A year ago I bemoaned the lack of third-party native iPhone apps and could suggest few workarounds for absent medical applications. Looking back at The medical Palm (written in 2004) serves to illustrate how stagnant the Palm platform has become—my list of software was essentially unchanged when I retired my Palm from clinical practice earlier in 2008. Although I did experiment with Windows Mobile and tried equivalent medical applications, it wasn't a relationship with a future. Following the lukewarm reception of Web apps Apple's native App Store for iPhone/ iPod touch opened on July 10, and the mobile medical landscape has been transformed in the space of just three weeks. Already we have seen the release of some impressive tools aimed at doctors, medical students, and patients/ well-being enthusiasts.
iPhone apps for clinical practice
Epocrates Rx (free) is a cross-platform drug formulary featuring monographs, a new visual "Pill ID" tool, an interaction checker (something I found especially useful on home visits using the Palm version), prescribing formularies (downgraded to US-only), and free wireless updates:
Which "little white pill" do you mean Mrs Smith? (© Epocrates, Inc.)
iChart EMR (£80) is an electronic medical record manager with patient lists, lab reports (manual or automated* retrieval), electronic prescribing*, diagnostic/ procedure codes and billing, and notes (with drawings and graphing of vitals) modules (* requires additional $US100 pa subscription for sync via a web-based application):
A clinical information system in your pocket (© Caretools, Inc.)
MIM (free) will appeal to referring physicians who can download non-diagnostic radiological images for remote viewing and discussion with patients, or radiologists who might wish to explain their interpretation to clinical colleagues:
A viewer for showing patients their insides (© MIMvista Corp.)
I could never manage without a gestation calculator. OBWheel (free) is just that, requiring the date of last menstrual period (LMP) in order to derive the estimated delivery date (EDD):
Accurate gestation has legal and care plan implications (© Chris Hanson)
Although this next app could have equal appeal for stressed-out medical students and patients, physicians often have particular difficulties Attaining Zen (£1.20) after an especially difficult consultation. Perhaps re-arranging rocks and drawing in the sand with your finger in between recurrent boils and chronic back pain will offer a means to "recharge"?:
De-stress in the sand after a deflating patient encounter (© Trileet, Inc.)
iPhone apps for medical students
Frank Netter is a god among medical illustrators; Modality, Inc. have produced stunning "flash cards" for revising general anatomy, musculoskeletal anatomy, head and neck anatomy, and neuroscience (£24 each). The illustrations are accompanied by annotations and a quiz mode:
Learning the cranial nerves should be easier now (© Modality, Inc.)
iPhone apps for patients/ well-being enthusiasts
Several applications are designed to help monitor dieting progress by tracking weight, BMI, calorie counts, and other nutritional data (e.g. foodstuff salt content). An example is Weight Tracker (free) which relates actual achievement to pre-defined goals:
Are you meeting your goal weight? (© Foundation HealthCare Network)
Other applications focus on (or also include) exercise routines which may include activity logs or even links to workout videos. For example, Cardio Track is a simple logbook of sessional activity that might help you decide if you're getting value-for-money from a gym membership:
No pain, no gain—and a wasted gym membership (© Bryan Gruver)
If you can't yet exercise due to shortness of breath, Quitter (free) will illustrate the considerable financial merits of overcoming your nicotine addiction—a highly visible incentive to stop smoking:
Keep smoking or enjoy the holiday or a lifetime? (© Paze, Inc.)
For obsessive types Kenkou (£3) tracks a number of personal health variables over time such as blood pressure, with both data and graph views:
Monitor your blood pressure (© Well Built Software, Llc.)
In case of emergency (ICE)—if you're prepared to leave your iPhone unlocked—the aptly-named ICE (60p) is one of several apps that detail emergency contacts, allergic reactions, medications, and medical conditions:
In case of emergency, give the medics your iPhone (© Catalyst Software, Llc.)
Comment
We have yet to see a number of "old favourites" available for Palm and/ or Windows Mobile remade for iPhone, including a medical calculator to rival MedCalc, differential diagnosis aids like Diagnosaurus, an Eponyms dictionary, and reference tomes such as Mobile MerckMedicus. Then again, the Store has been open just three weeks, so we can expect a deluge of development activity to bear fruit in due course as players like Unbound Medicine and Skyscape "go native".
There are of course other apps already available for a general audience that will appeal to clinicians, such as news readers (for skimming the journals), personal information managers, and productivity tools. I know many of my colleagues could use an Oxford English dictionary when writing referrals—what say you Mobipocket? Another personal wish as I enter academia is a reference manager (perhaps something OOoBib-compatible).
The apps mentioned above may be early versions but they are (almost without exception) beautifully crafted and executed—something that bodes well for the future of iPhone and physician or patient partnerships. I'm sure there are novel approaches to patient education and self-motivation just waiting to be conceived of that fully harness the computing power of the iPhone platform (although I do note that the "top apps" lists are dominated by sedentary gaming!).
For a first showing there's something for everyone—no matter which end of the needle you're on.
Update (notable apps added since 03.08.08):
- Eponyms (medical eponyms; free or £1.20);
- Diamedic (diabetes logbook; £3.50);
- Glasgow Coma Scale (brain function calculator; £1.80);
- Netter's Histology Flash Cards (medical education; £24);
- Mediquations (medical calculator; £3);
- OB Patient Tracker (patient data calculator; £9);
- Asthma-Charter (peak flow diary; £3);
- GI: Upper (Zollinger's atlas of surgical operations; £21);
- Phone Aid (animated CPR & choking, first aid; £1.80);
- Skyscape Medical Resources (drugs, clinical outlines, calculator; free).
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What an interesting array of apps.
However, I am slightly concerned about your comments on Epocrates, specifically:
My imagination has run riot based on your caption:
Good gracious, how many people don't keep their little white pills in a clearly marked bottle?
8-O
As the Social Services lady said to my ancient Mother on Monday - "you'd be surprised..."
@Oh Waily: One of the safety benefits of clinical information systems has been the decision-support utility that helps doctors decide whether a drug is safe to prescribe or not. All the systems I've used in the UK and NZ do this behind the scenes as the doctor selects a drug for prescription. It's not an alternative to sound clinical knowledge—but it is a good backup check.
Although you can take a printed formulary with you on a home visit, consulting it for interactions, cautions, or contraindications is challenging when the patient has polypharmacy (as they often do on home visits). The advantage of tools like Epocrates is that you can input drugs the patient is already taking (particularly those with a narrow therapeutic window) plus any new scripts you propose, and it will tell you if there are any issues you might not have considered with that combination (e.g. drug E increases plasma concentration of drug C; reduced dose required).
The "little white pill" phenomenon is very real; many people just don't know (or can't pronounce—e.g. wrap your tongue around bendroflumethiazide) what they're taking. A typical consultation (to which patients come without their medication bottles) goes like this: (Dr) "So you think your headache is due to one of your medications Mrs Smith? Which one?" (Mrs Smith) "Yes, it's one of the little white ones I think" (Dr) "What do you take that one for, or when do you take it?" (Mrs smith) "Once in the morning, for my heart—like the other ones" (Dr with Epocrates) "Does it look like this, with a single score mark, or this one, which is double-scored?"
Yes, the iPhone app store is outstanding for medical apps. My favourite provider is QxMD Medical.
They produce free specialty specific calculators in the areas of Cardiology, Hematology, Nephrology and Gastroenterology.
They also have 2 paid apps, 'The ECG Guide' and 'Safe OR'. The ECG Guide seems very popular - I just tried it today and it's quite a thorough guide to ECG interpretation. Safe OR is based on the recent NEJM article which shows that post-op complications (including mortality) can be reduced by using a pre-op/intra-op checklist.