Decision tools and medical calculators to use at the point of care

These three apps help you make informed decisions about imaging, diagnoses, treatment and more.

By Iltifat Husain, M.D. | Fall 2016 | Tech Notes

 

In this edition of Tech Notes, we’ll cover three great medical apps that can make you into a more efficient physician: MDCalc, Ottawa Rules and SmartIntern Sepsis. Each of these apps is focused on helping health care providers practice evidence-based medicine. In addition to providing a wealth of information, these apps can be used quickly at the point of care. All of these apps are also free to download and use.

MDCalc: Medical Calculators, Scores, and Clinical Decision Support

MDCalc

Price: Free. App Store Link: apple.co/1Lm4Nac Android Link: Currently not available

It’s hard to find a practicing physician who hasn’t been to MDCalc.com. The popular physician-run website is a go-to for finding medical calculators and clinical decision tools. Thanks to a recent release, the website is now available as an app, also called MDCalc.

This app is now a must-have for any physician; it provides access to nearly every type of medical calculator or decision tool. Although popular clinical decision apps such as Medscape, UpToDate and DynaMed also have their own calculators, MDCalc makes the process much easier because it lets you enter data into decision tools with just one click.

What further separates MDCalc from other medical calculator apps is the amount of evidence-based medicine it teaches. Every clinical decision tool within the app has a section dedicated to the evidence behind the actual equation. Some clinical decision calculators within the app—such as Wells’ Criteria—even have direct quotes from the tool’s creators.

The app is currently free, but in the past the developers have mentioned in its App Store description that they may charge for it in the future.

Ways the app could improve. Unfortunately this app is currently unavailable on Android.

Key ways to use the app. You will no longer need to search for decision tools on Google or on the actual MDCalc.com website. The app loads quickly, and you can use its search function to find the clinical decision tool or medical calculator you want. I would also recommend using this app to learn more about clinical decision tools. If you’re a physician new to the iPhone, this is definitely the most important medical app to download.

Ottawa Rules

Ottowa Rules

Price: Free. App Store Link: apple.co/2a3YHKN Android Link: bit.ly/2auaR3L

In medical school every physician gets taught the decision tools related to the Ottawa rules, which include C-spine, knee and ankle rules. Instead of having to look up these clinical decision tools online, you can now access the Ottawa rules from this free app provided by the Ottawa Hospital Research Institute itself.

Though the app can be used simply to access the tools, it’s much more than that. The app also has videos and commentary that provide a wealth of information about the rules. The videos in particular are a great touch because they explain in great detail the nuances behind the rules.

Ways the app could improve. Overall the app is slick, but it would be helpful if it gave you access to the criteria more quickly. Right now it’s faster to use the MDCalc app or another medical calculator’s decision tools at the point of care. The Ottawa Rules app does, however, contain a wealth of valuable information that still makes it a critical download for those who use these tools.

Key way to use the app. At this time the best way to use this app is for educational purposes. The app is free to download. There are some great figures and algorithms included, and the videos, though not flashy, provide contain great content.

SmartIntern Sepsis

SmartIntern Sepsis

Price: Free. App Store Link: apple.co/2anvtIx Android Link: Not available.

Earlier this year a consensus group published changes to the definition of sepsis in the Journal of the American Medical Association (JAMA), calling for a move away from systemic inflammatory response syndrome criteria in favor of the sequential organ failure assessment score. Also known as “Sepsis 3.0,” this is the first set of new guidelines since 2003.

The SmartIntern Sepsis app takes the new sepsis guidelines and puts them into easily understandable formats. It also has built-in calculators. In addition, the app has educational aspects to it, helping health care providers better understand the new guidelines. There is some controversy surrounding the Sepsis 3.0 guidelines, so it would be prudent for health care providers to read the JAMA study in detail.

Ways the app could improve. Though this app isn’t as popular as MDCalc, it, too, is not available for Android devices.

Key ways to use the app. If you are trying to implement the new Sepsis 3.0 guidelines, this app will help you calculate scores and learn the new algorithms. This app is focused on emergency medicine physicians, critical care physicians and hospitalists.

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

 

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Two of the best medical apps of 2016 (and one just for fun)

This issue’s app reviews include a prescription saver, a daily aspirin decision tool and a vein seeker not yet ready for clinical use.

By Iltifat Husain, M.D., founder of iMedicalApps.com | Tech Notes | Winter 2017

 

In this edition of Tech Notes, we’ll cover GoodRx’s new app for physicians; a critical app for primary care physicians related to daily aspirin use; and an app that helps you see veins using just your iPhone’s camera. Each of these medical apps is free to download and easy to use.

Aspirin Guide Simplifies the aspirin decision-making process

Aspirin Guide

Price: Free iTunes: http://apple.co/2emt84s Android: play.google.com

For any physician or provider who has to determine whether or not to start a patient on daily aspirin for primary prevention of cardiovascular disease, Aspirin Guide is the most important app you will use.

It’s one of the best medical apps released in 2016 and is a must-have for primary care physicians and cardiologists. It’s from researchers at Harvard Medical School and helps health providers decide which patients are candidates for the use of low-dose aspirin.

The decision to start patients on aspirin is much easier for secondary prevention of cardiovascular disease; it gets complicated when it comes to primary prevention due to the consequences that can arise, such as serious bleeding events.

The U.S. Preventive Services Task Force (USPSTF) gives various grades of recommendation for use of aspirin in primary prevention for cardiovascular disease and colorectal cancer. The determination isn’t based just on age, but also various medical calculators the USPSTF wants providers to use.

Aspirin Guide simplifies the decision-making process. The app can be used at the point of care with patients. It does all the backend work of calculating risk scores based on your various inputs. Aspirin Guide also can email the results to your patients so that they can see why there was a decision to start on daily aspirin or not.

The app is available for iPhones and Android and is available as a web app as well.

Key ways to use this app. Use this app to determine if your patients should be on daily aspirin use for primary prevention of atherosclerotic cardiovascular disease (ASCVD). Use it to calculate 10-year cardiovascular disease risk score, and use it to email a summary of the decision-making process.

GoodRx For Doctors Helps your patients save money on prescriptions

GoodRx

Price: Free iTunes: http://apple.co/2fAFjby Android: http://bit.ly/2fodKS9

GoodRx has been one of the most downloaded medical apps in the App Store for the last few years. It provides coupons for prescription medications and can help patients save money on prescription drugs.

Patients or physicians are able to input a particular drug and dosing and then get a list of pharmacies that offer the lowest price.

GoodRx is particularly useful for patients who do not have insurance, but it can also help those who have insurance save on prescription drugs.

For example, clindamycin can cost my patients paying out of pocket more than $60, but using GoodRx, I can get them the prescription for less than $15.

GoodRx partners with a pharmacy benefit manger (PBM) in order to get lower prices of prescription medications. PBMs are able to negotiate discounts with pharmacies, and they earn a transaction fee for sending customers to a pharmacy.

GoodRx recently released a physician-centric version of their app, GoodRx For Doctors. The app makes GoodRx much easier to use with patients. In the past, I would have had to use GoodRx on a desktop, search for a drug, and print out the coupon for my patient. With GoodRx For Doctors, I’m able to save my favorite prescriptions more easily, and I can easily send my patients a text or email of the coupon right from my phone. When the patient gets the coupon via text on their phone or in their email, it doesn’t convey my personal information.

Key ways to use this app. Use this app if you have patients without insurance or the drug isn’t on the $4 Walmart list. It’s best for patients who have smartphones (otherwise, just print the actual coupon for your patient in clinic). Use this app to look up information on the drug prescribing; there is a decent drug monograph available.

VeinSeek Identifies vein location with an iPhone

Vein Seek

Price: Free iTunes: http://apple.co/2fobTfY Android: Not available

Unlike the other two serious apps mentioned for clinicians, VeinSeek is a fun app that only health professionals will get a kick out of. It’s important to note this app should not be used for medical purposes or on any patients.

VeinSeek is a live video processing app that uses your iPhone’s camera and layers of algorithms to show veins on your arm. “Vein seeking” devices have been around for awhile—they use infrared light to show veins. But VeinSeek doesn’t require any add-ons or attachments; it simply uses algorithms to help distinguish veins.

This app is nowhere near ready for primetime, but it shows the power of what a smartphone camera can do when connected to smart software.

Key ways to use this app. As mentioned, you definitely can’t use this app for any type of patient care or any type of medical treatment. But it’s a good proof of concept and an example of how live video processing apps have potential to be used in the medical setting in the future.

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

 

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Medical apps for STDs, statins and cancer-screening

These three medical apps help physicians treat STDs, reveal the costs and benefits of screening for cancer and recommend statins based on patient particulars.

By Iltifat Husain, M.D. | Summer 2016 | Tech Notes

 

This issue’s apps include a great statin management app from the American College of Cardiology, an STD treatment app from the Centers for Disease Control and Prevention, and an evidence-based cancer-screening app. In addition to helping physicians make the best treatment decisions for their patients, all three of these apps are free to download and use.

STD Treatment Tx Guide by the CDC

The CDC isn’t new to the App Store—their STD Tx Guide app has been in the store since 2013. Whereas previous iterations of STD Tx Guide were OK, their most recent version of the app is a must-have for physicians. This version, released in January 2016, contains the most recent updates to treatment algorithms for sexually transmitted diseases.

In addition, the app itself now has key functions that were not present prior. When you open the app, you can go through the conditions immediately. Not only are sexually transmitted diseases listed, but so are other conditions such as sexual assault.

STD Treatment app

Price: Free. App Store: apple.co/1HY9g0e. Android: bit.ly/1nDS0F8

My favorite feature of the updated app is that the information is now native to the app. Previously, all the information for treatments and conditions had to be accessed online through the app, but now, almost all the information is native. This means you can use the app even when you don’t have an internet connection, and it loads significantly faster than before.

Ways the app could improve. A more thorough “More Info” section for each of the conditions would improve this app. Currently this section has short paragraphs and great references, but more details about diagnosing, managing and caring for conditions would be welcome.

The “Sexual History” section could also be improved if it lost its PDF feel and were instead optimized for mobile devices.

Key ways to use this app. Use this app if you need the latest information on the medication regimen for an STD, if you have a pregnant patient and need to figure out what medication would be OK during pregnancy, or if you have a patient who is allergic to penicillin and needs an alternative treatment regimen.

ePrognosis: Cancer Screening

ePrognosis is a decision support app created by the authors of the popular GeriPal blog in collaboration with health experts at the University of California, San Francisco and Harvard Medical School. This cancer-screening app focuses on colorectal and breast cancer screening for geriatric patients.

One of the key tenets of the app is the understanding that screening and testing can lead to harm. The authors list, for example, some potential harms of colorectal cancer screening, such as severe abdominal pain and the need for hospitalization. These potential harms have been well documented in medical literature, so one goal of the app is to help physicians and patients determine whether screening would benefit them or cause more harm than good.

ePronosis app

Price: Free. App Store: apple.co/1TADCs3. Android: Currently not available

ePrognosis lets you choose colorectal or breast cancer screening or both and then presents you with a standard set of questions. These questions take approximately two to three minutes to fill out. It would be much quicker to flip through the questions while you’re with the patient. For example, one question asks whether the patient has difficulty walking a quarter mile without help from other individuals or special equipment.

Once you go through all of the prompts and questions, you are presented with a meter that ranges from “Harms” to “Benefits.” The meter’s arrow shows to what extent the decision tools within the app recommend screening for that particular patient. My favorite part of the app is the “Learn More” section. In this section you are able to tell your patient their chance of harm if the path of screening or testing is chosen. ePrognosis presents this in an easy-to-explain format with a graph that shows 1,000 units (to represent patients) and highlights how many of those units would experience harm in the first year due to testing. It’s a great graphical representation that makes sense for patients.

Ways the app could improve. It would be great if more data about the decision tools ePrognosis uses were presented in the app. You are able to access information about the decision tools used in the “Information” section, but the “Calculations” section isn’t very detailed and can be difficult to go through. Additionally, there is currently not an Android version.

Key way to use this app. Use this app with elderly patients for whom you are considering colorectal or breast cancer screening. Discuss the results with your patients and show them the graph in the “Learn More” section to help them see how many individuals would be benefitted versus harmed by testing based on their individual variables.

Statin Intolerance by American College of Cardiology

The American College of Cardiology has a great number of medical apps in the App Store. One of my favorites is Statin Intolerance.

This app is useful because the fact that a patient reports muscle aches does not necessarily mean he or she is truly intolerant to statins. If a patient has side effects to the first statin prescribed, cardiologists will often try utilizing other types of statins. Statin Intolerance helps you determine which would be best.

Statin Intolerance app

Price: Free. App Store: apple.co/1VXaVtt. Android: bit.ly/1NGh9L8

The app has three basic sections: Evaluate, Follow-Up and Compare. The “Evaluate” section is the most comprehensive; this is where you input risk factors, medications, patient demographics and symptoms. This section takes a few minutes to complete and is pretty detailed. In the “Follow-Up” section, you are presented with more specific advice such as titration of meds and other types of statins to use. In the “Compare” section, you can learn significantly more details about statins, such as their half-lives and whether they are lipophilic or not.

Ways the app could improve. The “Evaluate” section could be designed significantly better. Overall this section feels cumbersome to use.

Key way to use the app. If you have a patient who is having side effects to the first statin prescribed, you should consider using this app.

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

 

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Achieving automation through apps

These medical apps support surgeries, reschedule no-shows and ping physician networks for referrals and consultations.

By David Geer | Tech Notes | Winter 2016

 

As with any other busy professional, physicians are always searching for ways to offload and automate tasks that are not their core business—caring for people.

This issue’s apps, together with input from end-user physicians, merit your consideration.

Product in Action Dashboard

The Luma Health web-based app and service is available at lumahealth.io. Cost is $250 per provider, per month. A free two-month trial available.

Luma Health fills canceled appointments through patient texts

The Luma Health solution is about as significant as the challenges that it solves. Appointment cancellations and no-shows lead to make-shift approaches to scheduling and rescheduling patients: paper lists, Post-It Notes and Word documents. Not to mention the hours staff members spend calling patients to finalize appointments. This process scales poorly at best. And the larger the practice, the more the chaos.

“Luma Health enables practices to automate appointment workflows and reduce appointment cancellations. It automatically identifies appointment cancellations—filling those slots from a wait list, no phone calls required. The app reschedules canceling patients as well,” says Tashfeen Ekram, M.D., cofounder of Luma Health.

The Luma Health app and service uses secure SMS messages that meet HIPAA requirements. “Our first point of contact reminds patients about their appointment, providing additional pertinent information such as co-pays and pre-appointment instructions,” says Ekram. The SMS message prompts the patient to confirm or cancel. The app pulls the real-time message data from the patient and records it for medical staff to access in a centralized dashboard.

Shahriar Heidary, M.D., is a non-invasive cardiologist in San Jose, California, whose practice is part of the South Bay Cardiovascular Medical Group. Heidary was looking for an easier way to fill canceled appointments for office visits and tests when he found Luma Health.

Ortraxe

The web-based OR TRAX platform is accessible from any Internet-capable devide. Apps are also available through the Apple App Store and Google Play. Free to physicians whose facility uses the OR TRAX service.

“I enjoy the fact that it is automated, saving time,” he says. “Multiple users can use it. Patients like the app’s streamlined approach. Receiving a text is easier, and the app can send texts in multiple languages.”

It’s also mobile-enabled. “I am able to use it from my iPhone and my Windows PC,” says Heidary.

For future versions of Luma Health, Heidary would like to see expanded text-based communications that include reminders about a patient’s required exercise time, medication regimens and billing payments.

OR TRAX sends surgical schedules to support the operating room

OR TRAX is an electronic medical standard database that enables providers to send surgical schedules to surgeons and medical device vendor representatives who supply products such as implants, instrumentation and support to the operating room.

“The app is free of any PHI (Protected Health Information) and is only accessible to vendors who are credentialed at the given facility,” says Abram Liverio, COO of OR TRAX.

OR TRAX’s database returns time to health care professionals, strengthens HIPAA compliance, and reduces OR expenses that would result from vendor tardiness. It’s unique in that it transmits this information in real time, notifying surgeons and vendors automatically of case time changes, cancellations and reschedules.

Ira Guttentag, M.D., FACS, is the head team physician and medical director for the Tampa Bay Lightning hockey team. He was looking for a technical solution to keep him abreast of what surgeries he is performing, when and where they will take place and any changes to the cases.

“Prior to adopting OR TRAX, my office staff or PA would coordinate between the surgery centers, the vendor representatives and the hospital staff to set up and change appointments and case times. Then they would relay the information to me,” says Guttentag. OR TRAX automatically notifies Guttentag of changes to procedures and guarantees that the proper vendor representatives, trays and implants will be available at each case time. “I just wait for the notifiers to come in on my updated cases screen,” he says.

Guttentag’s favorite features on the app include the ability to check case times, locations and particulars anytime, with live updates.

OR TRAX

PingMD for the web, Android, and iOS comes in four versions, from basic for secure messages to a version with eVisit, concierge and virtual care abilities and services.

Pingmd builds professional networks for referrals and consults

Kenneth E. Grant, M.D., head of gastroenterology at CHOC Hospital in Orange, California, was used to texting, paging and calling his fellow physicians to make referrals, and was interested in a tool to ease the process.

Then he found pingmd, which secures transmissions of unstructured data—such as messaging content, still images, videos, PDFs and synchronous video chat—in a HIPAA-compliant manner.

“The app enables practitioners and health care providers to build their professional networks to manage care transitions, referrals and consults efficiently,” says pingmd CEO and cofounder Gopal Chopra, M.D. “It enables patient engagement to manage patient queries, surveys and care management for primary, specialty and chronic care.”

Grant uses the app every day in support of consults and reports enhanced productivity when working on complex decisions that require group interactions in real time.

“Now I benefit from efficient referrals from my external primary care network and the availability of better and more secure communications with my colleagues and care teams,” he says.

His favorite features of the app include the video chats, VoIP, networking, referrals and its ease-of-use when compared with other solutions.

 

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Mobile medical apps ease communication among physicians, nurses and patients

It all adds up to better patient care experiences.

By David Geer | Fall 2015 | Tech Notes

 

As we approach year 2020, 5G wireless communications will come into use, according to the Next Generation Mobile Networks Alliance. That’s when multimedia and communication applications in medicine will grow to include ubiquitous 3-D medical imaging and high-quality video calls and conferences anytime, anywhere.

While we wait for 5G, mobile apps available today include drawMD for sketching out the body with drawings and overlays of medical conditions for patient education. This app should see broad exposure thanks to its recent retooling that enables physicians to use its templates and resources across many specialties.

The eAttending app enables the physician to be in many places at once virtually—at least where verbal orders are concerned. Errant transposition of prescription spellings due to unclear voice communication should be a thing of the past.

The Medicode app pushes medical algorithms further from printed paper resources, helping to save more patients (and trees). If you never forget your phone, you’ll never be without a backup in the form of Medicode’s algorithmic life support data.

drawMD illustrates what the doctor needs to say

DrawMD urology

The drawMD app helps physicians illustrate conditions to patients.

DrawMD from Visible Health is an iPad app that enables physicians to illustrate health information by drawing when consulting with patients. “There are more versions of drawMD in the works and plans for up to an infinite number of additional apps down the road,” says John K. Cox, President of Visible Health, Inc., in Austin.

The app helps a physician educate patients about their conditions and the procedures they are about to undergo. “The drawMD app makes medical concepts understandable as the physician selects a template with a background image, such as a prostate,” says Cox.

Physicians use their fingers to draw on the template and map out conditions such as a prostate tumor, its orientation, and how to treat it.

The physician can also add the drawing and any subsequent drawings to the patient’s medical record or email it to other physicians.

Eli Sprecher, M.D., is a general pediatric fellow at Harvard’s Boston Children’s Hospital, where he serves a 15,000-patient hospital-affiliated pediatric practice that is largely comprised of complex pediatric cases. Sprecher was looking for a way to better explain his patients’ conditions and needs to both them and to their parents. “While I was still a resident, asthma was a big issue as a chronic disease in children,” says Sprecher. A visual aid would help to illustrate the difference between kids who have their asthma under control and kids who don’t have asthma.

Using the pediatric version of drawMD, Sprecher educates patients, explaining their conditions so they can understand their health. “I also use it to explain pathophysiology from lab findings, to explain the medical history, and to guide parents in what to look out for,” he says.

Sprecher’s favorite features in the app include the quality of the ability to annotate and draw on the templates. “Kids love to draw on it. It also helps me to customize and emphasize medical information,” Sprecher says. A physician can draw attention to a certain area of concern in a template, call out certain aspects through illustration, and generally make the discussion more effective through imagery.

Sprecher says that Visible Health has been very open to suggestions. He is looking forward to the additional medical conditions that drawMD will eventually include. “I would like to see the ability to pull background images from one app to the next,” he says. “It would be nice to add animation and video with more dynamics, to illustrate joints in motion, for example.”

If all goes as planned, Visible Health will have provided a major release overhauling the drawMD app as of early September 2015. “We are releasing a unified drawMD application (today there are many of them, each specialty-specific) in which users are able to configure content from across our library to meet their needs. The initial launch will be available for both iOS and Android in both phone and tablet form factors,” says Cox. This release should address much of Sprecher’s wish list.

Medicode keeps algorithms handy

Medicode

Medicode is available free in the Apple App Store.

This app for the iPhone and iPad is a life support reference tool that presents information as an overview of an entire algorithm or as a step-by-step walk through in using the algorithm in an emergency, says Karl Disque, D.O., cofounder of National Health Care Provider Solutions (NHCPS) in Henderson, Nevada. “Physicians use it to eliminate carrying books and cards in pockets so they can instead keep the latest algorithms for BLS, ACLS and PALS on their smartphones or tablets,” says Disque.

Anesthesiologist Baroukh Levi, M.D., works at the West Suburban Medical Center in Oak Park, Illinois. “Though I use algorithms for life support protocols frequently, it is good to have a reference to refer to,” says Levi.

Levi has memorized the necessary algorithm information he needs in his work. “There are also pocket references and cards available with this information—they are just never handy when you need them as they are easy to lose or damage,” says Levi. “But I always have my phone with me, and it keeps a wealth of information available at the tap of my finger.”

Levi likes the ease of use of the Medicode app as well as its simplicity. “It presents the most important information quickly,” he says.

eAttending rescues verbal orders from the clutches of communication errors

EAttending iPhone

The eAttending mobile app is available for $24.99 at the Apple App Store. The first 10 faxes are free.

This app for the iPhone, iPad and iPod Touch replaces verbal orders, enabling a physician to send signed written orders via fax to any nurse’s station equipped with a fax machine, says Larry A. Wolk, M.D., the app’s creator. “There has been a need for this app since the inception of phone orders to take the burden off the nurse to get the verbal order that they take down as a written order correct,” says Wolk.

“An eAttending fax-based written order has the same accuracy and authority as a signed, written order given by the doctor in person,” says Wolk. The app enables the physician to record and send prescription names accurately so there’s no miscommunication. The app is also useful when faxing pharmacies directly.

A physician can add medications and dosages to communicate via the app using its internal drop down menu, by copying and pasting the data in, or by typing the information into the app. The physician then selects the nurse’s station and fax number from among those previously recorded in the app for repeated use.

Miles C. Ladenheim, M.D., is a psychiatrist based in Wynnewood, Pennsylvania, who practices in the Philadelphia area. Ladenheim found verbal orders to be challenging. “Medicine is rapid. You can’t ask a nurse to wait until the doctor gets back to the floor to prescribe medication. If the patient’s condition changes, a medication change is needed as soon as possible,” Ladenheim says.

At this point, traditionally the nurse would call the physician and discuss the patient’s condition, and the physician would give a verbal order for a different medication, Ladenheim says. “The doctor must sign such an order in person in 24 hours. This is OK if the doctor will be in the hospital the next day,” he says.

eAttending enables the physician to give a signed remote order that produces a written document at the nurse’s station via fax, meeting regulations without further signing and without miscommunication.

Ladenheim’s favorite features include the ability to record frequently used medication and fax information in the app so he can select it rather than type it out again and again. “It saves me a few seconds each time, avoids errors, and I also don’t particularly like the iPhone keyboard especially well,” Ladenheim says.

 

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Data on the go

Medical apps that support remote electronic consultations and provide multimedia anatomical navigation give physicians more options then ever.

Summer 2015 | Tech Notes

 

Medical technology includes tools that extend a physician’s access to information and help them magnify and clarify the precise physical need of patients. These medical apps enable remote consultations and map the human body.

CodeHeart: Cardiac consultations at the click of an app

The free CodeHeart app from Vidyo for mobile Apple and Android devices is available via an encrypted link. For more information, visit MedStarHeartInstitute.org or contact Eileen.M.Searson@MedStar.Net.

4 Satler w technology 2010 467

Lowell Satler, M.D., is developer of the CodeHeart app, which compresses the time for cardiac consultations.

Using any device with wireless access and a camera, a referring physician can contact an interventional cardiologist at MedStar Heart & Vascular Institute—the busiest and largest private, not-for-profit hospital in the nation’s capital—for a consultation complete with ECG images, says Lowell Satler, M.D., medical director of the Cardiac Cath Lab with MedStar Heart & Vascular Institute.

When an ER physician orders an ECG for a presenting patient, they must evaluate it and follow with a treatment plan. For a second opinion, they would previously have had to fax the ECG to a tertiary care facility, such as the MedStar Washington Hospital Center, and place a voice call for the consultation.

“This process takes time—about 10 minutes or more. Even a one-minute delay can be critical for a patient having a heart attack,” Satler says. CodeHeart compresses that time through real time consultations via secure, HIPAA-compliant, two-way video calls with digitally transmitted ECGs.

To use the app, physicians click on the CodeHeart desktop icon to open the app, automatically connect, and join a split-screen video call with a cardiac specialist. “Physicians conduct concurrent, face-to-face conversations in real time. The referring physician holds the ECG up to the computer camera or uses their smart phone to capture the image, which the system then transmits to our consulting cardiologist,” says Satler. The system saves all video call data so either physician can call it up again at any time.

John Schnabel, M.D., is medical director of Emergency Medical Services at Calvert Memorial Hospital in Prince Frederick, Maryland, which sees 42,000 patients annually and also runs three urgent care centers locally that see 20,000 more in acute care patients.

Before using CodeHeart, Schnabel’s team had to share an ECG on a physical print out via fax.

As in any hospital, the ED at Calvert Memorial must care for patients with acute myocardial infarction and heart attack symptoms. “This easy-to-use application allows us to communicate seamlessly with internationally renowned interventional cardiologists at the MedStar Heart & Vascular Institute,” Schnabel says. “We use an HD camera to read the EKG while we communicate with the interventional cardiologist, who is able to ask us to zoom in on the EKG or otherwise share information.”

Schnabel’s favorite CodeHeart features include the simplicity of launching the app, the high image quality, and the fact that he has not seen any real glitches with the app. “That’s amazing these days,” he says.

The BioDigital Human: Viewing the body in 3-D

The BioDigital Human app from BioDigital, Inc. works on Apple and Android devices. A basic version is free; a premium version is available for $48 per year. Customization is available and priced on a case-by-case basis.

BioDigital image Eye Cross section

Visualizing complex anatomy and system relationships becomes easier with the 3-D BioDigital Human app.

“Built as an entirely cloud-based simulation platform, the BioDigital Human presents thousands of medically accurate anatomical subjects and health conditions within an immersive, interactive, 3-D environment,” says BioDigital CEO and cofounder Frank Sculli. Once a physician chooses a visual from the content hierarchy, they can add detail, then print a snapshot to instruct the patient. Each visual comes with links and descriptive data.

The value in the tool lies in its efficacy in clarifying the human body and informing patients about their health and conditions so they can make medical choices with confidence.

The tool offers a layering capability for adding multimedia content over the 6,000 pieces of human anatomy. “Similar to the way geo-browsers such as Google Earth have revolutionized the way we navigate our planet, the BioDigital Human provides a powerful body visualization platform. Once integrated with patient health records, the platform has the potential to deliver increasingly personalized views of the body,” says Sculli.

Roberto L. Flores, M.D., is a reconstructive plastic surgeon at NYU Langone Medical Center and an NYU Associate Professor of Surgery. Flores was looking for an easier way to explain procedures to patients and to his residents and fellows when he found the BioDigital Human app.

Before adopting the app, he used anatomy textbooks to explain procedures. “The textbooks were limited in that they could only express 2-D information, and only from one perspective at a time. I found myself jumping around to 20 or more pages to explain a procedure,” Flores says.

Textbooks were equally perplexing in preparation for actual operations. “If I was going to prepare for a complex surgery, I found myself referencing several anatomic textbooks in order to obtain all the vantage points of the anatomy that I needed in order to process the surgery to my satisfaction.”

With the BioDigital Human, Flores can explore and manipulate all aspects of the human body in virtual 3-D. “There is no limit to the type of anatomy you can study or the vantage point from which you can view it,” Flores says. The app enables a highly sophisticated study of the relationships between bodily structures that is impossible with textbooks. “I can convey complex anatomic and surgical information to my patients and trainees using the app as my visual guide,” says Flores.

BioDigital is adding disease-specific tutorials to the app; Flores would like to see that work continue. “I think there is also a great opportunity to make versions of the BioDigital Human that are suitable for children at different ages, so they can learn about the human body,” he says.

RubiconMD: Remote specialist consultationsfor PCPs

The RubiconMD platform is available to primary care providers through a smartphone’s web browser and to specialists online and through an app for any Apple device via a monthly subscription or a pay-per-case basis. For more information, visit rubiconmd.com.

RubiconMD Platform

RubiconMD maintains a panel of specialists who provide remote consultations to primary care physicians.

Primary care physicians use the RubiconMD app to contact specialists online for remote consultations. On receiving the patient’s case, the specialist returns a clinical opinion.

“The PCP selects from 32 specialists and sends any labs or photos with the patient case and question,” says Gil Addo, RubiconMD’s CEO.

RubiconMD maintains a panel of specialists from elite U.S. academic medical institutions who are available to field consult requests. “We have designed the platform to fit seamlessly into a PCP’s clinical workflow so providers can efficiently send questions to specialists and receive timely answers,” Addo says.

Tom Brown, M.D., is an internist and medical director at four AFC-Doctors Express Urgent Care center franchises: one in West Hartford and three in Danbury, Connecticut. Brown develops best practices for streamlining patient flow and improving the efficiency of care while also caring for his patients. He was looking for a more expedient way to access and leverage the expertise of subspecialists when he found RubiconMD.

“I use the platform with patient diagnoses where I do not have a great amount of experience or a high confidence level. For example, I use RubiconMD with orthopedic fractures to determine in a timely manner whether or not patients require orthopedic evaluation,” Brown says. “I like that I can upload images and X-Rays, and also ECGs to RubiconMD for cardiologists. I get a response in a few hours and receive an email alert notifying me.”

David Geer is a regular contributor to PracticeLink Magazine’s Tech Notes department.

 

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On the go? Keep on going with these apps

By David Geer | Tech Notes | Winter 2015

 

Any of these scenarios sound familiar?

To watch and learn from a surgeon’s techniques, you have to stop serving patients and go to a specific location at a set date and time.

To read quality medical research, you have to take time away from your work to search and find resources.

Your licenses and certifications risk lapsing unless you manually reapply and renew them.

Waste time no more.

Instead, explore these three free apps you can use to meet your research, practical education and certification needs while you’re on the go.

Aggregate your content with Docphin

Docphin is available free on iTunes, the App Store and Google Play.

Docphin Logo

Docphin Logo

This free app for iPhone, iPad and Android devices streamlines access to medical research from more than 5,000 journals and recommends content that is relevant to your interests and the topics that are trending among your peers.

“Physicians save their subscription credentials to their mobile device and quickly access PDF versions they can save for later or share with colleagues,” says Sachin Nanavati, cofounder of Docphin.

Docphin accepts content from hospitals for physicians’ research needs. Docphin’s hospital platform enables medical departments and residency programs to add clinical guidelines, hospital protocols and decision-making references for mobile access and provides detailed engagement metrics to help accelerate the implementation process within the health care system. “Residency programs can leverage Docphin’s unique platform to track and measure objective metrics that can be used to help meet new accreditation milestones set by the ACGME (Accreditation Council for Graduate Medical Education),” says Nanavati.

Docphin

Docphin aggregates medical research from any of more than 5,000 journals. The hospital platform also provides mobile access to specific clinical guidelines, protocols and decision-making references for on-the-go access.

The makers of Docphin strive to make evidence-based medical research more accessible through mobile technology and keep the content meaningful for providers who have limited time and resources.

Rishi Sharma, M.D., is chief gastroenterology fellow at the Henry Ford Hospital in Detroit. “As a training physician, my goal is to be current with the latest research articles that are relevant to my interests and that journals I trust and respect publish,” says Sharma.

But since most of the content is fragmented, it can be hard to keep up with research.

“I often don’t have time to read articles when I discover them,” he says. Sharma tried manually flagging articles in emails and lists to read later. However, this proved time-consuming. “I marked articles in various places and then—when I couldn’t relocate them consistently—I had to find the articles via my hospital’s library website, which could take several minutes.”

While looking for other ways to stay current, he came across Docphin.

With Docphin on his iPhone, Sharma can locate saved articles while moving through the hospital. “I can bring up the app any time to browse trending articles and to search for and access landmark papers. Since I have affiliated my account with my institution, I can get to a full-text article very easily, which saves me a lot of time,” he says.

Sharma has found Docphin especially useful in staying abreast of specific diseases and treatments. “I am able to stay up to date with Hepatitis C treatments, which have been changing rapidly over the past few years,” he says. “Being able to read the articles easily on my phone during brief periods of downtime has helped me treat patients because I am able to offer them a greater understanding of future options regarding their treatment.”

Learn from a curated library of videos on MEDtube

Medtube

MEDtube is available free on iTunes, the App Store and Google Play.

MEDtube is available free on iTunes, the App Store and Google Play.

“The MEDtube app brings a library of 11,000-plus medical videos to physicians’ phones and devices globally,” says Wojtek Dolkowski, MEDtube’s CEO. Practicing physicians, universities and trusted medical institutions contribute the video and multimedia medical resources including surgical videos, animations, visualizations, presentations, interviews, academic lectures, reports and podcasts.

MEDtube follows stringent quality guidelines to produce video materials that stand up to high scrutiny. “MEDtube’s editorial team, which consists of physicians with expertise across specialties, reviews all submitted materials before accepting them into the library,” says Dolkowski.

Jeffrey Eakin, M.D., a board-certified general surgeon specializing in minimally invasive gastrointestinal, bariatric and robotic surgery and practices at Specialty Surgery of Utah in West Valley City, was searching for a solution to a challenge when he found MEDtube.

“I was trying to find high-quality video content that is curated and allows me to see world-class surgeons performing cutting-edge operations with a laparoscopic or robotic approach,” he says.

Eakin had been viewing YouTube videos in an attempt to meet this need. “But now [the YouTube] ecosystem is over populated with irrelevant and low-quality material that often doesn’t even pertain to what is advertised,” Eakin says.

“The ecosystem MEDtube has created provides me with relevant. high-quality videos that help me to branch out my techniques and stay current on changes in my field. It is a great resource to cruise on my iPad when I have downtime at lunch or in between operations,” he says.

The only improvement Eakin recommends would be for MEDtube to enable some kind of social networking with the app. “I would like to see more ability to create a social network consisting of the app’s users so that we can connect with each other and share ideas in a more fluid, facile fashion,” he says.

CertAlert+ helps you manage your certifications

NHCPS Logo

NHCPS

CertAlert+ is available free from iTunes and the App Store. Android version coming soon.

CertAlert+ for iPhone and iPad enables physicians to track, share and manage their medical certifications and licenses. Rather than carrying certification cards in their pockets as proof, they can store images of certification cards on their devices.

“Physicians can export and share their certification card images with the parties that require them via email. They can set reminders to renew certifications to avoid untimely expirations. CertAlert+ really simplifies managing your certifications, licenses and in-service credits,” says Karl “Fritz” Disque, D.O., a board-certified, practicing anesthesiologist and cofounder of National Health Care Provider Solutions (NHCPS) in Henderson, Nev., which produces the app.

CertAlert

CertAlert+ is available free from iTunes and the App Store. Android version coming soon.

Richard Andersen, D.O., a family medicine physician at Captain James A. Lovell Federal Health Care Center in North Chicago, was looking for an easier way to manage his required licenses and certifications. “I was using traditional paper records with some assistance from my administrative staff,” he says. But this approach was fraught with inconveniences such as slow and tedious license renewal and sharing.

Andersen uses CertAlert+ on his iPhone, which he always carries with him. “CertAlert+ stores my license, certification, and in-service information and gives me reminders to renew them,” he says. Now, he can quickly, easily and personally maintain these records for real-time viewing and sharing.

Andersen is happy with the intuitive way that CertAlert+ captures license and certification records. “Rather than typing in large amounts of data by hand, I can take photos of the front and back of cards and certifications. It makes it easy to track the information I need,” he says.

CertAlert+ replaces all the busy work of tracking paper cards and manually reapplying for certifications once they have expired, all while keeping the certifications at hand and current.

Says Andersen: “Before I have to renew my licenses or certifications, I enter the information into the app and set reminders to notify me when I need to renew each of them.”

David Geer is a frequent contributor to PracticeLink Magazine’s Tech Notes department.

 

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Small technology with big impact

Heart failure management in a capsule; help connecting small blood vessels; and exponentially improving spinal implant success.

By David Geer | Spring 2015 | Tech Notes

 

If you treat heart failure, cancer or spinal maladies, you’ll be delighted to read how shrinking medical technologies are sparking undeniable improvements in your patients’ quality of life.

The CardioMEMS HF System helps physicians monitor pulmonary artery pressure from afar

To learn more about the CardioMEMS HF System for comprehensive heart failure management, visit sjm.com/cardiomems.

St Jude Medical Logo No Tag 1950X664

The CardioMEMS HF System tool for comprehensive heart failure management is in its first generation, says Mark Carlson, M.D., chief medical officer of St. Jude Medical in St. Paul, Minnesota. “It is the first and only FDA-approved heart failure (HF) monitor proven to significantly reduce HF hospital admissions and improve quality of life in NYHA Class III patients when managed by physicians,” he says.

The CardioMEMS HF System uses a miniaturized wireless sensor in a sealed capsule form factor, which is implanted into the patient’s pulmonary artery during a minimally invasive operation. The encapsulated sensor measures the pulmonary artery (PA) pressure and transmits the pressure readings to an external electronic system in the patient’s home.

“The system allows patients to transmit PA pressure data from their homes to their health care providers, allowing for personalized and proactive management to reduce the likelihood of hospitalization,” says Carlson.

CardioMEMS Miniaturized Sensor

The CardioMEMS HF System transmits pressure readings.

The miniscule sensor functions without batteries or leads and does not produce any sensation in the patient either at the time of the readings or otherwise.

Rami Kahwash, M.D., is an assistant clinical professor in cardiovascular medicine at Ohio State University in Columbus. Kahwash was looking for a tool to measure and trend data on fluid retention in the lungs. Because fluid builds up over a couple of weeks prior to the resulting clinical event or hospital readmission, such a tool would enable Kahwash to intervene well ahead of such an event to give just-in-time care.

In the past, Kahwash and his colleagues tried to manage heart failure patients and adjust medications based on weight. “However, that turned out not to be very sensitive,” he says.

Today, Kahwash uses the CardioMEMS sensor, which provides an early warning as to the status of the pressure inside the lungs. “The pressure inside the lungs is really reflective of what’s going on inside the heart,” he says.

CardioMEMS

“This sensor gives us this information while the patient is at home, so we now have the luxury of simply sitting in our clinic while the patient and the technology send us the measurements every day,” Kahwash says. The system retrieves the data and receives it in a secure website where physicians can review it daily. With that information, Kahwash and his colleagues can intervene with therapy or by changing the patient’s medication dosage prior to an acute heart failure event.

Kahwash’s favorite CardioMEMS feature is the durability of the sensor. “In the CHAMPION study, sensor failure was almost at 0 percent,” he says. And any cardiologist can implant the device.

Kahwash would like to see an even smaller sensor and an improvement in the ability to know when the patient sends the data. “The sensor is pretty small, but there is maybe some room in the future to make it smaller,” says Kahwash. “And the patients currently send the data to the website and we wait until we log into the website to see the measurements. Perhaps the system could alert us when there is an abnormal trend.”

The GEM FlowCoupler joins very small blood vessels

To learn more about the GEM FlowCoupler, visit synovismicro.com.

GEM Logo

“The GEM FlowCoupler mechanically joins very small diameter blood vessels from about 0.08 mm in diameter up to about 4.3 mm in diameter,” says Terry Harrell, Director of Sales for Synovis Micro Companies Alliance, Inc., in Birmingham, Alabama. The GEM FlowCoupler includes Doppler technology for monitoring blood flow.

The GEM FlowCoupler enables an intima-to-intima vessel anastomosis that meets very high standards, stenting the anastomic site open in about five minutes, says Harrell.

Daniel Liu, M.D., is a board-certified plastic and reconstructive surgeon at Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Illinois, where he works on breast cancer reconstruction. Liu was looking for a better, faster way to join blood vessels than simply suturing them in a relatively long procedure using standard microsurgical instruments under a microscope. Liu found what he was looking for in the GEM FlowCoupler.

FlowCoupler

“The introduction of the GEM FlowCoupler eliminates sewing one of the blood vessels, which considerably cuts down the time we spend on the microscope,” he says. The GEM FlowCoupler works well when joining veins. Liu still must sew the artery because its wall is more dense, which is not compatible with how the GEM FlowCoupler works.

The GEM FlowCoupler makes the work of the assisting surgeon easier as well. When using sutures, the assisting surgeon has to be attentive to ensure there’s no unnecessary blood vessel trauma. “With the GEM FlowCoupler, the assistant has an easier job, holding the coupling device, while I stretch the vessels onto the tines of the coupler,” says Liu.

The benefits of the GEM FlowCoupler include increased patient safety. “The veins are flimsy and in a low-flow state. Blood can clot or the vein can compress, causing a total failure of the operation. Because the coupler is a rigid ring, it actually stents the vessel open at the weakest point,” he says.

Other GEM FlowCoupler features Liu appreciates include its ease of use and the fact that the learning curve leading up to using the device is small. “We often train our residents and fellows to do this with ease,” he says.

For future improvements, Liu would like to see the vendor come up with a technology that can overcome the artery’s rigid state, as well as a means to overcome the size mismatches between the different sized couplers and the veins—the challenges with arteries would probably require a completely different type of engineering, he says.

The 4WEB Spine Truss System improves patient outcomes

To learn more about the 4WEB Spine Truss System, visit 4webmedical.com.

4WEB

4WEB Medical uses multidisciplinary engineering principles such as structural mechanics and adjacent material reaction to create implants for spine fusion surgery that actively participate in and accelerate the healing process, according to Jim Bruty, vice president of sales and marketing for 4WEB Medical in Frisco, Texas.

The vendor designed its implants to create faster fusions while potentially reducing the chance of complications that physicians would find with existing devices on the market, says Bruty.

“4WEB Medical produced the first-ever FDA cleared 3-D printed spine inter-body fusion device,” says Bruty.

Cameron Noble Carmody, M.D., is an orthopedic spine surgeon at Plano Orthopedics Sports Medicine and Spine Center in Texas.

“As an orthopedic surgeon, I am always looking for implants that have the potential to improve patient outcomes, decrease post-operative pain, and minimize the risk of subsidence, non-union and other implant-related complications,” he says.

4WEB

Prior to finding 4WEB trusses, Carmody used osteobiologics as well as rigid internal fixation and anterior column support methods. Osteobiologics are a relatively expensive option. “And there was always a race between bone growth and fusion and the mechanical stability of the instrumentation over time,” says Carmody. This means that the bone might not always grow across the gap from end-plate to end-plate and start to share the load transmission with the implants before the effects of subsidence or screw interface loosening or even hardware failure set in, leading to micro-motion and non-union.

But the 4WEB web design, anatomic shape and textured titanium material stabilize the new state of the spine and provide uniform load distribution across the end-plate, avoiding these potential complications. “And due to the open-architectural design, there is always ample room for bone,” says Carmody.

Carmody’s favorite 4WEB truss features include the early stability and the maximum contact area of the trusses, the many sizes and shapes available, and the science that suggests that the truss structure and titanium surface work together under load to promote bone growth.

The 4WEB truss is on its way to meeting all of Carmody’s hopes for spinal truss implants. As the additive manufacturing science blossoms, according to Carmody, 4WEB should be able to decrease the Effective Elastic modulus of the titanium implants not only to that of PEEK but to that of cancellous bone. “This technology will soon meet Nakajima’s seven criteria for the perfect bone implant,” he says.

David Geer is a frequent contributor to PracticeLink Magazine’s Tech Notes department.

 

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Exciting surgical, diagnostic & EHR tools

Robotically aided surgery of the brain and spine, diagnostic tests and an EHR for the heart round out this issue’s technology update.

By David Geer | Fall 2014 | Tech Notes

 

With the global robotic surgery market forecasted to grow 11.65 percent between 2013 and 2018, and cardiovascular diseases still the leading killers globally, consider the following technologies for your robotic surgery or cardiovascular diagnostics tool belts.

Mazor Robotics Renaissance Guidance System

Learn more at MazorRobotics.com.

Mazor Logo

The Renaissance Guidance System is Mazor Robotics’ next-generation mechanical guidance system for spine and brain surgery. Renaissance is an FDA-cleared mechanical guidance surgical system. The system offers 3D pre-operative planning for each patient’s specific anatomy and guides the surgeon intraoperatively for precise execution of that plan. Preplanning is advantageous as the system identifies challenging anatomy so the surgeon can make adjustments in implant size and location prior to the operation. This increases operating efficiencies by minimizing unforeseen anatomical issues. Neil Badlani, M.D., an orthopedic surgeon with the Orthopedic Sports Clinic in Houston, trained in spine surgery was looking to incorporate innovative technology and techniques into his practice to benefit his patients when he discovered the Renaissance Guidance System. “In order to place spinal instrumentation through smaller incisions with less muscle dissection and less radiation to myself and the patient, I have been interested in various types of intraoperative navigation. Renaissance is by far the best I have seen,” he says.

Badlani uses the Renaissance System in any surgery requiring posterior lumbar spinal instrumentation for spinal deformity, trauma, instability or severe disc degeneration. He also uses it in complex open spinal deformity cases to aid screw placement with difficult anatomy or for minimally invasive cases to percutaneously place screws through tiny incisions with minimal intraoperative radiation.

The Guidance Unit

The Guidance Unit—roughly the size of a Red Bull can—guides the surgeon’s tools within 1.5mm of accuracy.

“This technology allows me to place screws in the spine with extreme precision, safety and efficiency through smaller windows. This leads to more accurate surgery with less blood loss and quicker recovery,” Badlani says.

His favorite Renaissance System feature includes the preoperative planning capability. “I create a complete surgical plan before entering the operating room. During surgery, the system is quick, efficient, accurate and reliable,” he says. The Renaissance System also delivers cutting-edge technology while remaining very user-friendly, according to Badlani.

CardioDx Corus CAD

Learn more at cardiodx.com or email service@cardiodx.com.

CardioDx

CardioDx Corus CAD is a commercially available gene expression test that provides a current-state assessment of obstructive coronary artery disease (CAD) in non-diabetic patients presenting with typical and atypical symptoms. The test diagnoses obstructive CAD, taking the biological differences between men and women into account. This point is critical, as more than half of women with CAD present with ambiguous symptoms such as shortness of breath, fatigue and abdominal pain, making diagnosis difficult.

According to a CardioDx spokesperson, the patient’s cardiologist or primary care physician can both implement the simple, accurate Corus CAD blood test and order test results the day of the patient’s visit, receiving the labs within two to three days. The test results provide the physician with a score signifying the likelihood that the patient has obstructive CAD.

Courus CAD

Courus CAD provides current-state assessments of obstructive coronary artery disease (CAD).

Lee E. Herman, M.D., is an internist and founder of Johns Creek Primary Care in Suwanee, Georgia, and a user of CardioDx Corus CAD. Herman heads the private practice in internal medicine with a focus on preventive medicine and a special interest in preventive cardiology. When he found the Corus CAD test, he was looking for a non-invasive way to rule out CAD in the 90 percent of visiting patients whose chest pain and symptoms are actually due to non-cardiac causes such as heartburn, anxiety or musculoskeletal issues. The right tool would help him avoid exposing patients who most likely do not have CAD to unnecessary radiation risks and the procedural complications that are associated with traditional cardiac tests, he says.

“I use Corus CAD on my non-diabetic patients who present with non-acute typical or atypical symptoms of obstructive coronary artery disease. It is not indicated for patients with unstable angina, history of MI, diabetes, chronic and acute inflammatory illnesses, or previous revascularization procedures,” Herman says. According to Herman, in five years of his use of Corus CAD, the gene expression test has helped hundreds of his patients avoid unnecessary non-invasive imaging tests with radiation exposure.

Herman’s favorite Corus CAD features include the fact that the test works equally well in both men and women.

Herman’s wish list for the Corus CAD test pertains to reimbursement. “While I was pleased to see the recent announcement that Aetna is now covering Corus CAD (along with Medicare),” says Herman, “it would be nice to see broader insurance reimbursement as it is a fantastic tool for primary care and even cardiologists. The cost-effective tool can also lower health care costs, which is important in this environment.”

Objective Medical Systems (OMS) Cardiovascular Diagnostics Suite

Learn more at objectivemedicalsystems.com or email contactus@omscardio.com.

Objective Medical Systems

The Objective Medical Systems (OMS) cardiovascular diagnostics suite offers 16 modules including invasive and non-invasive diagnostics tests. Practicing cardiologists designed the cardiovascular diagnostics suite from the ground up with cardiologists in mind. In fact, one of the company’s own cardiologists coded much of the software himself, says CEO Colby LeMaire. The OMS cardiovascular diagnostics suite interfaces directly with the OMS EHR, giving cardiologists a 360-degree view of the patient.

According to LeMaire, the cardiovascular diagnostics suite interfaces directly with medical devices, seamlessly analyzing thousands of discrete data elements in the background. This provides the physician with actionable intelligence at the point of care, all the while eliminating dictation, transcription and free-text typing. “This provides state-of-the-art reporting for echo, vascular US, holter and nuclear perfusion among others,” says LeMaire.

Bart Denys, M.D., medical director and interventional cardiologist at Cardiovascular Institute of the South in Thibodaux, Louisiana, serves patients in a single-specialty cardiology group covering a large territory in Louisiana with 15 locations. With an average of 225,000 patient encounters per year, the practice’s primary concern is the high volume of patient visits per physician, says Denys. The practice employs 60 physicians in all.

Cardiovascular Diagnostics Suite

The cardiovascular diagnostics suite from Objective Medical Systems enables physicians to conveniently create reports, review studies and more.

When Denys discovered the OMS system, he was looking for a next-generation electronic medical record system that would facilitate the high volume practice, interact with hospital and state-based systems, and work with national professional databases, such as the interventional national database, as well as address many other practice needs. Denys decided on OMS and today uses the OMS EHR version 1.0 and the OMS Diagnostic Module version 1.2 to meet all these needs.

The new system helps his patients immensely. Denys says that whenever all pertinent information is readily available and a system alerts physicians to abnormalities, possible side effects, interactions and recommendations, physicians are less likely to miss things and more likely to address issues to a currently accepted standard of care. “The dynamic aspect of all this data helps our physicians with continuity of care,” he says. “Our patients can walk into any of our clinics over a large geographical area and find that the same information plan and recommendations are available to each of our physicians. Additionally, the availability of this data over a virtual private network from outside our practice allows our physicians and nurse practitioners to access all patient information 24/7 for hospitalized patients or emergency room admissions.”

Instant availability of information, trending information and help with the appropriateness of E&M codes are his favorite features of the system. “Unlike general hospital systems, where one has to wade through pages and pages of information, this system does what an electronic medical record is supposed to do: It gets the information, it presents it, it compares it, and it uses the information to actively suggest how we can improve patient care,” Denys says.

His wish list for future OMS system features includes an integrated OMS module linking cath lab data, angiographically and hemodynamically, to inventory, cost and billing.

David Geer is a frequent contributor to PracticeLink Magazine’s Tech Notes department.

 

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Summer medical app spectacular

Stay UpToDate, MedCalc-ulate, and Get Together for an AppVisit.

By David Geer | Summer 2014 | Tech Notes

 

Summer is upon us. It’s a time when patients and physicians try to get out more and catch some vitamin D-rich rays while becoming more active, too. For those actively seeking help staying current on medical research, calculating medical formulas or keeping up with patient care via app-based “visits,” PracticeLink Magazine presents three apps to help you do just that.

MedCalc MedCalc MedCalc ($1.99) and MedCalc Pro ($4.99) are available from iTunes.

According to MedCalc developers Pascal Pfiffner, M.D., PhD and Mathias Tschopp, M.D., MedCalc and MedCalc Pro medical calculators help physicians save time while leveraging an expansive and ever-increasing variety of often complex formulas, scores and indexes.

Most physicians can only memorize a handful of the formulas they use most when caring for their patients. MedCalc remembers all the formulas, accessing any of more than 300 with only a few taps on an Apple device.

After presenting the mathematically derived results, MedCalc goes two steps further, interpreting calculations and offering bibliographic references in support of those interpretations. MedCalc Pro adds a native iPad interface, notation of formulas and additional data, as well as a patient database for storing results, notes and captured patient images.

Med Calc

MedCalc presents a fast, efficient interface enabling the physician to use it at the patient’s bedside, in an ambulance and in other emergency situations. Physicians designed and created MedCalc to meet the needs of their peers.

Joel Topf, M.D., a nephrologist with St. Clair Specialty Physicians in Detroit, says: “Nephrology is all about the numbers. I run a number of calculations daily; MedCalc is fundamental to my practice.”

MedCalc excels at making an enormous library of formulas available to Topf right at the point of care. “It is very simple to use and enables me to easily switch from one unit of measure to another. MedCalc meets my needs as well as any app,” he says. MedCalc provides supporting references for all of its formulas so Topf knows where the tools are coming from, such as from PubMed.

“MedCalc offers significant time savings. Otherwise I would be searching for a copy of a formula. What was a five-minute procedure now takes 30 seconds.”

AppVisit AppVisit AppMedicine, Inc. (appmedicine.com) offers a variety of billing models depending on the type of medical practice. Email support@appmedicine.com for purchase options.

AppVisit is a mobile physician-patient communications and virtual medical appointment tool. The app facilitates medical diagnosis by leveraging text messaging, email and multimedia e-visits in a HIPAA-compliant solution, says Lisa Serwin, CEO of AppMedicine, Inc., which develops AppVisit. The platform uses cloud-based hosting to scale AppVisit’s capacity for individual practices up to multispecialty clinics and hospitals.

AppVisit requires no medical appointment, unlike video calls. Patients can open the app on their devices and immediately input information. The visits are with the patient’s own trusted personal physician. A reliable message notification system keeps physicians aware of patient conditions, which helps them provide timely care while also reducing legal risks. AppVisit provides direct patient billing for these unreimbursed remote visits, paying doctors the amount they determine.

Other Symptoms Screen

AppMedicine designed AppVisit for easy customization using templates and drag-and-drop features so medical professionals across a wide range of specialties can adapt it to their needs. Medical providers and physicians will find the app available for Android phones, the iPhone and iPad iOS 6.0 and above. Patients will find versions for Android tablets as well.

Darren Phelan, M.D., runs a concierge style (retainer-based) medical practice in Menlo Park, California. “My partner and I care for 300 patients,” he says. For many medical issues, patients can feel as though they may be bothering the doctor after hours, he explains. They may also have issues that don’t require a visit or a visit after hours to urgent care. “AppVisit has created an organized ‘virtual visit’ that you can accomplish from your phone. It pre-asks many of the questions that the doctor would ask you on the phone, germane to the particular issue,” Phelan says.

Before using AppVisit, Phelan and his partner used email, with a few emails going back and forth to acquire the same data that one AppVisit can provide. “Otherwise, we were picking up the telephone or trying to obtain information the old fashion way,” he says.

Phelan found AppVisit after considering how his patients most want to communicate with him and how he can reach more of them. “HIPAA compliance is what really sold me on AppVisit,” he says. “It communicates securely in an organized, logical fashion so the patient record presents the visit succinctly.”

Phelan’s favorite feature is the check-in feature. “I can securely send the patient just a quick ‘How are you doing?’ message, which many times returns a reply of ‘great’ or ‘fine,’ but also may give me clues early on to potential problems,” he says. Phelan would like to see the ability to send in refills or new medications from the app.

UpToDate UpToDate   A one-year subscription (installed on up to two devices) is $499 for individuals. MobileComplete (with offline access to all content) is $548 for an annual subscription. Get it at uptodate.com/home/uptodate-mobile-access.

UpToDate is an evidence-based clinical decision support resource with accurate medical data to help even the highly trained physician stay current.

The UpToDate Mobile App and UpToDate MobileComplete for Android, Apple and Windows 8 phones and tablets combine physician-authored clinical knowledge in an innovative technology package that has become integral to clinical workflows for more than 700,000 physicians around the globe, says Andre Rebelo with Wolters Kluwer Health, maker of UpToDate.

UpToDate provides an extensive, continuously updated, searchable data store of clinical content for practicing physicians. The app enables quick information retrieval using a continual login and suggested search terms. Physicians can assign bookmarks, allow auto-complete for search terms and save their search histories.

UpToDate connects physicians to more than 10,000 topical reviews across more than 20 medical specialties. Data from UpToDate vendor Wolters Kluwer Health suggests that physicians use UpToDate more than 18 million times per month to aid their diagnostic and treatment decisions. This suggests a highly trusted resource. UpToDate data is peer-reviewed for accuracy and timeliness.

UpToDateUpToDate

Peter Chang, M.D., associate program director and academic hospitalist for the University of South Florida Morsani College of Medicine, also practices at Tampa General Hospital.

“I needed a way to source all my medical queries—whether searching general knowledge on a medical topic or finding the most current evidence-based guidelines,” Chang says. “UpToDate meets my needs. With the advent of the UpToDate app, I have a platform I can access when I’m outside the hospital as well.”

Prior to using the UpToDate app, Chang used Internet searches, which are often unreliable. “Those responses are not uniform, and I would have to sift through a large amount of data to find what I needed,” he says. “PubMed searches were a more reliable option, but it was time-consuming trying to gain access to the articles that those searches returned. I really had to commit to sitting down behind the computer to execute my searches, which was not the most efficient method.”

Chang uses UpToDate on his iPhone to brush up on topics before teaching residents and students or giving patient-specific education on a particular disease process.

“The UpToDate mobile app makes it much easier to access information quickly,” he says. “Our residents also rely on the UpToDate app when admitting a patient.”

Chang uses UpToDate when researching from home. UpToDate searches often serve as a springboard for more extensive research using other evidence-based information such as journal articles.

His favorite UpToDate features include UpToDate Mobile’s calculators, which aid in-patient care diagnoses. “We may need to calculate fractional excretions of sodium, MELDs or GFRs. With the UpToDate mobile app, I can pull up almost every medical formula there is, see how it is derived, and plug in patient information to perform calculations,” he says.

The only improvement Chang would recommend is access within the app to full journal articles rather than only the article citations and abstracts.

David Geer is a frequent contributor to PracticeLink Magazine’s Tech Notes department. 

 

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