Evidence-based apps for physicians

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

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

 

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

Frailty Tool

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

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

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

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

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

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

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

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

GOLD 2017 Pocket Guide

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

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

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

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

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

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

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

EBM Stats Calc

Price: Free Apple: apple.co/2IQFSvI

Price: Free Apple: apple.co/2IQFSvI

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

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

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

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

 

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4 free apps to download today

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

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

 

Young hipster using a mobile phone

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

Choosing Wisely

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

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

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

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

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

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

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

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

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

Pneumonia Guide

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

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

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

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

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

Pregnancy Passport from P&M

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

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

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

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

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

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

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

CKD Care

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

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

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

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

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

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

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

 

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7 new apps for physicians to try

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

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

 

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

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

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

Dx Challenge

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

iTunes: appstore.com/dxchallenge

CorticoCalc

CorticoCalc

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

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

ASCO Guidelines

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

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

Prescription Check by Warby Parker

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

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

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

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

PsychoPharm Research

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

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

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

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

Pterional Craniotomy

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

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

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

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

REBEL EM

REBEL EM

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

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

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

 

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Medical Apps for Physicians

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

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

 

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

CDC Opioid Guideline: Motivating behavior change

CPC Opioid Guideline

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

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

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

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

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

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

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

DAPT Risk Calculator: Help deciding on treatment

DAPT Risk Calculator

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

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

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

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

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

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

Proceducate: Refresh your skills

Proceducate

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

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

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

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

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

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

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

 

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Fractures, Fevers, and Helping Patients Understand Your Choices

Summer 2017 | Tech Notes

 

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

OrthoFlow: Fracture management

Orthoflow

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

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

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

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

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

Febrile Infant

Free. Apple: ow.ly/1NcV30aLkJE

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

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

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

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

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

Making Healthy Choices: Explaining treatment decisions

Health Choices

Price: Free. Apple: ow.ly/xTYy30aLkZr

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

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

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

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

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

 

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Evidence-based apps take on gout, drug dependence and smoking

These three apps help physicians diagnosis gout, employ the SBIRT method and give patients the tools they need to quit smoking.

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

 

In this edition of Tech Notes, we’ll cover three great evidence-based apps: one for determining whether a patient is suffering from a gout flare or something more serious, one for screening for substance abuse, and one that may help your patients quit smoking. All three apps are free to download.

Gout Diagnosis

Gout Diagnosis

Price: Free iTunes: apple.co/2j69V9m Android: Not available

When a patient presents with joint pain, there is always the concern that an acute infection is the cause of the pain. Often a physician will perform a joint fluid analysis by doing an arthrocentesis of the joint—a procedure that can be very painful—even though he or she suspects gout is the etiology of the symptoms. The Gout Diagnosis medical app utilizes evidence-based algorithms that are straight from the literature to help physicians determine without a joint fluid analysis whether gouty arthritis is the source of a patient’s pain.

This medical app is based off research by Hein Janssens, M.D., and Jaap Fransen, Ph.D., et al. (Their original paper is called “A Diagnostic Rule for Acute Gouty Arthritis in the Primary Care Without Joint Fluid Analysis.”) With the permission of the authors of the original study, Joshua Steinberg, M.D., a prolific physician app developer, turned their decision algorithm (which has been validated in the literature and is widely used) into a point-of-care medical app.

The Gout Diagnosis medical app is very easy to use at a patient’s bedside. It offers you seven Yes or No fields, six of which can be answered just by talking to the patient. The decision algorithm then gives you a score along with recommendations about whether or not a joint aspiration may be necessary.

The app is free and easy to use. Unfortunately, it is not available for the Android platform right now. (In the past I’ve asked Steinberg and other medical app developers why they often don’t create analogous Android versions, and they’ve said they see tremendously fewer downloads on Android than iOS.)

Key ways to use this app. Use the app to determine if a gouty flare is causing joint pain or if an arthrocentesis should be performed. You can also use it to learn more about the original research by Janssens and colleagues and how it can be applied in clinical practice.

OHN SBIRT

OHN SBIRT

Price: Free iTunes: apple.co/2iFqU1G Android: Not available

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based method to help identify and reduce dependence on alcohol and illicit drugs. Given the current opioid crisis, this methodology has been gaining huge traction in the clinical arena.

Though specific SBIRT training is available, it would be difficult to learn the method simply through reading about it. The SBIRT app, however, provides a great means for learning how to use the method.

Created in partnership with the University of California San Francisco (UCSF) and the Substance Abuse and Mental Health Services Administration (SAMHSA), the app not only takes you through the steps of SBIRT but also provides the evidence behind the methodology and offers informative content (such as in the Epidemiology section) to foster an understanding of the opioid crisis and other substance abuse problems plaguing the general patient population.

One of the coolest features of the app is the video modules included. These video modules (found in the Key Resources section) show you examples of SBIRT evaluations and help you understand how to use the approach with your patients.

Because the app has screening sections built in, it can be used at the point of care with patients, so even if you don’t have extensive training with the SBIRT process, you can use the app at a patient’s bedside. It even gives you scripts to help you ask key questions of your patients.

The medical app also has questions at the end of the app that allow you to track your progress with SBIRT. You are able to denote your comfort level with the process and do self checks to see if you are mastering the technique.

Key ways to use this app. You can use this app to learn the SBIRT methodology, to go through the SBIRT process at a patient’s bedside and to learn more about substance abuse and how it’s affecting your patient population.

QuitGuide

QuitGuide

Price: Free iTunes: apple.co/2hTIRbo Android: bit.ly/2iJjZ7x

Apps to help patients quit smoking have been around since the launch of the smart phone. Not all are created equal, however, and not all use evidence-based techniques in their processes.

QuitGuide is a free smoking cessation app launched by the National Cancer Institute. It’s great to see a medical app from such a reputable source, and unlike several of the currently popular smoking cessation apps in the App Store, this one follows the practice recommendations for smoking cessation from the Tobacco Control Research Branch. Though the app has been around for a while, there have been many iterations over the years that continue to improve its overall functionality.

Some of the key highlights of QuitGuide are its ability to integrate social networks (such as Facebook) into the decision to quit smoking. Users can even post custom messages about why they want to quit smoking. The app also has a personal, customized touch to help patients with smoking cessation.

Key ways to use this app. This app is a great resource for educating patients on why they should quit smoking. If patients are ready to quit smoking, consider prescribing this app to them.

 

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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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