iPhone Apps for Health Providers, a Path Emerging?

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Last year we did a series of posts on Electronic Medical Records and Electronic Medicine. One of those articles, “Electronic Medicine, iPhones and Path-Dependence” noted the emergence in Electronic Medicine of the iPhone and the Blackberry. We also noted that the iPhone and Blackberry constitute “an advantaged path” (already in the pockets of roughly 64% of doctors, early popularity further attracting skilled labor, financing, and support) and that these platforms might be capable of playing a part in allowing us to avoid building a costly high tech Tower of Babel: offering “flexibility, interoperability, liquidity of information, and the ability to substitute technologies as the need arises.”

We wrote the following:

A Washington Post article, “New Tool in the MD’s Bag: A Smartphone,” states that “Nationally, about 64 percent of doctors are now using smartphones, according to a recent report by the market research company Manhattan Research.” Georgetown’s medical school has recently begun requiring them, and Ohio State’s is handing out the iPod Touch (sans phone) to its students. Mike McCarty, the chief network officer at John Hopkins Health Systems, “believes that smartphones will soon assume a permanent place in medicine.”

As such, designers have engineered applications to suit the needs of those doctors. And as a matter of path-dependence, presumably they will continue to do so. WaPo states that “the iTunes app store lists 674 applications related to medicine available.” There are iPhone and Blackberry apps to “pull up instructional diagrams and videos for patients, write electronic prescriptions and check basic information,” “look up drug-to-drug interactions, to view X-rays and MRI scans,” and even determine pill names derived from physical descriptions.

As we posted a while back,

In the words of Dr. Farzad Mostashari,  an assistant commissioner in New York City’s health department and head of the much heralded Primary Care Information Project (which is functioning as a sort of I.T. Department for many of the City’s doctors using EMR),  “There’s no way small practices can effectively implement electronic health records on their own. This is not the iPhone.”

Later, we noted that in their NEJM article,  No Small Change for the Health Information Economy, Kenneth D. Mandl, M.D., M.P.H., and Isaac S. Kohane, M.D., Ph.D. suggest that it should be. That

As do Professors Sharona Hoffman and Andy Podgurski, the authors of “No Small Change…” stress the need for flexibility, interoperability, liquidity of information, and the ability to substitute technologies as the need arises.  To do this they propose governmental encouragement of the use of a platform with interoperable applications (blog builders, think: “plug ins” and “widgets”)

similar to the iPhone.

We also noted in that post, “Electronic Medical Records: It’s Not too Late to Build the Tower on an Interoperable Platform,” that

Perhaps the good news here is that the relative scarcity of EMR implementation thus far means that we can yet still devise an interoperable system without rendering substantial but incompatible investments obsolete. Which is to say that we are not yet too far down nine different non-intersecting roads and that “a communicative Tower” can still be built, and sustained, on a Platform.

Now, it seems the path is beginning to emerge–and that interoperable system may actually be the iPhone and Blackberry platforms–which, it seems, are already sitting in doctors’ pockets.

And now via email from NursingSchools.net, an interesting list:

The 15 Most Forward Thinking iPhone Apps for Doctors & Nurses

It’s amazing how much we use our phones for anything but phone calls. The widespread use of applications, driven by the explosion of iPhone sales, has helped to redefine just what we’re able to do with our phones in all walks of life and work. The medical profession has been one of the biggest beneficiaries of iPhone app development, with life-changing tech showing up in nursing schools and hospitals nationwide. Some gather information from patients in new ways, while others help medical professionals better sort and understand that information. They’re all designed to help those in the medical field do their jobs in revolutionary ways. Here are some of the most forward-thinking and revolutionary iPhone apps out there for doctors and nurses:

1. e-911: Emerging Healthcare Solutions is developing an app called e-911, which would allow a user to store critical personal medical information that’s sent to health care providers when they dial 911 from their iPhone. The benefits are clear and enormous: Instead of wasting time discovering a medical history, first responders would know instantly what the victim’s medical past looked like.
2. Epocrates: One of the most popular free medical apps available for the iPhone, gives doctors and nurses up-to-date information on thousands of drugs, lets them identify pills by physical description, and describes the effects of combining different drugs. A Stanford university doctor even made a video about how much he loves it. (Free)
3. ICD9 Consult: Never go hunting through a book to find a code again. This app lists ICD9-CM diagnosis codes and lets you search and browse by category. It includes more than 21,000 individual codes, making it a phenomenal portable tool for medical professionals. ($14.99)
4. Human Body Advanced Encyclopedia 3D Anatomy: Don’t let the clunky title fool you: Doctors and nurses everywhere should have this app on their iPhones. The app includes three-dimensional renderings of the body’s 14 anatomical systems as well as the ability to see all sides and angles of organs. It’s like having an anatomy textbook in your back pocket. ($3.99)
5. Medscape: From the WebMD people, this is a fantastic all-purpose app that’s packed with information on brand-name and generic drugs, clinical procedures, and more than 150 videos. (Free)
6. iRadiology: This app for students is also a good resource for doctors and nurses who’ve been working for years. It features more than 500 images designed to help users hone their detection skills and become better at reading film, CT, and MRI images. It’s a smart, progressive app because it operates under the assumption that knowledge is something you constantly build, and it helps medical pros stay at the top of their game.
7. Reach MD CME: This is an awesome app for doctors and nurses looking to further their education in unique and time-saving ways. Reach MD CME is an accredited app for continuing medical education that lets you download and listen to medical programs and then take the certification test all on your iPhone. (Free)
8. NeuroMind: NeuroMind is a smart, thorough app that helps residents and surgeons by acting as an index for a variety of brain-related surgical topics. It also provides a checklist of Safe Surgery items from the World Health Organization. (Free)
9. Drug Trials: If you’re a doctor or nurse, you need this app. Drug Trials is all about the latest drug tests, whether it’s an established drug being tested in new ways or an entirely new product being tested for the first time. This is one of the best ways to stay informed about what’s happening in drug research, and it also includes facts like eligibility requirements. (Free)
10. Informed RN Pocket Guide: The $9.99 cost is more than most apps, but nurses get a lot for that price with this in-depth app. The Informed RN Pocket Guide is a PDF version of the printed book, and it features a ton of helpful information nurses need to know, including metric conversions, pain assessment tools, pediatric care information, and even Spanish translations. Worth the buy.
11. Nursing Central: I take it back: This app is the pricey one. Nursing Central requires a subscription payment of $159.95 before you can view the content, but if you can afford it, it’s a worthwhile purchase. The constantly updated database covers more than 5,000 drugs, and it features info on all manner of diseases and treatments plus a dictionary with more than 60,000 (!) entries. If you don’t know it, this app does.
12. Nursing Pharmacology: A handy app for nurses that features flash cards designed to teach you the ropes of nursing pharmacology. Basic features, but helpful. ($0.99)
13. PubMed on Tap: This is the full version, not the lite one. The PubMed on Tap app searches PubMed for reference info and then lets you store PDFs or e-mail the results to yourself or someone else. For medical pros on the go, or those who need to do some quick research away from the computer, this app is a life-saver. ($2.99)
14. Skyscape’s Medical Bag: Call it the digital version of the classical little black doctors’ bag. This app includes a number of helpful tools, including more than 100 medical calculators and multiple articles on life support. ($1.99)
15. iMurmur 2: This app is a great fit for practicing doctors as well as med students. It’s got a library of actual recordings of different heart sounds, complete with accompanying descriptions and phonocardiograms. A must-have for cardiologists or any pro looking to brush up on the heart. ($2.99)

Here’s an Idea: Asking Doctors about Health Care Reform

The New York Times just published a very interesting article that ties the efforts of the medical community to bring about change in the American health care system with Congress’s attempts to reform health care through legislation.  The article, which details the research of a team of health care providers in the Intermountain Healthcare system in Utah and Idaho, offers insight into what doctors are doing on their own to effect change while waiting for our nation’s leaders to implement the means to better health care for Americans.

As can be seen by American Medical Association’s recent endorsement of the Democratic House bill, and the long time call of the National Physician’s Alliance for reform, there is a consensus among  health care providers for health care reform.

Of course, essential in that reform is delivery system reform. Part of delivery reform is likely to emphasize not only preventive care, a cornerstone of Obama’s plan, but also a careful monitoring and consideration of the outcomes of health care practices.  Although there is debate about the best way to monitor and measure such practices, and some bridle at the prospect of being “confined” to protocols derived from large studies,  the evidence-based medicine model is emerging  as a favored tool with which to analyze how health care providers themselves can produce more cost-effective, life-preserving results. Evidence-based medicine puts protocols in place (which may be overridden at a doctor’s discretion) and relies heavily on the statistical analyses of a health care system’s performance (i.e., patient outcomes from particular practices).  Such is the model executed by the Intermountain Healthcare system highlighted in the Times article.

The protocols ultimately implemented sometimes differ from the usual course of treatment offered by some doctors. The physicians at Intermountain Healthcare admit that it is often hard for doctors to hear that they are doing something wrong– or perhaps “not optimally” would be a better choice of words.  The Executive Director of Intermountain Healthcare Institute for Healthcare Delivery and Research, Brent James, relates that some doctors do not believe the results of the statistical research because doctors are reluctant to change their ways, but that oftentimes when presented with clear statistical evidence doctors change their practices.  He gives the example of obstetricians who were performing elective inductions prior to 39 weeks for pregnant women for the sake of convenience, as the inductions save hours of labor for the mothers and therefore hours of hospital time.  However, an analysis showed that babies born prior to the 39th week of gestation were far more likely to wind up in intensive care. After doctors saw the data, and protocols were put in place, James found that the rate of elective inductions fell dramatically. A similar protocol developed for the treatment of one form of pneumonia was said to have cut the rate of death for that condition by 40% over several years.

Some doctors contend, however, that the medical metrics of evidence-based models are not the best way to bring change in health care practice, both because doctors will feel pressured to follow set protocols without considering other possible treatments and because humans are not statistical data that can be remedied through calculations and formulas. The danger, of course, is in negating the healing art– in throwing the proverbial baby– independent critical thought– out with the bathwater.  Doctors of this school of thought often espouse  revamped medical education as a better way to reform health care practices; after all, the basis of how health care providers develop their practices is the way in which they were/are taught.

And one wonders if there isn’t room for both approaches. If the education of medical students can be changed to incorporate better and cost effective practices based on studied outcomes (perhaps in part culled from the Health IT initiatives), and changed to incorporate greater emphasis on preventive care (coupled of course with a pay system which rewards patient wellness), while still respecting doctor autonomy so as not to prepare a generation of medical robots. It doesn’t sound “un-doable.”

Interestingly enough, medical schools have seen an increase in students applying to their programs.  In response, four new American medical schools have opened.  With the older generation of health care practitioners on its way to retirement, the need for more doctors is imminent.  But, we need doctors that are able to help carry the new ideals and practices of a reformed health care system; reaching into the med school curriculum would seem to make a lot of sense.

Two New Reports Look at Increases in Health Care Spending

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The Wall Street Journal reports that CMS estimates overall U.S. health care spending will reach $4.35 trillion in 2018, accounting for one-fifth of GDP. The findings by CMS were published Tuesday in the journal Health Affairs. In 2009, U.S. health care spending is expected to reach $2.5 trillion, a 5.5% increase from 2008.

The CMS study expects government health care spending to increase by 7.4% to $1.19 trillion this year. However, the study forecasts that, by 2016, the government will pay for more than 50% of total health care spending. The increase in government health care spending is expected to come from baby boomers enrolling in Medicare and increased enrollment in Medicaid.

Meanwhile, The New York Times reports that Medicare spending continues to vary widely across the U.S., according to a report to be published today in The New England Journal of Medicine.

According to The Times, Dartmouth researchers found that:

The regional differences in the growth of Medicare spending suggest doctors are helping to drive up costs when they more frequently order tests or admit patients to the hospitals. In areas where there are plenty of hospital beds and sophisticated imaging equipment available, doctors generally spend more on their patients.

Dr. Elliott S. Fisher, the director of the Center of Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice and one of the work’s authors, told The Times that:

[A]ny attempt to rein in health care costs . . . needs to address how doctors and hospitals are paid, where they are rewarded on the basis of the volume of services they perform.

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