What you need to know about medical apps for you and your patients

Although physicians seem happy to embrace the smartphone for personal use, only one in 10 already uses smartphone apps in their work with patients – however, 48% believe that they will be introducing mobile health apps into their practice in the next five years [1].

Patients, on the other hand, are downloading and using all kinds of health-related apps. A quarter of adults are using health or fitness-tracking apps, and a remarkable nine out of 10 patients would be happy to receive a mobile app ‘on prescription’ from a physician [2]. Furthermore a third of clinicians say they have recommended an app to a patient [3].

So how do we pick our route through this rapidly developing topic? With the number of healthcare apps in the tens of thousands, where are the opportunities and where are the dangers?

How to use apps with patients

One possible reason for physicians making little use of mobile apps as part of their practice is a reluctance to pick up their phone and start using it in front of a patient. However, doctors don’t really need to worry, the evidence is that patients in the hospital setting are quite happy for doctors to start using their smartphones or tablet if it means better diagnostic decision making. Patients say that the secret is to make sure that you tell them what you are doing. Patients in a recent small study acknowledged the complexity of their condition and recognised the need for caution in avoiding drug interactions. The patients interviewed during the study stressed the importance of doctors explaining why they are using the mobile device [4].

Mobile apps are also a very convenient way of keeping up to date with developments in your speciality, and keeping up with your continuing professional development.

Do you recommend apps to your patients?

If you are thinking of recommending apps to your patients, caution is advised. At present there is no control or regulation of the information and recommendations contained in mobile apps. An examination of apps intended to help patients with peripheral vascular disease found that only 13 of the 49 apps examined had received any input from a medical professional [5]. A 2012 examination of apps related to cancer found that nearly half of the apps did not contain scientifically validated data [6].

It has even been suggested that mobile apps should be regulated as medical devices and that randomised controlled trials should be undertaken to ensure the quality of apps [7].

The use of apps without proper medical input can have serious repercussions. For example, a recent systematic assessment of smartphone apps for calculating insulin dose found that the majority of insulin dose calculator apps provided no protection against, and might actively contribute to, incorrect of inappropriate dose recommendations [8].

Reviewing the thousands of possible apps that might be relevant for a patient is an unrealistic aim but help is at hand: the NHS maintains a ‘health apps library’ [http://apps.nhs.uk/] which only lists apps that have been reviewed. This is probably the best starting point.

Apps for physicians

Overall the usage of mobile apps for physicians falls into three main areas:

• News feeds, current awareness and general support
• Reference material, textbooks and education
• Point-of-care materials such as diagnostic algorithms, guidelines and medical calculators

Not surprisingly, many of these apps are created in the US for American physicians. More surprisingly many are for iOS only! This situation should change in the near future as Android devices continue to capture a larger market share.

It isn’t possible to provide here a comprehensive list of recommended apps appropriate for physicians, but we list some of the best known examples below. To remain current with new apps as they are launched it is worth regularly viewing websites such as iMedicalApps where the healthcare-based team behind the website regularly reviews medical mobile apps (http://www.imedicalapps.com/).

If your favourite medical app hasn’t been included in this list, please add it in the comments box below.

(Note that some of the apps listed below may require some registration or payment.)

News feeds, current awareness and general support
MedScape’s app is a classic that provides access to medical news, drug information and tools, disease condition information, medical calculators, drug formulary information and continuing medical education.
See: http://medscape.com/mobileapp

PubMed is accessible through a number of independent apps on both platforms. The value of having a literature search resource at your fingertips is unarguable.
See: http://www.imedicalapps.com/2011/01/best-top-pubmed-iphone-ipad-medical-apps/

BMJ Best Practice provides online or offline access to information about over 1000 conditions along with links to NICE and other guidance.
See: http://bestpractice.bmj.com/best-practice/marketing/best-practice-app.html

Some major hospitals provide lists of apps that they have developed
See for example: http://www.guysandstthomas.nhs.uk/news-and-events/download-our-apps.aspx

Reference material and textbooks
The Lancet app gives subscribers access to their Lancet content.
More: http://www.thelancet.com/app

JAMA provides a ‘network reader’ app
More: http://app.jamanetwork.com/

NEJM has an iPad edition available for subscribers but nothing for Android users
More: http://www.nejm.org/page/about-nejm/mobile-applications

UK GMC launched an app in August 2015 that allows users to record their learning activities to keep track of CPD progress during the year. The app provides a ‘hot topics’ section alerting users to potential learning opportunities, but doesn’t appear to provide any learning content through the app.
More: http://www.gmc-uk.org/education/continuing_professional_development/27539.asp

Point of care
NICE Guidelines This app allows users to access NICE guidance direct from their smartphone or tablet, include access when offline.
Read more: https://www.nice.org.uk/About/What-we-do/NICE-apps-for-smartphones-and-tablets#

NICE BNF The NICE British National Formulary (BNF) and NICE British National Formulary for Children (BNFC) apps have been developed to provide easy access to the latest up-to-date prescribing information from the most widely-used medicines information resources within the NHS. Both the BNF and BNFC apps are available to download for free by health and social care professionals who work for or who are contracted by the NHS in England, Scotland and Wales.
See: https://www.nice.org.uk/About/What-we-do/NICE-apps-for-smartphones-and-tablets#

UpToDate (for Android) from Wolters Kluwer. Well-respected clinical decision resource that has been the subject of a number of research studies. Subscription required for physician content.
See: http://www.uptodate.com/home/uptodate-mobile-access

@Point of Care provides and extensive library of apps some of which are suited to point-of-care use. Subjects covered include multiple sclerosis, diabetes, dermatology, leukemia and rheumatoid arthritis.
See: http://atpointofcare.com/

Epocrates is another app that has been around for many years but is beginning to receive criticism for lack of offline functionality.
Android: https://play.google.com/store/apps/details?id=com.epocrates

Pulse toolkit contains several useful calculators for common issues in primary care clinics such as screening tools for dementia, alcohol abuse, eating disorders, and more. There are also disease specific calculators like BPH symptom scales, Centor criteria, and Wells score.
See: http://www.imedicalapps.com/2015/07/best-medical-apps-may/6/

Friendly Base Deficit Calculator is a blood gas calculator app that was created by the Medical College of Wisconsin. Not only does it do simple calculations, but gives more complex information, such as alerting you to hyperchloremia with large volume crystalloid resuscitations.
See: http://www.imedicalapps.com/2015/08/best-new-medical-apps-of-the-month/3/

Bili QuikCalc is a medical app that enables you to manage and evaluate infants with jaundice in the newborn nursery. Bili QuikCalc incorporates the original information from the Bhutani article and follows the current AAP hyperbilirubinemia guideline. The app also has a companion Apple Watch version.
See: http://www.imedicalapps.com/2015/08/best-new-medical-apps-of-the-month/4/

OphthDocs Eye App is an ophthalmology app created by health providers in New Zealand. The app includes various sections that enable you to use it as a standalone app to help with your eye exam — E chart, Amsler Grid, Color Test, Astigmatism Fan, LEA symbols, and APD testing. The goals of the health inventors who make the app and the accessories is to provide affordable ophthalmic equipment. They have various accessories listed on their website that attach to your iPhone and turn it into various examination devices — such as a slit lamp and macro lens. In order to use the app you have to register (free), but it appears to be focused on New Zealand providers. No Android version
See: http://www.imedicalapps.com/2015/08/best-new-medical-apps-of-the-month/6/

Psych Journal Club is an app developed by a psychiatry resident who summarises nearly 50 key psychiatry studies, including methodology and key findings. The app is a nice quick reference to help trainees familiarise themselves with some core literature as well as clinicians who may periodically need to refresh their memories on studies.
See: http://www.imedicalapps.com/2015/08/best-new-medical-apps-of-the-month/12/

ACCU-CHECK is one diabetes app that is FDA approved. Making sure your patients are giving themselves the right amount of insulin based on carbs and current levels isn’t always straightforward
See: http://www.imedicalapps.com/2015/08/best-new-medical-apps-of-the-month/2/

If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.

References

1. Research Now. Are mobile medical apps good for our health? A new study by Research Now reveals that doctors and patients say ‘yes’[Internet]. 2015 [cited 2015 Sep 15]. Available from: http://www.researchnow.com/en-gb/PressAndEvents/News/2015/april/are-mobile-medical-apps-good-for-our-health-infographic
2. Digitas Health. mBook 2013 edition – Marketing mobile health [Internet]. 2013 [cited 2015 Sep 15]. Available from: http://m.2013.digitashealth.com/Mbook2013_web.pdf
3. Manhattan Research. Taking the Pulse U.S. 2014 Environment. http://manhattanresearch.com/Products-and-Services/Physician/Taking-the-Pulse-U-S
4. Patel R, Green W, Shahzad MW, Larkin C. Use of Mobile Clinical Decision Support Software by Junior Doctors at a UK Teaching Hospital: Identification and Evaluation of Barriers to Engagement. JMIR mHealth and uHealth. 2015 Aug 13;3(3):e80.
5. Carter T, O’Neill S, Johns N, Brady RRW. Contemporary Vascular Smartphone Medical Applications. Annals of Vascular Surgery. 2013 Aug 1;27(6):804–9.
6. Pandey A, Hasan S, Dubey D, Sarangi S. Smartphone Apps as a Source of Cancer Information: Changing Trends in Health Information-Seeking Behavior. J Canc Educ. 2012 Dec 30;28(1):138–42.
7. Zhang Y, Koch S. Mobile health apps in Sweden: what do physicians recommend? Stud Health Technol Inform. 2015;210:793–7.
8. Huckvale K, Adomaviciute S, Prieto JT, Leow MK-S, Car J. Smartphone apps for calculating insulin dose: a systematic assessment. BMC Med. 2015;13:106.