Why should doctors use medical apps?
A Canada Health Infoway study from 2014 indicated 67% of Canadian family physicians owned a smartphone. 82% used them for drug references and 50% for clinical decision support.
This number has increased in the last 5 years. It’s difficult to get an accurate number, but some statistics state that 90% of physicians have a smartphone in 2019 and use it in some clinical manner.
There are many reasons why physicians should use medical apps. These range from improving efficiency by saving time, speeding up diagnoses and limiting unnecessary visits. Others want access to electronic health records or their colleagues. Most just want to find accurate information quickly. The reasons are endless.
I personally want to use my “over 40” memory for other things and offload what I can.
I have been giving medical app talks and workshops now for almost 2 years. Initially in 2018, when I reviewed the literature, there were a handful of articles with sporadic mention of apps and the options for download were limited. Today, the number of medical apps has exploded.
However, before considering an app, you should review it like anything else. We are taught to use clinical judgment and evaluate anything before incorporating it into practice. If we are looking at a journal article or study, we have a standard way to assess the results and conclude if the information is accurate and useful.
Medical apps should also be assessed in a similar fashion. You should always ask yourself the following questions before you consider using them in your toolbox:
- Who produced it? Who developed the app? This is a very important question to ask. Is it a private company or a drug company? Is it a university or association? What do they have to gain from you using it?
- Is it regularly updated? This can be found at the download point of the app, as it is better if updated more regularly. If you are using it to make clinical decisions, then it is important to know it is using the latest medical knowledge.
- Is it properly referenced? If the app uses an algorithm, does it tell you what the clinical judgment is based on? Does the app actually do what it is supposed to do? How is the developer getting their conclusions?
- Is it possible to give feedback? Can you contact the developer to provide input regarding its accuracy and its use?
- Is it peer-reviewed? Is it widely used, and does it come recommended?
- Is the app’s primary purpose to inform health professions or patients?
- Any issues with privacy? Does the app collect data? What is the data used for? Does it adhere to local privacy regulations?
The majority of these answers can be found in the App Store or in Google Play prior to downloading the app. Alternatively, a quick search online could also yield the answers.
If you are still reading, I can only assume that I have caught your interest and you are ready to venture into the wonderful world of apps.
Or perhaps you have looked at the “questions to ask before downloading” and are overwhelmed. So you have assessed the situation carefully and concluded that it is better to download what I have recommended hoping that I have already done the work.
My recommendations are a mixed bag. I was asked to limit the apps to the most relevant but this proved to be a difficult task. There are so many wonderful apps and so little page space.
For this article, I have looked mainly at point-of-care apps and guideline apps. Should this blog become widely successful, I may be welcomed back and can recommend more apps per specialty.
Few of the apps are bilingual and are available in both official languages.
Here they are in no particular order:
1. UpToDate by Wolters Kluwer
This app needs no introduction―most physicians have heard or used UpToDate at some point in their careers. But not all have used the app. You have to have a subscription in order to use it and it is a great point-of-care app. It uses Lexicomp as the drug database.
The cost of subscription varies. It costs about $519 US per year for individual physicians. There are discounts if you are a CMA or CCFP member. There is a special discount for residents and medical students as well. Certain medical schools and institutions even cover the cost.
2. DynaMed by EBSCO
This is another point-of-care app that was founded by a family physician and is now owned by EBSCO. Similar to UpToDate, you need a paid subscription in order to use the app. It uses Micromedex as its drug database.
The subscription is about $399 USD per year but if you have a CMA membership, it's free.
3. RxTx mobile
This app is developed by the Canadian Pharmacists Association―it’s literally the old blue CPS we used to have in our offices in days of yore. I remember it fondly with its paper-thin pages and very small, minuscule font. I am unsure why we ever left that format, as it was a great door-stopper for the ever-closing exam door.
The new and improved RxTx includes the same information as the old book and includes regular updates and Health Canada Advisories and a limited medical calculator. It unfortunately cannot do multidrug interactions and doesn’t provide LU codes. It will not hold the exam door open either.
Cost varies on the functionality and content. For the basic drug database, it is $239 and increases if you wish to have therapeutics content added. The CPS and Drug Choices (RxTx) is included with the cost of CMA membership.
4. Joule (no longer available)
By now, you may be sensing a pattern about the CMA. I can wholeheartedly say that I do not have any affiliation with the CMA other than buying a membership so I can have access to these apps and other clinical content.
The Joule app is easy to use and includes the latest POEMs, InfoPratique as well as quick access to CMAJ, DynaMed, RxTx and ClinicalKey.
ClinicalKey gives access to over 1000+ texts, 600 journals, handouts, practice guidelines, images and videos. Journals include AFP, Lancet, JOGC and many others. It also gives you access to a clinical librarian who will answer your research questions.
All for the cost of a CMA membership ($195).
5. Thrombosis Canada (Free)
This app provides clinical guidelines and algorithms for the use of antiplatelet agents and oral anticoagulants. It is easy to use and allows you to enter anonymous patient data and achieve individualized recommendations. It is developed by Thrombosis Canada and was last updated in November 2019. It is bilingual.
6. INESSS Guides (Free)
This is a guideline app which is developed by the Institut national d’excellence end santé et en services sociaux (INESSS) and is supported by the Quebec government. It was originally a French app, but is now available in English. Their website is available in French and English, outlines their methodology and answers all the pertinent questions.
It is simply a great app that gives you antibiotic prescribing information and guidelines for various chronic diseases including dementia, type 2 diabetes, STIs, indications for testing and much more.
7. CDN STI Guidelines (Free)
This is a very useful guideline and treatment app developed by the Public Health Agency of Canada. It examines the Canadian Guidelines for Sexually Transmitted infections and provides treatment recommendations as well as advice on diagnosis. I particularly like this one as antibiotic resistance is constantly changing and it gives me the current options.
8. Anti-infective Guidelines (MUMS)
This is an app version of the infamous “ Orange Book” anti-infective guidelines that was released for the first time 20 years ago. This was a game-changer app for me as I used to carry that orange book with me everywhere. I would write across the front page with a black Sharpie daring anyone to take it from me. I would glare at anyone who would even look at it. Now that it is on my iPhone, I am quite happy to lend my tattered paper copy! They also just had a free update about 1 month ago. This wonderful book/app is developed by MUMS Health/PAACT CME.
It costs $24.99 in the App Store and there is an Android app in development.
9. Visual Anatomy Lite (Free)
I would be remiss if I didn’t recommend an anatomy app of some sort and picked a free one as a simple option.
This is a basic anatomy app that allows physicians to refresh their memory about the human anatomy. It is also a good app to use for educating patients. There are a large number of paid apps that are more comprehensive and seem to be much better.
10. GRC-RCMP Drugs Awareness (Free)
This a simple app developed by the RCMP to educate about drugs and illegal activities. It was recently updated to remove cannabis from the illegal list.
Where else can you learn the many names used to refer to certain drugs? The app discusses the drug, its effects, visible signs and symptoms of usage, myths and truths, information for parents, legal status and more. It also gives numbers to call if in need of help and discusses ways to prevent drug abuse. It is a necessary app for the medical toolbox, but also a good one to recommend to patients.
11. Aspirin Guide (free)
This has made it to my list of recommended apps as this seems to be the big question in my clinic lately. Do I stop ASA or do I start? For some reason, I was not able to find a great algorithm online to help me with my clinical decision until now.
Developed by researchers at the Brigham and Women’s Hospital (Harvard Medical School), it helps clinicians decide who is a candidate for low dose ASA in primary prevention of atherosclerotic cardiovascular disease (ASCVD).
It walks you through a screen-by-screen algorithm that allows you input anonymous patient specific data and it gives you a clinical summary with NNT and NNH for ASA. Brilliant!
12. TELUS EMR App (free to users)
This app is recommended for those PS TELUS EMR users who are unaware of its functionality. I am biased because I use this EMR.
This is a rather easy-to-use app that adheres to all privacy regulations. It allows you to manage your schedule and your patients. It gives you access to their chart at any time of the day. Who wouldn’t want to work 24 hours a day?!
The advantage of this app is the camera. I often use it in office as it allows me to take pictures of rashes or medical anomalies and downloads them directly into the EMR. It does not store the photo on your phone.
Another unique feature is that the app allows you to dictate directly into the EMR using the microphone function. At times it is faster to dictate into my app while I am sitting at my desk in the office than type in my notes.
I hope you find these apps useful and see you at one of my talks someday.
What are your favourite apps? Any that are truly amazing?
This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including CMA Joule.