developed by the Psychopharmacology Algorithm Project at the Harvard Medical School Department of Psychiatry, South Shore Program (founded by David Osser, M.D., an associate professor of psychiatry at Harvard Medical School).

This application really is tremendous. It helps primary care physicians and psychiatrists with a decision tree for patients who have depression, bipolar and other psychiatric complaints that haven’t responded to the first line of therapy. It’s a must-have for primary care physicians to try, especially when choosing second line options for patients who have depression or general anxiety disorders. It’s remarkable that this application is available to download for free.

iTunes: itunes.apple.com/us/app/psychopharm-research/id1238087068?mt=8&uo=4&at=10l9yE

Pterional Craniotomy

Pterional Craniotomy is a real-time 3-D neurosurgery simulation app that shows you one of the most common neurosurgery procedures: the pterional craniotomy. The app teaches about and enables you to actually perform the surgery. Users are given controls at a granular level, even determining how to position the patient during the surgery by utilizing tap and zoom functions on your phone.

The team of neurosurgeons that helped develop the app state that it was built through “a systematic 3-D reproduction of real surgical scenes.” The app gives you an idea of how future medical students and residents might learn complex surgical procedures by using their phones.

iTunes: itunes.apple.com/app/pterional-craniotomy/id1239319725?uo=5&at=10l9yE

Android: play.google.com/store/apps/details?id=com.upsurgeon.pterionalcraniotomy&hl=en

REBEL EM

REBEL EM

REBEL EM by AgileMD organizes the content from the RebelEM website into easy to use, point-of-care accessible information. RebelEM.com was founded by Salim Rezaie, M.D., and is run by a group of academic emergency medicine physicians. The website provides great peer-reviewed blog posts that focus on various emergency medicine topics.

Instead of simply turning the website into an app, AgileMD divided the app into key systems, such as cardiovascular and gastroenterology. Within each of these sections, you’re given summary morsels of information. My only issue with the app is that I wish they put links to the full posts on each of the subsections for further reading. That said, this is a great example of distilling a website into an easy to use, point-of-care form.

Iltifat Husain, M.D., is editor-in-chief and founder of iMedicalApps.com, the leading physician publication on digital medicine. He’s also assistant professor of emergency medicine and director of medical app curriculum at Wake Forest School of Medicine.

 

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Medical Apps for Physicians

The CDC, ACC and University of Toronto help physicians motivate patients, make better decisions and refresh their techniques.

By Iltifat Husain, M.D. | Fall 2017 | Tech Notes

 

In this edition of Tech Notes, we’ll cover a medical app from the Centers for Disease Control and Prevention (CDC) essential for the current opioid epidemic, an app from the American College of Cardiology, and an app that helps providers do quick and minor procedures at a patient’s bedside.

CDC Opioid Guideline: Motivating behavior change

CPC Opioid Guideline

Price: Free Apple: ow.ly/yiOH30d7PAg Android: ow.ly/Bj8Z30d7PHL

Every health care provider is currently aware of the opioid epidemic that is gripping our nation. Many of us see this on a daily basis with patients who come in for overdoses. It has become common to administer naloxone to patients who come into the emergency room with decreased mental status. Per the CDC, overdose deaths involving opioids, including prescription opioids, have quadrupled since 1999.

To help physicians manage this crisis, the CDC released the “CDC Guideline for Prescribing Opioids for Chronic Pain” in 2016. These guidelines were meant to help physicians treat chronic pain in patients who are outside of active cancer therapy, palliative care and end-of-life care. The guidelines address when to initiate opioid therapy, the types of opioids to choose, and how to assess the risks and harms of prescribing opioids.

At the end of 2016, the CDC released a medical app dubbed CDC Opioid Guideline, an app that condensed the recommendations the CDC had made earlier in the year pertaining to chronic opioid management. The app itself offers some great features. One of the favorites is the morphine equivalency calculator and a subsection that explains how to perform motivational interviewing with chronic pain patients.

I can’t overemphasize the importance of the app’s motivational interviewing section. It gives physicians the opportunity to use evidence-based techniques for behavior change. The techniques have been proven to reduce the risk of opioid misuse, increase patient motivation to change, and decrease depression in the setting of opioid use.

This app is a must-have for primary care physicians and other physicians who prescribe opioid therapy on a daily basis.

Key ways to use this app: If a patient presents with chronic pain, use the app to determine if their medication dosing should be changed, or if they are at risk for opioid addiction. Use the morphine equivalency calculator to determine conversions for opioid therapy. Use the motivational interviewing section with patients. It’s a patient-centered approach to causing behavior to change.

DAPT Risk Calculator: Help deciding on treatment

DAPT Risk Calculator

Price: Free Apple: ow.ly/YSvT30d7PTK Android: ow.ly/PTeT30d7Q5n

The American College of Cardiology (ACC) is one of the most active medical societies in the mobile space. The DAPT Risk Calculator is one of their latest medical apps and continues the association’s trend of producing useful and free medical apps.

Duration of Dual Antiplatelet Therapy (DAPT) is a big deal for patients who undergo cardiac catheterization procedures. While the length of DAPT after bare metal stents and drug eluting stents is well established, guidelines aren’t as clear on what to do after 12 months.

Serious harm can arise from continuing antiplatelet therapy, such as gastrointestinal bleeds. The DAPT score, developed from the DAPT study randomized trial data, helps physicians determine whether or not anticoagulation therapy should be continued based on a patient’s comorbidities and stenting characteristics.

Though there are online calculators for this, having it available at the point of care provides ease of use and helps you go over the score with the patient as well.

Key ways to use this app: This app helps family physicians and cardiologists decide whether or not to continue antiplatelet therapy after 12 months.

Proceducate: Refresh your skills

Proceducate

Price: Free Apple: ow.ly/oiiW30d7SdJ Android: ow.ly/1UxU30d7S21

Having a medical app that helps with you with both learning and refreshing your medical procedure skill set can be very useful. Proceducate is a medical app that fills this role. The app is focused on procedures encountered in the primary care setting and would also be useful for urgent care providers and emergency medicine physicians.

The great thing with the videos and explanations is how abbreviated they are, enabling them to be used at the point of care to refresh on anatomy or key parts of the procedure. The app is part of a research study at the University of Toronto that is looking at how to best integrate mobile applications in learning and teaching.

Proceducate isn’t a great app to use if you’re just learning a procedure; for that, you need formal training and to see several being done. But it’s a great tool to use if you have already learned a procedure and want to reinforce and learn some of the finer points, or if you need to refresh your memory on a key part. The following are key procedures discussed within the app: suturing, cryotherapy, biopsies, toenail management, aspiration/injections, IUD insertion, speculum exam and perineal laceration repair.

For almost every procedure, there is a short video along with the following information: indications, risks, equipment needed, detailed review of the procedure and various steps, complications, and references to where the procedure steps were sourced.

Key ways to use this app: There is often not just one way you can do a procedure. Use this app to learn a variation on a technique or to refresh your memory of any key part.

Iltifat Husain, M.D., is editor-in-chief and founder of iMedicalApps.com, the leading physician publication on digital medicine. He’s also assistant professor of emergency medicine and director of medical app curriculum at Wake Forest School of Medicine.

 

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Fractures, Fevers, and Helping Patients Understand Your Choices

Summer 2017 | Tech Notes

 

In this edition of Tech Notes, we’ll cover three useful medical apps for daily practice: two for physicians, and one to share with your patients.

OrthoFlow: Fracture management

Orthoflow

Price: $4.99 Apple; $5.99 Android. Apple: ow.ly/SqM630aLkmv Android: ow.ly/C3K330aLkyK

OrthoFlow is almost like having an orthopedic surgeon in your pocket. It’s especially helpful in primary care, urgent care and emergency room settings, where a lot of basic fracture management occurs.

OrthoFlow’s introductory screen shows a full human skeleton. Simply tap until you localize the affected bone. Once you’re done with this quick process, the app asks questions about displacement, neurovascular function and more. Then it provides specific recommendations, such as which type of splint to use and what key details to discuss with your orthopedic surgeon.

Key ways to use this app. If you are a primary care, urgent care or emergency medicine provider and your patient’s X-rays show a fracture, this app will help you determine fracture management. If you are an orthopedic surgeon, the app’s appendix will provide you with detailed information on necessary surgeries and items to discuss in morning fracture rounds.

Step-by-Step Febrile Infant: Validated Step-by-Step Approach

Febrile Infant

Free. Apple: ow.ly/1NcV30aLkJE

Step-by-Step Febrile Infant is yet another helpful app from Dr. Joshua Steinberg. Steinberg has created more than 15 medical apps, and this one is a great example of turning validated research into an easy-to-use app.

The app is based on the Step-by-Step Approach, a clinical evaluation protocol that helps physicians decide on care for febrile infants.

A validation of the Step-by-Step Approach was published in Pediatrics in July 2016. The app not only recreates the study’s findings and suggestions but also offers several sections that explain the study further.

A word of caution: Since the Step-by-Step Approach is a deviation from traditional practice and management of a febrile infant, make sure you understand your local practice and standard of care before using the app.

Key ways to use this app. If you are an emergency physician or pediatrician who cares for febrile infants, this app can help you understand the validated Step-by-Step Approach. If the Step-by-Step Approach has become the standard of care in your area, this app can help suggest management of care.

Making Healthy Choices: Explaining treatment decisions

Health Choices

Price: Free. Apple: ow.ly/xTYy30aLkZr

When patients come in with very specific expectations for care, it can be difficult to convince them that a particular test or a round of antibiotics is unnecessary. That’s where the Making Healthy Choices app comes in.

In the app, patients can drill down to specific procedures, tests and medicines to learn more about the indications for each of these. This helps them understand why you are—or are not—recommending a certain course of action.

One of my favorite features is the “Questions to Ask” section, which gives patients important questions to ask when a physician recommends a procedure.

Key ways to use this app. If a patient or a family member doesn’t understand your recommendations, encourage him or her to download the app and read about a particular procedure, test or medicine.

Iltifat Husain, M.D., is the editor in chief and founder of iMedicalApps.com, the leading physician publication on digital medicine. He is also an assistant professor of emergency medicine at Wake Forest University School of Medicine.

 

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