While consumer apps have evolved quickly, apps for physicians have lagged behind, in both quality and utility
While mobile health apps for consumers have proliferated in the tens of thousands, apps for physicians have stagnated, doctors and observers say. Many physicians use apps in their daily work, but most of them are reference and diagnostic apps and calculators that have not changed much in the past several years.
In the view of Jeff Livingston, MD, an OB/GYN in Irving, Texas, the static quality of physician apps “reflects a lack of innovation. There are plenty of apps made for doctors; there aren’t many apps for doctors that doctors really find useful.”
For a physician app to be worthwhile, it must make doctors’ lives easier and must improve patient care, Livingston says. UpToDate and Epocrates both meet those criteria, and so do certain calculators, he notes. But if a physician has to enter more than a few data points into an app, the doctor won’t use it.
Danny Sands, MD, a general internist affiliated with Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, agrees that most apps requiring data entry are non-starters for him. That’s one reason why a truly useful app like Isabel, which helps doctors double-check their diagnoses, is underused, he suggests.
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“I’ve got to enter all these facts about the patient [in Isabel],” he says. “Frankly, my EHR (electronic health record) knows all that stuff, and I don’t want to be transcribing it. That’s a barrier to any of these things. I can quickly enter a patient’s age and sex into an immunization app, but when it goes beyond that, it gets a bit cumbersome.”
Paul Brient, chief executive officer of PatientKeeper, which sells a suite of patient rounding apps, believes that a lack of interoperability with EHRs and the need to enter data manually in non-reference apps have held back innovation in this field. “In a world where app developers could get data out and put data into the core EHR, we’d see an explosion of creativity,” he says.
A new Health Level Seven (HL7) standards framework, known as Fast Healthcare Interoperability Resources (FHIR), is widely expected to make this possible. FHIR-enabled apps would act as plug-ins to EHRs that were able to accept them. As a result, developers could write a wide range of apps that would be able to re-use EHR data. But it might take a few years to achieve that goal, experts say.
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In the meantime, some vendors are embedding links to reference apps in their EHRs. For example, Medhavi Jogi, MD, an endocrinologist in Houston, Texas, says he can launch UpToDate within his EHR. But the reference app still can’t be populated by his EHR data, whether he uses it on his desktop or a mobile device.
Jogi loves UpToDate, partly because it allows him to look up information at the point of care and has the calculators that he needs. He also gets CME credits for finding and reading studies, and UpToDate manages that for him. All in all, he finds the app worth the $500 a year it costs him.
The fact that UpToDate is embedded in his EHR also makes it easier to use. In contrast, he doesn’t often use mobile apps, because he has to leave his EHR to take advantage of them. “If an app isn’t in my EHR workflow, I’m not going to use it,” he says.
One exception to that rule, Jogi says, is doxy.me, a free telemedicine app that he has on his iPad. He’ll leave his EHR to use it when he does virtual consults with patients. They can look at him, and he can see them on his tablet. Nevertheless, when he needs to find information in the EHR, he has to swivel back to his desktop, which means he’s looking away from the patient.
“In general, if you’re using an app, you’re not using something else, because you can only look at one thing at a time,” he points out. “So if I’m using an app, there’s something lacking from my workflow in the EHR. Unless I’m doing it for fun, to have to go look for that is a sign of an inefficient doctor.”
Jeffrey Pearson, DO, a family physician in Carlsbad, California, disagrees. He points out that if he needs to look something up, it doesn’t matter whether he does so on his smartphone or his desktop computer. “If I’m with a patient and prescribing a drug, I want to get the right dose, so I may have to look it up. I just keep my phone on my hip, silenced,” he says.
In the pre-smartphone era, when personal digital assistants ruled the world, the most widely used mobile apps were e-prescribers and charge capture programs. Few physicians use standalone e-prescribers anymore, Sands says, because EHRs have absorbed that function. But a number of charge capture apps are still available, although there’s some disagreement about their usefulness.
Livingston says that he doesn’t like charge capture apps because they require manual entry of patient names and census updates. Some programs also require doctors to enter procedure codes. Nevertheless, PatientKeeper, a hospital rounding app suite, includes a charge capture app that is employed by about one-third of its 60,000 physician users, Brient says.
These doctors use the app “because it helps them make money,” he says. It’s easy for them to record their charges as they round, and they can export those charges to their practice management system with two clicks when they return to the office, he says. In contrast, they may forget to fill out paper charge slips.
Standalone charge capture apps available in the iTunes store may require manual entry of demographic data, Brient notes. But PatientKeeper interfaces with hospital admission/discharge/transfer (ADT) systems, so census and demographic data, preauthorization codes, and insurance codes automatically go into the charge fields. Physicians just have to pick the right patients and click on diagnostic codes, he says.
Most of the leading EHRs have mobile versions, and Sands views that as a sign of progress for doctor apps. “One of the more useful things is that doctors are using EHRs on their mobile devices,” he says. “They’re able to look up patients’ records, their phone numbers, and their test results, and prescribe drugs.”
In addition, Sands points out, some patient portals attached to EHRs have mobile apps. He himself communicates with patients on a portal that he helped develop for BIDMC, he adds. “Having the EHR and the portal on your device is a godsend.”
But Jogi doesn’t care for his EHR’s iPad app. “It allows for data entry, but it is slower than my desktop and does not allow me to use the templates I usually use, which are best used on the desktop,” he says. A smartphone app, he adds, is okay for quick chart reviews, “but I use that only occasionally when patients call via my answering service.”
Physicians like free stuff, and free apps are no exception. For example, Pearson likes the Monthly Prescribing Reference (MPR), which originally came out as a pocket-size paperback. It’s more concise and easier to use than the Physician Desk Reference (PDR), he points out, and is now available as a free app for smartphones.
Other free apps he recommends are the Centers for Disease Control and Prevention’s vaccination schedule app and Calculate by QxMD, which includes calculators for risk scores.
Jogi likes doxy.me, the telemedicine app, because it’s free and provides secure remote consults, logs the stop and start time of each meeting, and includes a virtual waiting room. Most telemedicine apps cost $100 or more, he notes.
Livingston, who gets UptoDate from one of his hospitals, notes he could find most of the same references that the app provides by Googling them. However, he adds, he can locate them faster with UpToDate, and he also likes the way that the app summarizes the key information in studies.
Good apps are available for some specialties, but not for others. Jogi hasn’t found any useful apps designed for endocrinologists, for instance. If he needs the atherosclerotic cardiovascular disease ASCVD risk estimator published by the American College of Cardiology and the American Heart Association, he can quickly find it on Google, and he has a calculator for osteoporosis risk scores on his desktop.
In contrast, Livingston praises the “due date” calculator developed by the American College of Obstetricians and Gynecologists (ACOG). Another app, from the American Society of Colposcopy and Cervical Pathology, helps him decide how often a particular patient should get a Pap smear.
Livingston also uses Centricity Perinatal, an app provided to him by two of the three hospitals where he is on staff. This app is a “game changer,” he says, because it gives him real-time access to the patient monitoring equipment in the labor and delivery units. This allows him to see immediately when a mother or baby is in distress and helps him confer with nurses when they contact him about an emergent situation.
As a primary care doctor, Sands likes the electronic preventive services app from the Agency for Healthcare Research and Quality. Free and available for most mobile platforms, this app allows a doctor to enter a patient’s age and sex and find out what preventive care is recommended for someone with that profile.
Similarly, the American College of Physicians has an immunization advisor app that enables doctors to determine which immunizations a particular patient needs, he notes.
Livingston would like to see better apps for secure texting among healthcare providers. Currently, Tiger Text and Vocera offer such apps, but physicians don’t know who else is using those services, he says. The same is true for the secure messaging service offered by Doximity, the largest social network for physicians.
“With a doctor consult, I don’t necessarily know if they’re on Tiger Text or Doximity,” he notes. “It’s way more trouble to find out if they’re on one of these services than to find another way to communicate.”
Pearson says he rarely needs to message securely with other doctors. If he sends a patient for a treadmill test, for example, he’ll wait for the report to come back from the cardiologist. “If somebody is really bad, the doctor will call me, but it doesn’t come up that often,” he says.
Most doctors are still reluctant to communicate with patients via Facebook or Twitter, Sands points out, but they do so through patient portals. Pearson says he is Facebook friends with some of his patients, but he cautions them not to ask him healthcare questions on the site.
Physicians use a variety of non-medical apps in their daily work. Topping the list is Google. Besides helping doctors locate information immediately, it can be used to look up ICD-10 codes, notes Sands. Google has also scanned many medical textbooks and made them available and searchable to healthcare providers, Pearson says.
Sands frequently uses EverNote, a note-taking platform that stores virtual notebooks in the cloud for retrieval on any online or mobile platform. He uses this app to store tidbits of medical information, such as the rules for diagnosing diabetes or the latest immunization guidelines. Another folder contains information specific to his practice, such as how to reach the social worker on call or how the practice is doing flu shots this year in terms of reminders to patients and the urgency of vaccinations.
Another app he finds valuable is InstaPaper, which lets him store articles he wants to read later. He just clicks on an icon in a browser or on his smartphone to save the articles to this app. The app then formats the articles to make them easy to read.
Overall, despite the dearth of exciting new products, doctors have found a good variety of mobile apps that make their daily work a little easier and improve the care they provide.