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.
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.
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.