Transcript - Emory University

The Best Medical Apps
EBM tools for Clinicians
Allan Platt PA-C, MMSc
Faculty, Emory University School of
Medicine, Physician Assistant Program
[email protected]
How do you keep learning?
• Passive Learning (Lecture) does not work as
well as Active (Doing case basedlook-ups)
learning
• Lectures do nothing to change practice
• This lecture is worthless unless you do the
“Play list”
• -
Bluestone J, Johnson P, Fullerton J, et al. Effective in-service training design and delivery: evidence from an integrative
literature review. Hum Resour Health 2013;11:51 doi:10.1186/1478-4491-11-51 [PMC free article
Best Learning is Active learning
• Self directed learning is active and changes
practice
• Every patient can tell a story
• Review each patient’s problem list and do
active 2 min look-ups to refresh your brain
and practice
• Could have had a EBM (Evidence Based
Moment)
http://current.effie.org/winners/showcase/2008/2366
Why Smart Phone or PDA
• Mobile reference available anywhere at
anytime ( Maybe not in surgery…)
• Wear it so you will use it. If it is not fast, easy,
helpful and accessible you will not use it.
• Provides your communication and contacts
(Voice, email, texting…)
• Provides scheduling, reminding, planning
• References that are continuously edited and
updated.
References Help, but…..
• Never will they replace a thinking brain with
clinical reasoning looking through experienced
eyes and filtering the patient’s unique
circumstances.
• Learn medicine first and use the references to
keep up to date and to jog your memory.
• Learn from every patient you see.
• Do not let it interfere with interpersonal
communication like body language….
• Read, then read some more, then some more…..
What is Evidence Based Medicine or
EBM?
• "...the conscientious, explicit, and judicious
use of current best evidence in making
decisions about the care of individual
patients." (Sackett, Richardson, Rosenberg, and Haynes,
Ed. "Evidence-Based Medicine: How to Practice and Teach
EBM." 1st edition, Churchill-Livingstone, New York, 1997.
page 2.)
Evidence Sources
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Colleagues “What do you think?”
Textbooks – may be too old, down the hall….
Journals (Pubmed, Medscape)
Guidelines (www.Guidelines.gov)
Appraised evidence (Dynamed, Uptodate,
Essential Evidence, Pepid, BMJ: PDA or Web)
• Internet – Google #1, Wikipea #2 - Not GREAT
(there are better sites)
• E-textbooks– Harrisons Practice, 5min Clinical
Consult….
Dr. Google
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Multiple signs and symptoms:
“Headache, fever, tick bite”
Hard to find in references
Google searches for web pages with all the
words
• Lots of things to sort through
Google Results
• Look for
.gov, .edu
• Pub med
• nih.gov
CDC web page
WebMD
iTriage
Journals with research results
Review articles with meta analysis
PubMed, Medscape
Guidelines
www.Guidelines.gov
Current E-textbooks:
5minCC, Harrisons
Best Evidence
Pre-Appraised Evidence
Products – DynaMed,
UptoDate,
Best Evidence must be:
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Portable and accessible
Updated frequently
Cost effective (Free is for ME!)
Quick and easy to use
Credible
Incorporated into daily routine
Solution – PC/Internet in every room or
PDA/smartphone on every hip
Practicality
• Read the chart before seeing the patient and
do a quick disease look-up to refresh
• Read your references between the Hx and PE
while patient is getting undressed
• Read after the PE while patient is getting
dressed and you are writing your note.
• Read during breaks, lunch, train, between
patients.
• Multiple 2- 5 minutes chunks of
enlightenment
Too many apps - Help me PLEASE!
• Medical App Reviews – iMedical Apps at
http://www.imedicalapps.com
• App Evaluation Studies – Pub Med
A Review
• Evidence about the
Evidence
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Prorok JC, Iserman EC, Wilczynski NL, Haynes
RB. The quality, breadth, and timeliness of
content updating vary substantially for 10 online
medical texts: an analytic survey. Journal of
Clinical Epidemiology. Vol. 65 (12) December
2012, Pages 1289–1295
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Point of care information services: a platform
for self-directed continuing medical education
for front line decision makers Lorenzo Moja1,2
and Koren Hyogene Kwag2 Postgrad Med J. 2015
Feb; 91(1072): 83–91.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC
4345919/
EBM Apps
Best Resources
Top 6 Evidence Based PDA Medical Apps in rank order
PDA Based
Timeliness Breadth Quality Cost 9/14
1. DynaMed
1
3
2
$395
2. UpToDate
5
1
2
$499
3. BMJ Best Practice/Epocrates Essent
3
4
7 100/$159
4. First Consult
9
5
2 Free
5. Medscape Mobile
6
2
9 Free
6. PEPID
N/A
6
10
$299
1 = Best 10 = Worst
Prorok JC, Iserman EC, Wilczynski NL, Haynes RB. The quality, breadth, and timeliness of
content updating vary substantially for 10 online medical texts: an analytic survey.
Journal of Clinical Epidemiology. Vol. 65 (12) December 2012, Pages 1289–1295
Trial
yes
yes
yes
iThings
Free
yes
2016 Review
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Med Internet Res. 2016 Jan; 18(1): e15. Published online 2016 Jan 19. doi: 10.2196/jmir.5234
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Point-of-care information summary rankings with providers listed in alphabetical order. Quartiles
according to 2014 rankings for volume, editorial quality, and evidence-based methodology: black, bottom
dark gray, low intermediate; light gray, high intermediate; white, top - Best
Top 3 :
BMJ
(Epocrates)
Dynamed
UpToDate
New Dynamed app
• Easier to
navigate and
search
• For iThings and
Android
UptoDate
UptoDate Cost
• If you have a VA/ Institutional UpToDate login
– it may allow the mobile App to work
(download from the app store for free and use
your username and Password)
• $199/year Student price
Epocrates Essentials
• Disease information is BMJ Best
Practice (good EBM)
• Drug information
• Lab Reference
• Multicheck drug interactions
• Best Dose Calculator
• Best formulary information
• Best pill picture identification system
• Infectious Disease app – Bug/drug
• Calculators and Tables
Epocrates Essentials
Emory does not cover this
• There is a $100 Education discount when using your @emory.edu email to
register
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To get started with your Epocrates subscription, please click this link for
$49.99:
https://www.epocrates.com/referral.do?p_r_name=EMORYUNIVPA
If you do not have an Epocrates account
Click on ‘Register Now’ and follow instructions to create your account
If you already have an Epocrates account
Login to your Epocrates account.
The product will be added to the shopping cart automatically. Your total
should be $49.99 (plus any applicable tax). Click the ‘Check Out’ button.
Click ‘Confirm’ and click ‘Continue’ on the following screen.
When complete, follow the on screen instructions to download and
install.
Epocrates for Free
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Drug information
Multicheck drug interactions
Best Dose Calculator
Best formulary information
Best pill picture identification system
Calculators and Tables
Missing Disease information, Herbals, Lab, ID
Medscape Mobile
• Free on all devices
Best ID resource
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Clin Infect Dis July 1, 2012 vol. 55no. 1 114-125 Free at http://cid.oxfordjournals.org/content/55/1/114.full
Johns Hopkins Antibiotic Guide
Lab Values
• ARUP Consult
(iThings)
• Quick Labref
(Android)
• Mayo Medical Lab
(iThings)
• Evidence Based
Primary Care(iThings)
American Family Physician –
AFP by Topic
Diagnose
• Likely hood ratios for signs and symptoms
PubMed
Free Medical Calculators
• MedCalc
• Calculate QxMD
• Epocrates Tools
Prevention – ePSS - Free
• Electronic Preventive Services Selector from AHRQ
• http://epss.ahrq.gov/PDA/index.jsp
Skyscape
• Register for free
at
http://www.skysc
ape.com/sml/
Free Drug, Merck
medical reference,
Calculator, news
Specialty books
Skyscape -Omnio
Best Emory SubscriptionsMobile Resources
http://health.library.emory.edu/resources/clinical/mobile-resources.html
Emory Resources
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Dynamed
U -Central
Access Medicine
Full Text Journals via Pub Med – Web
Textbooks – Web (Theime Series)
ClinicalKey
UCentral
Unbound
Medicine
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E Books updated
5min EM consult
5min Peds consult
Baby Bates - PE
JH- ObGyn
JH – Abx guide
JH – Diabetes
JH – HIV
Medline
Access Medicine
• Full Medical e-textbooks
• Need internet connection
• Pay by the book/yr
Access Medicine App
• Quick Medical
Diagnosis
• Tests
• DDx with
Giagnosaurus
• Derm book
ClinicalKey – Web based
• Search by
topic
• Results:
articles,
Elsevier
books,
guidelines
• Internet
based
• Save as PDFs
Thieme e-books
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http://ebooks.thieme.com.proxy.l
ibrary.emory.edu/bookshelf
Equipment links
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EKG: http://www.ecgcheck.com/
Pulse oximetry – iHealth
Otoscope - www.cellscope.com
BP cuff - iHealth
Weight scales -Withings WS30
Equipment
• Dermatoscope
• Microscope
• Glucometer
More Equipment
• Ophthalmoscope
• Finger pulse rate monitor
• Ultrasound - http://www.mobisante.com/products/product-overview/
Apps that can help
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Cloud storage – iCloud, Digital Dropbox, Box
Evernote, Good Reader
Documents to Go
Dragon dictation
WritePad – handwriting recognition
Kindle
Bottom Line
• Best device: any iThing or Android you wear
• Best EBM- Dynamed
• Best free drug interaction check with herbals
Medscape mobile or Epocrates Essentials
• Fastest free Drug dosing calculator, formulary
and pill picture identification Epocrates Rx
• ICD 10 codes - Dynamed
The Future
• Wearable sensors and point of care
diagnostics
• The $10M Qualcomm Tricorder XPRIZE
• Nokia Sensing Xchallenge - 1 drop of blood
http://sensing.xprize.org/teams/competition-2-teams
To Do – Action Plan
• Get Dynamed, Access Medicine, Ucentral, and all the Emory
sponsored apps for Free
• Get Epocrates Free at the App store
• Get the Free Medscape Mobile at the App store
• Play!