Keeping Smart with a Smartphone


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Lecture given at the 2010 Philippine College of Physicians annual convention

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Keeping Smart with a Smartphone

  1. 1. Keeping Smart with a Smartphone Iris Thiele Isip Tan MD, FPCP, FPSEM MS Health Informatics (cand.) Clinical Assoc. Professor, UP College of Medicine Section of Endocrinology, Diabetes & Metabolism Philippine General Hospital
  2. 2. No conflict of interest
  3. 3. To Err is Human: Adverse Building a Safer Health System events Institute of Medicine 1999 2.9% 6.6-13.6% Ooops mortality Colorado 44,000 - & Utah 98,000 50% 3.7% deaths/year Medical New York Errors
  4. 4. New Competencies Health Professions: A Bridge to Quality for Health Professionals Institute of Medicine 2003 Work in 1 Provide patient- interdisciplinary centered care teams Employ 2 3 evidence-based practices Apply quality improvement Utilize 4 5 informatics
  5. 5. “... in the next century, the study of informatics will become as fundamental to the practice of medicine as anatomy has been to the last.” Coeira E. Guide to Health Informatics, 2003 (2nd ed)
  6. 6. Health Informatics Study and application of methods to improve management of • patient data • medical knowledge • population data • other information relevant to patient care and community health
  7. 7. Information is the essence of medicine: we create it; we collect it; we search for it; we adapt it; we drown in it; and at times, we ignore it.
  8. 8. “Information is often not available to those who need it when they need it. As a result, patients often do not get care they need or do get care they don’t need.” Kohn et al. To Err is Human: Building a Safer Health System (2000)
  9. 9. “Mobile technology has the potential to revolutionize how physicians practice medicine.” Burdette et al Clin Inf Dis 2008;47:117-22
  10. 10. Smartphone SMS MMS No industry Voice calls standard Phonebook definition More than Miniature basic cell computer with phone phone capability capabilities Wikipedia
  11. 11. Smartphone Platform Market Share Palm Google 6% 9% Microsoft 16% 43% RIM Apple 26% comScore Feb 2010 (US)
  12. 12. US Physicians Using a Smartphone No smartphone 36% 36% 27% iPhone 64% 37% Blackberry 2009 Manhattan Research Survey “Taking the Pulse”
  13. 13. 40% of Sma! adverse Phone drug events (ADE) Point of care lack of at time of critical prescribing, patient and dispensing, drug administering information medicines Leape et al JAMA 1995
  14. 14. Epocrates Free Prescription medication OTC drugs Pill ID Drug interactions Medical iPhone/iPod touch Android calculator BlackBerry Windows Mobile Palm
  15. 15. Medscape Free Internet access not required 6000+ drugs 1000+ OTC 1000+ Herbal supplements Interactions between drugs, iPhone/iPod touch herbals & supplements BlackBerry
  16. 16. ABXGuide $24.95 Johns Hopkins Organized by diagnosis, drugs, pathogens, management and vaccines Renal dosing guide Diagnostic criteria Treatment iPhone/iPod touch Android BlackBerry Windows Mobile regimens/algorithm Palm Symbian
  17. 17. Today’s experienced physician needs close to 2 million pieces of information to practice medicine. Denekamp Y. IMAJ 2007;9:771-6 “Good information is the best medicine.” Michael E. DeBakey, MD
  18. 18. 71 successful CATs Evidence 23% searches Redbook corrected Best Evidence JAMA Series Cart previous Cochrane diagnostic test/ MEDLINE Textbooks treatment Simulscope 81% 18% affect led to additional diagnosis/ test or new treatment Used 98x management decisions decision in 1 month Sackett et al, JAMA 1998;280:1336-8
  19. 19. PubMed on Tap $2.99 Advanced search (AND, OR, NOT) Full text/free full text (via Safari) Order full text via Loansome Doc Retrieve/store pdfs in personal library Email references free lite version iPhone iPod touch iPad
  20. 20. DocGuide Free Articles & abstracts from 2000+ peer- reviewed journals Dispatches from top national & international conferences Forum Multiple specialties iPhone/ iPod touch & interests covered
  21. 21. Orkov Free Search PubMed Retrieve full text and PDFs Keep notes “Jump” to navigate Zoom in on figures Find related articles Built-in browser for iPhone/ iPod touch viewing documents
  22. 22. Free PLoS Medicine Created by Center for Biomedical Informatics (Harvard Medical School) with Public Library of Science PLoS is a leading open-access medical journal View online or get pdf Favorite & share iPhone/ iPod touch
  23. 23. $59.95 Harrison’s Manual of Medicine Derived from Harrison’s Principles of Internal Medicine Diagnosis & therapy (emphasis on patient care) Free 1-year access to Harrison’s iPhone/ iPod touch on the Web
  24. 24. $59.99 Oxford Handbooks Clinical Medicine Clinical Specialties Critical Care General Practice Endocrinology & Diabetes iPhone/ iPod touch
  25. 25. Clinician’s Pocket Reference Free (The Scut Monkey Book) Pocket reference for house staff, medical students & interns iPhone/ iPod touch
  26. 26. Auscultation $2.99 40+ Sound Study questions featuring heart murmurs, lung wheezes and stomach aches Timed exam Graphical performance statistics Bookmarks iPhone/ iPod touch Personalized notes
  27. 27. 2 unanswered questions for every 3 patients seen 40% fact MDs pursue 44% medical only 30% of opinion their questions Denekamp Y. IMAJ 2007;9:771-6
  28. 28. Most Common Obstacles Prevents pursuit Obstacles to of questions finding answers Question not that important Relevant Doubt about Uncertainty topic not existence of about where included in relevant to look for resource information Lack of time info to initiate a Resource search does not Ready anticipate availability of ancillary consultation info needs Ely et al JAMIA 2005;12:217-24
  29. 29. MD Recommendations Comprehensive information Anticipate likely clinical Emphasize Answer questions detailed clinical treatment queries Summary recommen- directly with bottom- dations Can a line recommen- smartphone Tell MD what help? dations to do even when evidence lacking Ely et al JAMIA 2005;12:217-24
  30. 30. $79.99 5-minute Clinical Consult Diagnosis & management of over 900 medical conditions New in 2011: 22 topics & 14 treatment algorithms Offered by SkyScape, Unbound Medicine & iPhone/ iPod touch Lexi-Comp
  31. 31. Diagnosaurus DDx $0.99 More than 1,000 differential diagnoses Disease, symptom or organ system searching Personalized favorites Extensive links to iPhone/ iPod touch related entries
  32. 32. Free CliniPEARLS Condensed versions of clinical guidelines by the British Columbian Guidelines & Protocols Advisory Committee (GPAC) Search for specific guideline, topic or keyword iPhone/ iPod touch
  33. 33. ACC Pocket Guidelines Free American College of Cardiology Adapted from ACC/ AHA Practice Guidelines Installs into Skyscape Medical Resources Environment iPhone/ iPod touch
  34. 34. STAT Asthma Free NHLBI Guidelines Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma Interactive tool Check off data - symptoms, nighttime awakenings, SABA use, lung function results etc. iPhone/ iPod touch
  35. 35. STAT Adult Immunization Free Full updated 2009 CDC Recommended Adult Immunization Schedule Includes all adult age groups & vaccine schedule based on medical & other indications iPhone/ iPod touch
  36. 36. Free STAT Framingham Heart Age Based on Framingham Risk Score Estimate a person’s ‘Heart Age’ which could be higher than their chronological age iPhone/ iPod touch
  37. 37. STAT Cardiac Clearance Free ACC/AHA 2007 guideline on perioperative CV evaluation and care for non- cardiac surgery Step-by-step cardiac evaluation & care algorithm iPhone/ iPod touch
  38. 38. Free Information on many traditional herbs & botanicals Medicinal used in Herbs complementary & alternative medicine (CAM) Not evidence-based iPhone/ iPod touch
  39. 39. Nearly impossible to stay up-to-date! Medical knowledge doubles every 19 years Body of knowledge increases by at least 400% in a 38-year career Smith, Richard. BMJ 1996, cgi/content/full/313/7064/1062
  40. 40. Skyscape Medical Resources Free Archimedes: medical calculator & decision resource Outlines in Clinical Medicine RxDrugs: includes drug dosing calculators MedAlert iPhone/ iPod touch
  41. 41. Free Pri-Med Mobile Watch concise expert presentations Solve real cases from real doctors Compete in compelling medical challenges Earn free CME credits iPhone/ iPod touch Android
  42. 42. Free AF Guide: The Atrial Fibrillation Reference Management of acute & chronic atrial fibrillation Estimate stroke & bleeding risk Warfarin dose calculator Quick access to drugs & dosing in iPhone/ iPod touch acute setting
  43. 43. Free Joslin CME Diabetes- focused certified CME Audio and slides Alerts for new programs Keyword searches to find CME you want iPhone/ iPod touch
  44. 44. Sale ECG Guide $0.99 ECG reference ECG library: over 200 high resolution sample ECGs 100 MCQs to test your knowledge iPhone/ iPod touch
  45. 45. iRadiology Free Quick review of classic radiology cases Lieberman’s iRadiology Classics Collection: >500 unique images Toggle image labels on and off Zoom, pan & iPhone/ iPod touch rotate images
  46. 46. Wirdy Medical Free Save PDFs to read off line Search medical news and research papers Landscape & portrait mode supported View full color eBooks and PDFs iPhone/ iPod touch
  47. 47. Free PandoraBox App Store has 10,000+ apps 100+ apps on sale & 300+ free apps everyday Receive the latest information about new apps Find about free or discounted apps iPhone/ iPod touch Track your favorites
  48. 48. iTunes U Learn anything, anytime, anywhere. A powerful distribution system for everything from lectures to language lessons, films to labs, audiobooks to tours
  49. 49. Patient Access to Point-of-Care Disease Communication Resources Documentation Management mHeal" Body Area Education Network Programs Pharma/Clinical Professional Trials Communication Public Ambulance/ Financial Administrative Health EMS Applications Applications
  50. 50. #ank Y$