Medical Apps for the iPhone: Diagnosaurus, ICD9 Consult, and WellAdult
Wednesday, April 22, 2009
Joshua Schwimmer, MD, FACP, FASN
As of this writing, there are over 400 medical applications in the iTunes App Store. Whether you're a health care provider or patient, and whether you have an iPhone or iPod Touch or not, it's worth exploring the impressive range of applications available for this new mobile platform. (Later this year, when iPhone 3.0 is introduced, these applications will be able to interact directly with compatible medical devices, like glucometers and blood pressure monitors.) Here's a brief introduction to three medical apps in the iTunes App Store.
Diagnosaurus. Many medical specialties—and Internal Medicine in particular—require working through a "differential" of possible causes of a patient's clinical presentation. Diagnosaurus ($.99) provides a polished interface for searching differential diagnoses for over 1000 conditions, divided by organ systems, symptoms, and diseases. As a bonus, at the end of each list is provided a list of links to related differentials. For example, "acute hepatiis" and "cholestatis" are listed at the end of "AST/ALT increased." Much like Wikipedia, you can spent half an hour browsing and clicking through links. For $.99, it's a steal.
ICD9 Consult. Health care providers must frequently scramble to come up with ICD9 codes for unusual or complex diagnoses in order to bill appropriately. ICD9 Consult ($29.99) is an excellent solution for those moments when you don't have time to consult a thick book or spend time seaching online for the right code. It allows you to easily search through the different codes or browse by type of disorder (infections, circulatory, respiratory, etc.) or procedure. At $29.99, it's not cheap, but if it saves you enough time, it's worth it.
WellAdult. The guidelines for optional clinical preventive services for adults—when to perform cholesterol tests or colonoscopies, for example—are scattered among many different expert organizations and are sometimes contradictory. WellAdult ($2.99) provides an easily navigatable database of recommendations from all major organizations for adults of different ages. Click on "Women Ages 50 - 64," for example, and you can easily compare the reommendations of different organizations for testing lipids, blood pressure, vaccinations, and cancer screening. For $2.99, this app is well worth it.
Information overload is an occupational hazard of practicing medicine, especially if you spend time online. There's too much potentially useful stuff out there for one person to process effectively: journals, news sites, RSS feeds, wikis, blogs, webinars, Flickr, Facebook groups, CME courses, Google alerts... And don't get me started on Twitter.
Two of my favorite medical bloggers—Bertalan Meskó from ScienceRoll and Dr. Ves Dimov from Clinical Cases & Images—recently shared their methods for dealing with information overload.
Clinical Cases & Images uses Twitter innovatively, to share interesting items from his feed reader, which he then aggregates into blog posts: "Health News of the Day," for example, and "Selection of My Twitter Favorites." (What's Twitter? Twitter is an instant messaging service, a microblog, a social networking phenomenon, a chatroom, the best crowdsourcing utility ever invented, or a colossal waste of time — depending on who you ask.) Ves also discusses using Google Reader, Google Bookmarks, and shares his backup strategies.
Bertalan Meskó from ScienceRoll writes about using Tweetdeck to filter the 1000 (!) users he follows on Twitter. He also uses Friendfeed and the "best of the day" feature to identify interesting discussions. He mentions Microplaza, Twilerts, and Tweetbeep—three services I've never heard of—to filter out interesting discussions and posts. Bertalan also uses Google Alerts—of which I'm a great fan—to track any content published about him or other topics of interest. He ends with my Life Hacks for Doctors presentation, which has received more than 10,000 views to date. (w00t.)
What strategies and resources do you use to deal with information overload?
My goal in Tech Medicine will be to explore the intersection of medicine, new technologies, and the Internet. This is a purposefully broad topic. Several times weekly I will post focused reviews of issues interesting to health professionals and nonprofessionals alike. Posts may include examinations of medical devices, pharmaceuticals, scientific advances, internet services, and other technologies involving health care and the practice of medicine. Mirroring as it does the nature of the Internet and the sometimes surprising nature of new technologies, the content may also include topics that are wonderful, unusual, hilarious, or strange.
I'm trained as a nephrologist (a kidney and blood pressure specialist). For the last three years I've written Kidney Notes, a blog designed to filter and process medical news. Most recently, Kidney Notes has become a collection of links, commentary, and scraps of information — a reference database of interesting things with the help of a popular social bookmarking service called del.icio.us. While I will continue posting to Kidney Notes, several friends have asked me to write longer posts of original content — and this is what I will be writing on Tech Medicine. Recently, I have also written a blog on personal productivity called The Efficient MD (in association with the American College of Physicians) and hosted The Efficient MD Wiki. I'm also writing a book with the American College of Physicians on physician productivity and life hacks. My collected posts may be found on jschwimmer.net, a tumblelog.
There are many topics I plan to cover, but I'm also open to suggestions, tips, and even posts by guest bloggers. My email is techmedicine@gmail.com.
Google is working on a peer review system, gpeerreview.
1. First, you read someone's paper. 2. Next, write a review. (The review is just a simple text file that contains a few scores and your opinions about the paper.) 3. Use GPeerReview to sign the review. (It will add a hash of the paper to your review, then it will use GPG to digitally sign the review.) 4. Send the signed review to the author. If the author likes the review, he/she will include it with his/her list of published works. 5. Prospective employers or other persons can easily verify that the reviews are valid.
A new report from Manhattan Research discusses the use of online social networks by physicians. iHealthBeat has a summary. Sermo and Medscape Connect are the two biggest online physician communities, each with about 100,000 users.
Physicians participating in such online communities are more likely to:
* Be primary care physicians; * Be female; * Own a PDA or smartphone; * Go online during or between patient consultations; and * Be slightly younger than the average physician.
Finally, In The New York Times, Alan Krueger writes about calculating the opportunity cost of the time patients spend waiting for physicians. His conclusions are surprising.
If you count health care-related activities writ large – including time traveling to a doctor, waiting to see a doctor, being examined and treated, taking medication, obtaining medical care for others, and paying bills – the average American spent 1.1 hours a week obtaining health care in 2007...
If we value all people’s time at the average hourly wage of production and nonsupervisory workers ($17.43 in 2007), Americans spent the equivalent of $240 billion on health care in 2007.
Notable New iPhone Medical Apps: ECG Guide and Safe OR
Sunday, February 08, 2009
Joshua Schwimmer, MD, FACP, FASN
Many users of the iPhone — and certainly developers — view it not so much as a phone, but as a handheld computing platform. The iTunes App Store currently lists more than 200 applications in the "medical" category. "Notable New Medical iPhone Apps" is an occasional series describing apps that I use and/or recommend.
The ECG Guide is an impressively detailed ECG reference for the iPhone and iPod touch. For $4.99, it features sections on ECG basics (such as the function of the ECG and positioning); ECG interpretation; waves and segements; chamber enlargement; ischemic and infarction; arrythmias; and a selection on miscellaneous clinical conditions such as hypothermia, dextrocardia, and brugada syndrome. The ECG Guide also features 100 high-resolution ECG examples and a quiz. (The text and sample ECGs rotate to landscape mode and are easily visible when you zoom in.) It's perfect for medical students, residents, and any health care practitioner who wants to have immediate access to a detailed ECG reference guide.
Safe OR: Safety Checklist is based on the 19-point WHO surgical safety checklist published in the New England Journal of Medicine Article, "A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population." In the study, use of the checklist was associated with a reduction in mortality of over 40%. The checklist includes questions to be asked prior to induction of anesthesia (for example, "Have you confirmed patient identity?" and "Is the surgical site marked?"); questions prior to the skin incision (for example, "Confirm all team members have introduced themselves by name and role." and "Has antibiotic prophylaxis been given within the last 60 minutes?"); and questions prior to the patient leaving the OR (for example, "Has the nurse verbally confirmed with team that instrument, sponge, and needle counts are correct?"). Safe OR is available for only $1.99 in the App Store.
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have an iPhone or iPod Touch or not, it's worth exploring the impressive range of applications available for this new mobile platform. (Later this year, when iPhone 3.0 is introduced, these applications will be able to interact directly with compatible medical devices, like glucometers and blood pressure monitors.) Here's a brief introduction to three medical apps in the iTunes App Store.
