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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Spring medical app roundup

Apps for sharing securely and making reference checks easy.

By David Geer | Spring 2014 | Tech Notes

 

As everyone knows, the vast majority of physicians use medical apps on their smartphones and mobile devices. It’s no surprise then that colleagues’ reviews of medical apps make for popular reading material. This time, PracticeLink presents apps for secure file sharing, communications and physician reference.

Share securely with DocbookMDdocbookMD

Securely share patient files and message colleagues from your phone or tablet.  DocbookMD.com

DocbookMD (docbookmd.com) is a secure, real-time messaging and file sharing app for contacting colleagues and staff members and sharing files such as X-rays, EKGs, lab reports and wound images. The app comes in versions for the iPhone, iPad and iPod Touch as well as Android smartphones and tablets. The app is free to members of the more than 200 state and county medical societies that partner with DocbookMD.

Docbook Enterprise versions are available to physicians whose hospitals, groups or other organizations sponsor them. DocbookMD bases pricing for Docbook Enterprise on group size and need.

DocbookMD includes a virtual directory of local colleagues the physician can instantly message with files and important communications.

The app enables quick collaborations, test result updates and specialist consultations. DocbookMD intends to transcend practice settings and medical technologies including EHR systems to enable immediate, secure communication and critical alerts to improve daily workflow, according to Tracey Haas, D.O., MPH, chief medical officer and cofounder.

According to Haas, DocbookMD exceeds HIPAA/HITECH standards for mobile technology by using 256-bit encryption and a secure cloud-based server to keep health information private. Physicians, hospitals and groups can discuss patient care and share data in real time without fear of falling out of compliance with HIPAA regulations.

Tammy S. McConnell, D.O., a pediatrician at Children’s Medical Group in Austin, works in private practice with another pediatrician. “It challenges me to touch base with subspecialists when we are seeing patients every 10 to 15 minutes,” McConnell says. Carving out time to call with so many layers of contacts to wade through can put a strain on both McConnell’s and the subspecialists’ schedules. “It’s often very challenging to communicate valuable information in a time-effective manner,” she says.

DocbookMD helps resolve these challenges in a number of ways. “Sometimes I may want to give subspecialists a heads up about a patient they are seeing or a follow up about one they saw. We can often do this through DocbookMD without interrupting their day. They can choose to deal with the information at their convenience. This helps with point of care continuity enhancement,” says McConnell.

DocbookMD helps with urgent matters such as sending films/X-rays to a subspecialist to make a decision about fracture management, such as whether to splint and send the patient over immediately; splint and send them over in the morning; or simply observe. “It saves the specialist from unnecessary appointments and helps them to expedite more urgent appointments,” McConnell says.

As for future improvements in the app, McConnell suggests that DocbookMD included a way to tag messages as urgent vs. FYI vs. respond at your convenience. “It would be a good way for physicians to use DocbookMD in a time-effective manner,” she says.

Reference roundup:  OmnioOmnio

Access several reference sources through one central app. Omnio.com

Omnio, a physician reference tool, offers more than 1,200 medical journals and news sites so physicians can turn to one resource for many things. Omnio includes a revamped reference section and more fully integrated drug information and interaction checker as well as resources with medical conditions, symptoms and medical images.

Omnio ScreenshotOmnio is available for the iPad, the iPhone (as of this winter), and will be available for Android tablets later in 2014, according to Guatam Gulati, M.D., senior vice president of the app’s producer, Physicians Interactive.

Omnio enables physicians to access, digest and share health care information in a simple and effective manner, applying it at the point of care. “Rather than having health care professionals go through emails, websites, different medical organizations, pharmaceutical companies and reference books to get the information they need, we enable them to access all that information in one place, through Omnio,” says Gulati.

Omnio uses an open infrastructure to integrate third-party content directly into the app. Omnio offers a social infrastructure that enables physicians to better communicate and share information among their peers. Omnio includes elements such as My Pages and Omnio Pages, which help customize the content for the end user so it is one tap away when they need it. It also lets physicians organize their content into as many custom pages as they need, according to Gulati. The Omnio sharing function alerts physicians to new information from different resources.

“Omnio is launching new content sources via a partnership with DocWise, which will give physicians the ability to use DocWise’s aggregated content reader for personalized, curated content. Physicians will also be able to create collections of information sources and share content via Facebook and Twitter,” Gulati says.

Jason S. Levitz, M.D., is an oncologist and hematologist at Oncology & Hematology Specialists in Denville, N.J. He offers a comprehensive range of diagnostic, therapeutic and treatment-related services including treatment for cancers and diseases of the blood. “I used to have to shuffle between different applications on the phone, closing one and opening another, then going back to the previous application again,” Levitz says.

“Omnio is a one-stop resource for medical applications. I don’t have to go to several different applications on my iPad to find what I am looking for. I can look up a drug reference, check out the latest literature on treating lung cancer patients and research the standards of care for the same patient, all at the same time.”

“With Omnio, I can dedicate my own pages to lung cancer or prostate cancer or any particular malignancy. I can include treatment protocols that I want to have easy access to, and have the calculators also as part of that. So it’s all integrated and easy to use within that one page.”

Empowered by the cloud: Sookasa Sookasa

Use the cloud to store and transfer files in a HIPAA-compliant manner. Sookasa.com

Sookasa enables physicians to use Dropbox and other cloud applications for sharing medical files in a HIPAA-compliant fashion through the use of encryption and audit trails. Sookasa currently works on both Mac and Windows desktop computers and mobile devices.

Asaf Cidon, Sookasa’s cofounder, says that an Android version will also be released later.

The Sookasa app in the full HIPAA-compliant package with audit trails and encryption is $150 per year, per user. With only the encryption, the app is available free.

“Sookasa protects medical files in the cloud and on mobile devices. The app not only encrypts the files, but also controls who can access them,” says Cidon. So if an employee leaves the practice, the physician can remove their access privileges and even wipe files from their mobile devices, protecting the private data. “You can also authorize or block access for third-party contractors,” Cidon says.

Many health care practices are using outdated technology that is costly and prohibits productivity. “Now you can use an application like Dropbox to transfer medical images from one office to another, between organizations, or transcripts to medical transcriptionists,” says Cidon.

Sookasa enables file access and sharing on the go. “There are stories where people had to drive for hours to pick up a DVD with medical images. Now they can just drag the image into a folder and synchronize it to the recipient,” Cidon says. The time and cost savings are tremendous.

Jonathan Kaplan, M.D., a plastic surgeon with Pacific Heights Plastic Surgery in San Francisco, couldn’t afford a traditional secure server like the one available at the hospital where he practiced previously in Louisiana. “I needed a more secure server than Dropbox by itself. I searched on Google for ‘how to make Dropbox HIPAA compliant,’ and Sookasa was at the top of the search results,” he says.

“I looked into other electronic health record systems but couldn’t find anything that met my needs in the way that my privately-built EHR system worked on Dropbox with Sookasa,” says Kaplan. He uses the secure, compliant version of the app. “It provides me with peace of mind that my patients’ records are safe, secure and encrypted.”

Kaplan uses Sookasa and his patient records on password-protected office computers and a password-secured iPhone. With Sookasa, patient data is available only to providers in Kaplan’s practice who need access. “If a provider is no longer employed by the practice,” he says, “we can easily exclude them from access to patient records.”

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

 

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Improve outcomes and relationships with apps

Mobile medical apps help children reach new heights, patients make appointments, and physicians manage referrals.

By By David Geer | Summer 2013 | Tech Notes

 

Physicians continue to welcome mobile medical apps that make their lives and work easier while increasing the length and quality of patients’ lives.
If you help children with leg bone length concerns, struggle with appointment scheduling, or lose track of patients between referrals and follow-up visits, then one of these apps is for you.

The Multiplier App takes human error out of calculations.

The Multiplier App
Links to download the free app for Android, iPhone, or iPad are at bit.ly/12qURV1

Physicians have reliably used the Multiplier Method for predicting children’s mature height and bone length for years. This helps them determine the appropriate treatment for maladies such as limb length inconsistencies or short legs. But the math can be tricky, leading physicians to make errors. And the calculations take a long time by hand.

The International Center for Limb Lengthening (ICLL) at the Rubin Institute for Advanced Orthopedics (RIAO) of Sinai Hospital, Baltimore, has addressed these hurdles with a free mobile software tool called the Multiplier App. The app, which is available for Android, iPhone and iPad, runs Multiplier Method formulas instantly based on a child’s gender, date of birth, and the length of their body or limb.

The Multiplier App runs 22 growth, length, and developmental calculations for height and limb length. The app includes a user guide, standard leg and foot measurements and other resources. Members of the ICLL were on the team that originally developed the Multiplier Method.

L. Reid Nichols, M.D., a pediatric orthopedic surgeon at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., was looking for a tool to perform Multiplier Method calculations without error. “It used to take me quite a while to do the math manually,” she says. “The Multiplier app helps prevent mistakes.”

Nichols uses the app to run equations on large discrepancies between leg lengths. The app runs equations that determine how many times a limb will need surgery as it develops. “If I have a 20-cm discrepancy, I am not going to do all that lengthening in one procedure,” says Nichols.

The app helps Nichols predict overall height. “If the child’s parents are tall and the discrepancy is not much, I can just slow the growth of the leg that is too long,” she explains. The Multiplier App also helps determine when to do the procedures.

“The Multiplier App is very user friendly,” she says. It runs complicated equations accurately so she can save those extra minutes she would have wasted on recalculating each problem.

Though Nichols is happy with the Multiplier app, she does have a couple of suggestions: “Maybe they could add the ability to go back and forth between centimeters and inches. Maybe there will be an app for the Blackberry some day.”

iTriage
Physicians use iTriage to enable patients to schedule their own appointments. Download free mobile versions at itriagehealth.com/Mobile.

When a practice’s staff are tied up all day on the phones scheduling patient visits, they’re unavailable for other duties. With iTriage, patients check a physician’s availability and schedule their appointments over a mobile app that works on Android and the iPhone.

With the iTriage app, patients can take better charge of their own health care needs.

The free iTriage app, which also comes in a .mobi version and a full web page for use on desktop computers, leads patients to their physician or an appropriate specialist based on symptoms and causes that are searchable inside the app. The app combines workflow improvements for physicians with timely, appropriate care for patients by searching ER wait times, pre-registering patients to alert medical staff about an incoming medical condition, and booking appointments anytime, anywhere.

William Gluckman, D.O., who runs the FastER Urgent Care center in Morris Plains, N.J., takes advantage of iTriage for the sake of his patients, his staff and his practice. “I was looking for a better system for scheduling patients. With iTriage, they go online to make appointments without having to get on the phone with staff. The patient selects an appointment time that is good for them, the application sends us a notification, and it’s a win for everyone,” Gluckman says.

“We save an hour a day in staff time by having patients who would normally call make their appointments through iTriage,” he says.

“Once my patients start using it, they no longer call us to make their appointments. Parents set up accounts for their children as well. A husband, wife and their children can each have individual accounts. They make separate appointments for each on their mobile devices in a minute’s time,” Gluckman explains. Patients make appointments in off hours, too. “If they feel sick at 2 a.m., they can make an appointment then and come in at appointment time.”

Gluckman really likes the web portal that he and his staff use on their end of the process. “Any approved staff can access it and see the name of the patient, what they are coming in for, and when they are scheduled. We can reschedule through the portal and it will send an email to the patient about the rescheduled time,” he says.

The only extra capability Gluckman could wish for is integration. “I would like to see it integrated directly with my practice management system from my EMR vendor. If they could make that happen, that would be ideal,” Gluckman says.

eReferrals
To learn more, visit inexx.com/signup.html

When a physician makes a referral, how does she know the patient actually made and kept the appointment? Without some help, she probably doesn’t. That’s where eReferrals comes in. More than a messaging service, HIPAA compliant eReferrals helps physicians track and manage referrals and referred patients.

The app’s dashboard presents data about whether the specialist accepted the patient for an appointment, scheduled it, and whether the patient showed up. By managing referrals instead of just making them, the app enables physicians to stay abreast of the all-important follow through.

Medicity offers the mobile application as a private web-based platform that physicians, practices and hospitals set up on their servers. Once installed, physicians and anyone with access rights can use the web-based application via any browser or handheld device.

James R. Morrow, M.D., a family physician at Morrow Family Medicine, runs a solo family practice with one physician assistant. “We see
35 to 45 patients a day; we pride ourselves on being a technology-
enabled practice, which is vital to our ability to provide high-quality, convenient care for patients, particularly considering the size of our practice,” Morrow says.

Morrow was looking for a better way to manage referrals, both to process them to other physicians and to follow up to get the results back from specialists who treat his patients. It was also important for Morrow to find ways to improve communication between practices.

“The app, unlike traditional approaches that try to retrofit a technology to solve a business problem, was designed to fit our practice workflow and enables us to take the time we used to spend tracking down referrals and direct that to focus on taking care of our patients,” says Morrow.

Morrow and his assistant access the app from an iPad as they move from room to room and on their desktop PC. “Using the Safari web browser on the iPad, I can monitor the status of my referrals and help improve communication with my staff and the specialists involved,” Morrow explains.

eReferrals helps physicians track and manage referrals and referred patients.

Previously, Morrow’s nurse would fill out a paper referral form for the patient to take to their appointment. Then his staff would begin the process of faxing the paper forms to the specialist and following up with phone calls to make sure they received the faxed information. “As you can imagine, this is a very time-consuming and inefficient process,” Morrow says.

The eReferrals app fully automates the process so that both Morrow’s practice and the specialist have better information.

“At the point of care, when I determine that I need to make a referral, my nurse enters the patient’s name into the app, selects the appropriate specialist, and the app automatically populates the referral with basic information to process the referral and relevant patient information for the specialist to effectively treat my patient,” says Morrow.

Then Morrow’s office can track the referral process through the app without all the extra manual processes. The app enables Morrow’s nurse to keep a work list with the ability to check the status of the referral. The specialist uses eReferrals to receive, accept and schedule an appointment and attach the results to the referral request to send them back to his office as completed.

Morrow would like to see Medicity someday add to the app the capacity to share EMR data like medication lists and to access medical imaging.

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

 

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Improvements in imaging machines

New ultrasound technologies make for happier physicians and patients.

By By David Geer | Spring 2013 | Tech Notes

 

In medicine, as in every market, an increasingly large, positive market impact generally translates into growing market value.

So with a forecasted global ultrasound systems market value of almost $11.2 billion by 2022, according to one report by Visiongain Ltd., it is no wonder that PracticeLink Magazine is reporting about physicians’ applications and opinions of two significant contributions among new ultrasound products.

Practical, pocket-sized Vscan ultrasound device
Price: $7,900
For more information: vscanultrasound.gehealthcare.com

The Vscan ultrasound tool fits in a lab coat pocket.

The Vscan from GE Healthcare is a mobile ultrasound visualization tool that fits neatly inside a physician’s lab coat pocket for anytime, anywhere ultrasound scanning for use in primary and emergency care, women’s health and cardiology.

Jason Jurva, M.D., a non-invasive cardiologist at the Milwaukee VA Medical Center, was looking for immediate access and views into patient heart function and structure when he found this new visualization tool.

“Of all the portable ultrasound devices, none of them are really pocket sized and travel with you all day from clinic to clinic except for the Vscan,” he says. It is the first portable ultrasound—about the size of an older generation cell phone—that offers instantaneous information, making a vast majority of diagnoses possible at a moment’s notice, Jurva explains. “At not much over a pound, it’s pretty innocuous and not too heavy to carry around all day,” he says.

And Jurva does carry the Vscan around in his daily practice, using it when rounding in the cardiology outpatient clinic at the Milwaukee VA Medical Center, for example. When Jurva is consulting with a patient and evaluating them for the first time, he can perform a quick scan of the heart, learn about the function and condition of the heart muscle, and share that information with the patient on the spot. “I can tell right away whether a patient has severe valvular disease and show it to them,” Jurva explains.

“And when seeing victims of active chest pains, I can look at the heart muscle to risk stratify them for their next treatment or early aggressive treatment.” The Vscan has utility across Jurva’s practice, running the gamut from healthy walk-in patients to critically ill people, wherever he needs to know what is going on with the patient at that precise moment.

These timesavings are especially important with critically ill patients.

“I can answer questions in one appointment in an outpatient setting, offering patients peace of mind without requiring them to make a second trip to the hospital to get their results,” he says.

Vscan features
“The Vscan’s built-in screen is larger than that of an average smart phone. The device delivers a good quality image for that screen size including color Doppler for direction and speed of blood flow across the heart valves. I can take diagnostic quality images on nearly everyone including people on ventilators,” Jurva says.

And there is no comparison between the Vscan and the typical echocardiogram when it comes to speed, availability and convenience.

When Jurva orders an echocardiogram, someone prints the order and takes the machine to where the doctor needs it, then boots it up and uses it.

“It can take one to three hours to get the results read,” Jurva says, “but the Vscan boots up in 15 seconds, enabling a point of service diagnosis in your hand. In two to three minutes, you can answer primary questions about the patient’s heart.”

Jurva’s favorite Vscan feature is the ability to demonstrate heart scan results to the house staff as well as the patient during rounding. “It enables a more intimate patient procedure because I am right there, telling them the results instead of calling them later,” he says.

As for Jurva’s wish list for future Vscan features, he is looking forward to lower pricing for his colleagues’ sakes. “Then it would be readily available to more doctors. It is fairly priced, but more than a physician can afford for daily rounds.”

Judy Mangion, M.D., applies the Vscan across research, teaching and patient care. Mangion is a cardiologist at Brigham and Women’s Hospital and was curious about the Vscan and searching for the right opportunity to acquire one when she managed to squeeze it in with a larger order. “I have since found the Vscan useful for fulfilling my patient care, teaching and research missions at this teaching hospital,” she says.

With reference to her patient care and teaching missions, Mangion uses the device as part of her rounding in inpatient cardiology with the house staff to enhance her instruction in physical diagnosis and to introduce cardiac ultrasound to residents.

Mangion has found the Vscan equally productive in outpatient care. “When outpatients return for follow up after a micro valve repair, I may not be able to justify a follow-up echocardiogram, but I can use the Vscan (to determine whether the heart murmur has increased),” she says.

Mangion further applies the Vscan to her heart failure population. “With this population, it is challenging to know what the patient’s volume status is,” says Mangion.

During a physical diagnosis, she examines the neck veins to see whether these appear distended. If so, the patient has an overloaded volume status. Mangion performs these kinds of examinations daily to determine the next form of treatment. But conclusions about volume status are difficult to make by eyesight alone if the patient is very large or thick skinned, Mangion explains. And she must make these kinds of decisions several times a day. With the Vscan, Mangion can take a closer look to be certain whether the neck veins are distended or flat and small. “I can be pretty sure of an accurate volume status assessment when using the Vscan,” she says.

The Vscan also provides evidence for patient consultations. In a case of atrial fibrillation, the patient was concerned about having what he saw as an expensive comprehensive echocardiogram. The resident who was working with that patient called Mangion, who was able to do a bedside Vscan in search of abnormalities. Finding an aortic insufficiency, Mangion was able to make a case to the patient for ordering the full echocardiogram. “Because of what I showed him, the patient agreed,” says Mangion.

When asked for her wish list of potential features for the Vscan, Mangion says, “It would be beneficial if GE could build an electronic stethoscope into it so I only need to carry the one device.” The device does occupy space in a lab coat, Mangion explains, and it can be challenging to fit it and a stethoscope in there as well. “And it would be really something,” Mangion adds, “if they could develop a 3-D Vscan to do scans in 3-D and download them to a computer for all the post processing.”

Improved Colorectal Care using the 3-D Flex Focus 400
Price: $69,900 to $89,900
For more information: bkmed.com/flex_ focus_400_en.htm

The Flex Focus 400 from BK Medical is a small, light, portable 3-D ultrasound machine with a high-resolution monitor, a fully cleansable keyboard and an optional four-hour battery.

Teresa deBeche-Adams, M.D., Colorectal Surgeon at the Center for Colon and Rectal Surgery, Florida Hospital, was looking for a 3-D ultrasound machine that could also produce better images with more detail when she found the Flex Focus 400. “We use it primarily for pelvic floor disorders and to make diagnoses pertaining to incontinence, rectal prolapse and rectal cancers in order to stage the patient properly, and to look at tumors and lymph nodes,” she says.

With pelvic floor disorders, deBeche-Adams and colleagues are able to make multiple diagnoses from one ultrasound examination using the Flex Focus 400.

“We can offer a better targeted therapy or treatment such as chemo, radiation or surgery for rectal cancers and we can taper our plans to the specific type and stage of tumor the patient has for better outcomes,” deBeche-Adams says.

Flex Focus 400 provides 3-D views.

Flex Focus 400 Features
In this unique ultrasound mechanism, a crystal takes the images while moving up and down inside a wand that the physician inserts into the rectum. “We can see inside the rectum top to bottom using 3-D images created on the device, all while the patient experiences a more comfortable exam,” says deBeche-Adams. She and her colleagues can examine tubes and surrounding tissues while looking at different slices or planes through the recreated 3-D cube visualizations of the area.

deBeche-Adams is particularly pleased with the increased level of patient comfort with the Flex Focus 400 (over a previous 2-D ultrasound machine) as well as the capacity to perform a much wider range of tests thanks to the 3-D technology. “These new images are very impressive when you see them side-by-side with old images from the previous technology. They are much better quality,” says deBeche-Adams.

As smaller, more evolved ultrasound machines advance the technology revolution, their investigative precision should insinuate itself into more planes of examination, closing the gap between near-immediate, exhaustive and accurate diagnoses and targeted rather than explorative treatments.

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

 

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Apps increase knowledge, enable intervention

Put your phone or tablet to good use with these apps for physicians.

By David Geer | Fall 2012 | Tech Notes

 

The mobile medical software market is proliferating with apps that fill various niches in the physician’s professional landscape. In this installment, Tech Notes highlights mobile apps that address domestic abuse screening and continuing medical education.

QuantiaMD, the app and network that keep physicians current

The medical community is well within the blast of the knowledge explosion.  New information bombards doctors, and it’s difficult for them to keep pace.

The QuantiaMD app accesses a learning network that engages physicians with brief, interactive presentations of four to eight minutes on topics of interest to their specialty. The physician can ask questions during a presentation and participate in discussions with other physicians.

Through QuantiaMD, physicians enjoy these presentations anywhere and anytime they have a connection on their mobile device. Physicians learn on their schedule, when they have a few free minutes. They simply log on to the QuantiaMD network where they have set up their profile. The app offers them open community discussions, private discussions and opportunities for one-on-ones with colleagues to learn critical information for their practices.

Access interactive presentations in your specialty and connect with colleagues and a faculty of 500 medical experts even with just minutes to spend.

In addition to interaction with the app’s other users, QuantiaMD has its own faculty of 500 medical experts. These experts monitor each of the special interest groups in the network and answer physicians’ questions.
The network currently serves 150,000 physicians.

QuantiaMD is compatible with iOS (Apple) devices version 4.0 and later and Android handsets running version 2.1 or later. The app is free and available for Apple devices on iTunes.

Steven Sandler, M.D., sees 80 to 90 patients per week at his cancer treatment centers in Chicago and Skokie, Ill. Sandler is involved in protocol research, though not with any academic institution, and participates in clinical trial studies to determine whether new drugs are beneficial.

Sandler must stay ahead of a broad array of medical developments. But emails, mailings, and representatives who come by his office inundate him. He also attends a lot of conferences and listens to audiotapes to keep up.
“I needed an application for medical education that would be thorough but not overwhelming, something I could apply to my practice needs,” Sandler says.

Those needs range beyond just working with cancer. The typical person with lung cancer or prostate cancer is around 70 years old, and some have also had bypass surgery and other procedures. “I need a way to deal with oncology and the patient’s other medical problems,” Sandler explains.

“QuantiaMD provides a user-friendly environment for keeping up with case presentations and lectures by notable experts,” Sandler says.

QuantiaMD presents cases and asks the physicians what they think a particular malady is. “It is fun because there is actual feedback,” says Sandler. “They give you the correct answer and after three to four cases, you see how you did and how your colleagues did.”

Using QuantiaMD, Sandler can easily select the topics he is interested in, including mental illness.

“Some patients come in with mental stress due to all the maladies they have. I can’t think of any other avenue I would use to look at this topic,” he says.

Other topics covered by QuantiaMD include HIPPA regulations and legal issues that are important to a medical practice.

“I have shared it with several colleagues,” Sandler says about the app.

“When I have called for support for minor issues, Quantia has been very helpful.”

The R3 App, a HITS-based screening instrument

Society has its failings, including domestic abuse. Physicians recognize symptoms of mistreatment but need better ways to communicate questions to those affected.

To meet such challenges, Harbor House of Central Florida, Inc., a successful domestic violence shelter and counseling program, created the R3 App, a domestic abuse screening app that uses the HITS screening tool recognized by the CDC. The app is compatible with the iPad and iPhone, enabling physicians to hand the tool to their patients for self-screening.

The app, which includes a comprehensive list of domestic abuse resources in the U.S. by their zip codes, is freely available for both Apple and Android devices.

Ademola Adewale, M.D., is an emergency medicine physician at Florida Hospital, East Orlando, and a fan of the R3 App. Adewale interacts with a diverse population of some 79,000 patients per year in the emergency department, too many of whom fall prey to their partners.

“We identified that intimate partner violence is prevalent in our population. Data suggests that it is under reported,” Adewale says. Due to the awkwardness that doctors confront when inquiring about abuse, Adewale sought a self-reporting application he could readily insinuate into treatment.

“This application makes the screening process seamless,” he says.

When the physician has evaluated someone and finds evidence of intimate partner violence, he or a nurse can load the R3 App on the iPad and hand it to the patient to fill out in private. “The application is self-explanatory, the questions are formatted in a user-friendly format, and the patient can use it with or without the physician present,” Adewale explains.

The app follows a format in which it presents the patient with weighted questions and then tallies the numbers associated with the responses. “The cumulative score helps us to classify the patient as low, medium or high risk,” says Adewale.

Adewale and his emergency department are conducting a prospective observational study to validate the use of the app in the ER.

MedPage Today app keeps CME within reach

The MedPage Today app combines award-winning medical news from the MedPage Today editorial staff, CME activities that are peer reviewed by the University of Pennsylvania Perelman School of Medicine, and best in class drug reference information from Thomson Reuters. Once physicians register through the app and note their profession and specialty, the app uses this data to direct them to the news that is most relevant to their interests.

Through its relationship with the University of Pennsylvania, the MedPage Today app offers real-time CME that covers breaking medical news.
Physicians completing CME activities can refer to their CME history within the app to fulfill their ongoing CME requirements for licensing. Access to historical CME activity and breaking news coverage are part of what set this app apart. The Thomson Reuters Micromedex drug data further enhance the app and increase its utility.

The free app is compatible with iOS (Apple) devices (it is optimized for the iPhone and iPad) and the Android platform (some design and functionality features work only on iOS devices).

Richard Savel, M.D., Medical Co-Director, Surgical ICU, Montefiore Medical Center, Bronx, N.Y., is a full-time ICU physician who makes continual use of mobile technology. “I use my iPad in a lot of ways, including for teaching and viewing X-Rays,” says Savel.

One of the gaps Savel noticed was the lack of an app to keep him updated on medical news. Savel tried other medical news apps but found that these did not meet his needs. “The app from MedPage Today is a real-time medical newspaper. They have integrated it with CME and built it up around the strengths of the iPad,” he says.

The app helps Savel meet his CME requirements for the hospital and for his academic appointments (he is also Associate Professor of Clinical Medicine and Neurology at the Albert Einstein College of Medicine) without disrupting his day. ‘The app breaks down CMEs to a quarter of an hour so that I can do them when I have time,’ Savel says.

The app enables him to digest and integrate new data including teaching data related to the ICU and the critically ill. “I take care of patients who come in on thrombotic drugs and have untoward effects from them. The information about this on MedPage Today is easier to digest than a flood of information. I particularly like the articles about cutting-edge therapy and atrial fibrillation in the ICU,” he says.

This grouping of apps helps physicians address broad and specific knowledge areas and medical issues.

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

 

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Telemedicine in action

Video conferencing capabilities serve a variety of patient needs

By David Geer | Spring 2012 | Tech Notes

 

Physicians are increasingly finding new ways to leverage telemedicine using video conferencing. With new technologies that vendors have conceived and tailored for medical applications, current video-based telemedicine has much to offer. To demonstrate how much, three physicians take PracticeLink inside their practices.

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4G or bust

Physicians find 4G tablets and smartphones alluring. The advantages are significant - if not game-changing,

By David Geer | Tech Notes | Winter 2012

 


It is no secret that physicians are giving increasing approval to medical applications of tablets and smartphones. The increasing demand for tablet- and smartphone-ready medical software speaks volumes on this. Anyone who has had a moment to catch a glimpse of the latest advertising has heard of 4G (Fourth Generation wireless) and the marked increases in speed, quality and convenience its vendors vow.

But everyone knows what you see in an ad and what you get after committing to a new device and plan can be two different things. Will 4G and its attendant devices lend momentum to mobile device uptake? Let us hear what doctors who are putting them into practice have to say.

 

From HTC EVO 4G to Motorola PHOTON 4G
The Motorola PHOTON 4G is available for $199.99 (with plan).
Gregg M. Alexander, D.O., a pediatrician at Madison Pediatrics, Inc. in London, Ohio, sees 25 to 30 patients daily. He also performs C-sections and treats newborns at Madison County Hospital in London. Alexander recently upgraded from the HTC EVO 4G to the Motorola PHOTON 4G. He gifted his wife with the EVO.

“My wife needed a phone upgrade, and I was eligible for an upgrade myself. I had been looking at different options,” he says. “The PHOTON is definitely more of a business workhorse than the EVO.” In Alexander’s experience, the PHOTON makes social networking applications such as Twitter and Facebook easier to use. The phone is compatible with Android medical apps. It is globally friendly, switching over easily to European cell systems for physicians who may travel there.

“It also has a nice look and feel and reboots very quickly. The EVO has a long boot process. But the PHOTON is very fast. It almost boots like an iPhone or iPad,” Alexander says.

Speaking of looks, the Motorola PHOTON 4G comes with two cameras, one in front and one in back. The front camera enables video chat with high quality and no skips, stalls or buffering. Alexander uses the PHOTON’s embedded rear camera for medical recording. “If I am examining a patient, I can capture an image of a rash, for example, using the phone’s 8MP camera. This is very handy,” he says.

But Alexander’s favorite feature is the impact the speed of the PHOTON and its 4G connection have on viewing and using medical applications. “I use Peak Practice, which Allscripts acquired when it purchased Eclipsys. It’s an EHR application,” Alexander says. Alexander uses the application through LogMeIn Pro. “I notice the difference when using Peak Practice where 4G is available while I am traveling,” Alexander says.

Despite those features he treasures, Alexander interjects that he does have a wish list of features and capabilities he would still like to see on 4G smartphones.

“The biggest thing is the interoperability factor. I would like to be able to use Microsoft Excel or Word on the device, sync that with my PC, and share those documents,” he says.

He would also like to be able to use telemedicine and remote telepresence applications on a 4G smartphone.

“I am in touch with people who are doing telemedicine and telepresence who are looking at using smartphones for online consults and on-the-spot consults without having to find a telemedicine conference room for it,” Alexander explains. He is also interested in using 4G to tie into patient communication applications to communicate with patients more. “I would like to make more use of social media, which will empower the physician-patient relationship,” he says.

The phone has some empowering hardware options too. Doctors should consider acquiring the compatible HD Station, which enables physicians to attach the PHOTON to a computer display, wireless keyboard, mouse and memory stick. Physicians can start calls from their computer displays and work with their browser windows simultaneously for multitasking. They can even launch calls by selecting a phone number on a website without having to key it in manually. A separate in-car navigation dock converts the PHOTON 4G into a GPS device.

The phone comes with IT policies for enterprise use, which can help enforce compliance with regulatory requirements. It is loaded with multiple messaging and web apps with access to many more. With a dual core processor and 1GB of RAM, this phone competes on speed with some tablets. The PHOTON 4G connects with both 3G and 4G hotspots when roaming for continual connectivity.

The Samsung Galaxy Tab 10.1 4G as MiFi
The Samsung Galaxy Tab 10.1 with 4G is $529.99 with a new contract.
A practitioner in family medicine, Pennie Marchetti, M.D., of Primary Care Physicians of Stow (Ohio) also acquired her 4G device as part of an upgrade. Though the tablet enables Marchetti’s mobile office, it might not be in the way that most people would think. “I use it as a MiFi device to connect my Lenovo to the Internet when on the go,” Marchetti says.

A MiFi device connects to the 4G wireless network, then makes that connectivity available to other devices via WiFi. With the Galaxy Tab, Marchetti takes her own WiFi hotspot with her wherever she goes.

EMRs and faxes come in all the time that require Marchetti’s signature. “I can do the paperwork in the car while someone else drives and keep it from piling up,” she says. The tablet is a critical tool for Marchetti to get her work done in a timely fashion.

That work includes receiving EHRs, answering phone messages, communicating with staff, ordering refills on prescriptions, and checking lab results all while connecting through the 4G tablet.

“I reach the office securely through a VPN connection that extends easily over the WiFi and 4G networks. I can then use the eClinicalWorks software on my notebook to complete my work,” Marchetti says.

The device also has built-in GPS, which Marchetti uses when traveling, and the ability to log on to secure messaging sites so she can communicate with her patients.

“It boots quickly, sets up easily, has a lengthy battery life of about eight hours and the 4G connection is strong and consistent all the way from Akron, Ohio, to Ithaca, N.Y., with very few dropped connections,” Marchetti says.

Finally, all that tablet speed and endurance saves time. “It has saved me hours of work that I would have to complete on my return to the office. It has made the work more efficient, and I don’t have to worry about old work when I get back, just today’s work,” she says.

The Samsung Galaxy Tab comes with a 10.1-inch touchscreen display, 1280 x 800 HD resolution, a fast NVIDIA Tegra 2 dual-core 1GHz chip, and 1GB of RAM memory. The device measures 0.34 inches thin and weighs 20 ounces. A keyboard dock for full legacy keyboard access is available separately.

The Samsung Galaxy S smartphone
The Samsung Galaxy S smartphone is $99.99 with a new contract.
Pedro A. Ballester, M.D., a family physician with a practice in Warren, Ohio, adopted his first smartphone with the Samsung Galaxy S. Though most of his use of the device is not for medical purposes, he does use Epocrates, Medscape, and other medical applications on it.

“I am torn about the lack of a keyboard. I sometimes wish I had a big touch screen or slide keyboard on it, but that would make the device more bulky,” Ballester says.

He would also like to see some kind of verification process for easier login on hospital networks when he first arrives. “I wish there was some way to login automatically and use the hospital’s resources as soon as I am in range of the network. It would be helpful to have access to Epocrates and Medscape as soon as I walk in, some sort of handshake protocol so I am immediately able to use the local WiFi network instead of having only guest access,” Ballester explains.

The phone has a front camera for video chat that uses the QIK video application from Skype and a rear 5MP camera suitable for taking photos or HD video. Busy physicians can use the device as a mobile hotspot and a WiFi phone.

For the physician who has to have more speed today, 4G smartphones and tablets abound with more in the works. With real-time video chat, high-resolution medical image capture, increasing support for social networking, more efficient access to medical apps, GPS navigation tools, and global roaming not the half of it (and discounts for those who choose to upgrade), there’s a lot to consider in the new world of 4G wireless.

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


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More apps for physicians

Transform your phone into a time- and money-saving machine that helps you provide better patient care

By David Geer | Fall 2011 | Tech Notes

 

Eighty-one-percent of U.S. physicians own smart phones, according to Manhattan Research. Without respectable apps, the devices make good voice phones or fair paperweights. The following apps can transition your phone into much more.

Skyscape Medical Resources app rains down clinical decision support 
How to get: Available for free at skyscape.com.

This free app pushes access to essential clinical decision support data to more than a million health care professionals on their Apple, Android and BlackBerry devices. Users can also purchase premium information resources from leading medical publishers. The respective apps are available from the iTunes store, the Android Market and the BlackBerry App World. Premium content is available from those sites and at skyscape.com.

Skyscape Medical Resources delivers access to the same data physicians used in training. Its makers produced more than 600 clinical drug guides, journals, medical calculators and tools in partnership with F.A. Davis, Wolters Kluwer, McGraw-Hill and Elsevier. Physicians can customize the app based on their specialties and unique professional needs.

The app’s SmartSearch feature queries search items across its library. Physicians can cross-reference multiple information repositories with seamless efficiency using the SmartLink feature. Physicians can move from clinical data to treatment guidelines and drug information during a single patient interaction. All content is regularly updated to reflect the latest findings.

Jason Bhan, M.D., a family practitioner in Sterling, Va., who also teaches in a residency training program connected to Virginia Commonwealth University, was looking for solutions to a few issues when he found Skyscape. “I needed to stay current with relevant journals from my practice area. I wanted a tool to keep me updated with highlights from different sources so I could pick and choose the items I wanted to read. I wanted to avoid buying or using big textbooks,” Bhan says. Skyscape Medical Resources was the answer for all of these needs.

Bhan’s favorite feature is Skyscape’s MedAlert, which messages his iPhone with breaking news. “The messages highlight recent journal articles that are pertinent to my specialty and practice and provide concise summaries,” Bhan says.

Real-time ECGs on the iPhone, iPad or iPod Touch
How to get: Physicians should express interest to their affiliated hospitals, and those entities can purchase the app.

AirStrip Cardiology (airstriptech.com) impressed Apple enough that the company featured it in an iPad 2 commercial. The app presents GE Healthcare MUSE Cardiology Information System data, empowering clinicians with access to precise, near-real time cardiac information on iPhones, iPads and the iPod Touch. (Android-based versions are coming.) Using the app’s high-resolution, interactive views, physicians detect minute changes (to 0.5 millimeters) in ECG measurements, enabling them to diagnose critical heart conditions while on the go. The app supports readings from 12- and 15-lead ECGs while making current and historical tests available for viewing in 10-second increments.

Jose R. Soler, M.D., a noninvasive cardiologist at the Northwest Medical Center in Florida, was looking for a mobile platform to provide him with reliable, rapid reviews of ECG data to assist in accurate diagnoses (of ST elevation MI vs. non-ST elevation MI) and to quicken treatment decisions (cath lab vs. medical management). AirStrip Cardiology in hand, Soler realized his diagnosis and treatment goals.

“On call, our cardiologists use iPhones and iPads to retrieve ECG data immediately. There is no need for a fax machine (there is never one at the restaurant) or to log on to the hospital system via a desktop or laptop,” says Soler.

Soler’s favorite features include the ability to recall past ECG data from the hospital’s MUSE database and compare it with the present ECG to assess for changes on the spot. He also likes the fact that he can zoom in while maintaining resolution so he can see those ST segments clearly up close and take reliable measurements.

In addition, the app stores 10 seconds worth of data so he can scroll through it and look at rhythm changes.

According to Soler, the app makes his work as a physician easier because he can access ECG data away from the hospital via iPhone or iPad quickly, reliably and securely—meeting HIPAA requirements. “I rely on the app for new consultations and when there are changes in patient status that require access to ECGs (changes such as ischemia or rhythm disturbances),” Soler says.

Dr. Rounds+ is all about rounding
How to get: Available for $29.99 at itunes.apple.com/us/app/dr-rounds-plus/id337465220?mt=8.

Dr. Rounds+ is a patient list organizer and charge capture service that Camil Sader, M.D., the app’s maker, has adapted to the iPhone, iPod Touch and iPad. He is also porting the app to Android-based phones (release projected for Fall 2011).

The app’s five key features include patient list creation; charge capture; secure email list generation for forwarding patient lists and data; an Internet-based answering service; and a search capability for finding missed charges and other information.

The patient lists offer data entry shortcuts and customizations that save the physician time no matter their specialty. The software maintains an accurate count of patients as well as charge captures to counter loss of revenue. So far, the app has saved users more than $15 million collectively in otherwise lost revenue.

The secure email list enables data sharing among physicians and secure sign out from the patient census. The answering service equips secretaries, clerks and ER nurses to log in to the Dr. Rounds+ WebApp to send consults or callback information for the physician’s easy retrieval. The service can send consults and callbacks to as many physicians as necessary. Doctors use these messages to generate patient records automatically. The search utility empowers physicians to search patient data for referral patterns, workload within the varying facilities, and case logs that they can upload to their certifying boards.

Alan Bank, M.D., a gastroenterologist working at Digestive Care LLP in Boca Raton, keeps up with an office practice and two sets of hospital rounds per day as well as GI procedures and colonoscopies. He was eagerly seeking an electronic package for tracking patients, diagnoses and billings that could perpetuate the data throughout the week. “Dr. Rounds+ guarantees that I do my billing and charges correctly. It keeps me from worrying where my patients and their data are, too,” says Bank.

But Bank’s favorite feature is the ability to transfer patient information from day to day and to search for patients he has seen. “I save 45 minutes a day over the previous handwritten process. This gives me more time to concentrate on caring for my patients,” Bank adds.

IQCharge amplifies patient interactions
How to get: Set up a demo account at https://iqserve.iqmax.com /demo/, or purchase a SaaS version for $50 per month.

IQMax makes practical physician apps for a host of platforms including the iPhone, iPad, Android, BlackBerry and even Windows Mobile. Its IQCharge app captures charge codes in minutes. Doctors set up their own one-click favorites to help them code quickly and accurately.

Mike Cowan, M.D., a neurosurgeon with Carolina Neurosurgery & Spine Associates, was looking for an improvement over recording charges on pieces of paper or in calendar entries on computers and handheld devices. Using IQCharge on his Droid X smart phone, Cowan enters charges directly so billing does not have to pull or compile charges from other resources.

“IQCharge is cleaner and more efficient,” he says.

Cowan likes the customized codes, which he uses for charges he enters frequently. “I just push a button to enter them rather than select all the different charges,” says Cowan. For example, if Cowan had to turn in a charge for surgery on a ruptured disk, there are three to four different codes to turn in. “Normally I would have to look through a menu for all the codes. IQMax created macros for me so I can go into a menu, pick the surgery, and it is preloaded with the codes I need,” he says.

Cowan’s favorite feature is the ability to turn in charges at the point of care. “When I was entering charges into my calendar, sometimes I would get busy and couldn’t get to a computer until later in the day, or I would forget and not get it done until later in the week. With IQCharge, I can pull up my phone, click open the specific patient and hit send,” says Cowan.

Physicians tired of going round and round with charges, who need a fount of knowledge in the palm of their hands or an app they can take to heart, may now be satisfied.

Though the variety of medical apps is variegated and increasing, their focus continues to center around saving time, data accuracy, efficiency, and enabling physicians to mobilize capabilities that once were tethered. Perhaps this is what physicians require most.

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

 

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