1) Smartphones provide physicians with access to medical resources and clinical tools at the point of care, which can help reduce medical errors and improve patient outcomes. 2) Numerous medical applications are available for smartphones that allow physicians to access drug references, clinical guidelines, medical calculators, journals and literature searches. 3) While smartphones provide opportunities to improve care, physicians still face obstacles in finding and applying relevant information to patient care due to time constraints and uncertainty about where to look for answers.

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. No
conflict
of interest

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. 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. “... 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. 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. 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. “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. “Mobile technology has the
potential to revolutionize how
physicians practice medicine.”
Burdette et al Clin Inf Dis 2008;47:117-22

10. Smartphone
SMS
MMS No industry
Voice calls standard
Phonebook definition
More than
Miniature basic cell
computer with phone
phone capability capabilities
Wikipedia

11. Smartphone Platform Market Share
Palm
Google
6%
9%
Microsoft 16% 43% RIM
Apple 26%
comScore Feb 2010 (US)

12. US Physicians Using a Smartphone
No
smartphone
36%
36% 27% iPhone
64%
37% Blackberry
2009 Manhattan Research Survey “Taking the Pulse”

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. Epocrates Free
Prescription
medication
OTC drugs
Pill ID
Drug
interactions
Medical
iPhone/iPod touch Android calculator
BlackBerry Windows Mobile
Palm

15. Medscape Free
Internet access
not required
6000+ drugs
1000+ OTC
1000+ Herbal
supplements
Interactions
between drugs,
iPhone/iPod touch herbals & supplements
BlackBerry

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. 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. 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. 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. DocGuide Free
Articles & abstracts
from 2000+ peer-
reviewed journals
Dispatches from
top national &
international
conferences
Forum
Multiple specialties
iPhone/ iPod touch & interests covered

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. 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. $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. $59.99
Oxford Handbooks
Clinical Medicine
Clinical Specialties
Critical Care
General Practice
Endocrinology &
Diabetes
iPhone/ iPod touch

25. Clinician’s Pocket Reference Free
(The Scut Monkey Book)
Pocket reference
for house staff,
medical students
& interns
iPhone/ iPod touch

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. 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. 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. 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. $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. 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. 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. ACC Pocket Guidelines
Free
American College
of Cardiology
Adapted from ACC/
AHA Practice
Guidelines
Installs into
Skyscape Medical
Resources
Environment
iPhone/ iPod touch

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. 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. 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. 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. Free
Information on
many traditional
herbs & botanicals
Medicinal used in
Herbs complementary &
alternative
medicine (CAM)
Not
evidence-based
iPhone/ iPod touch

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, www.bmj.com/
cgi/content/full/313/7064/1062

40. Skyscape Medical Resources
Free
Archimedes:
medical calculator
& decision
resource
Outlines in
Clinical Medicine
RxDrugs:
includes drug
dosing calculators
MedAlert
iPhone/ iPod touch

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. 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. 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. 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. 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. 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. 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. iTunes U
Learn anything,
anytime, anywhere.
A powerful distribution system for
everything from lectures to language
lessons, films to labs, audiobooks to tours
http://www.apple.com/education/itunes-u/

54. Patient Access to Point-of-Care Disease
Communication Resources Documentation Management
mHeal"
Body Area Education
Network Programs
Pharma/Clinical Professional
Trials http://www.mobih.org Communication
Public Ambulance/ Financial Administrative
Health EMS Applications Applications

55. #ank Y$
http://www.endocrine-witch.info
isiptan@gmail.com