462 Robust and Affordable Medical Apps Edward M. Zabrek, M.D. iPhone Life 1528-5456 2008-11-11 Spring 2009 1 2 87 Work iPhone

Healthcare professionals have a brand new and very affordable “black bag” of medical resources in the form of the iPhone or iPod Touch and a wide variety of healthcare applications available for them on the iTunes App Store. Many of these programs are free or inexpensive, and a few are moderately priced. But one cool thing about them is that most do not require a direct link to a PC or Mac—all you need is a wireless connection to the Internet via Wi-Fi or the iPhone’s broadband data connection.

Below is a detailed look at two cool new apps, iChart EMR (available directly from the App Store) and the new Epocrates Essentials (a resident app downloadable using the devices’ Safari browser). I also mention an update to a third app, Skyscape, towards the end of the article. While these Apps are a bit pricier that some, they are well worth the investment for healthcare professionals using an iPhone or iPod touch.


Epocrates Essentials: Prescription and diagnostic support

imageFollowing the introduction the popular Epocrates Rx free drug and formulary reference, Epocrates introduced its premium clinical decision support suite earlier this year. imageEpocrates Rx was downloaded by more than 50,000 physicians in the first four months. However, even with the availability of the free content, many Epocrates users were eagerly awaiting the launch of the premium features and content that was available only on Palm and Windows Mobile devices up to this point.

Building on the company’s top ranked free drug guide, the new Epocrates Essentials suite offers disease and diagnostic resources doctors need to answer pressing clinical questions. Developed exclusively for the iPhone platform, this premium product takes advantage of the touch-screen interface, and introduces new disease content, features and functionality. For access to this full suite of information, first purchase a one or two year subscription ($149 and $249 respectively) on the Epocrates Web site (epocrates.com). Then, locate Epocrates in the Apple App store and install it on your device. Once downloaded, Essentials will reside on your device and can be continually updated via a Wi-Fi or broadband data connection.

Epocrates Essentials offers disease and diagnostic resources to healthcare professionals (left/right above).

Included in the premium software solution:

•   Information for more than 3,300 drugs that helps physicians prescribe the safest and most cost effective medication for their patients

• Pill pictures to identify patient’s medications when they cannot recall the brand or dosing (e.g., round, blue pill)

• Peer-reviewed disease content to support the diagnosis of patient’s symptoms

• Infectious disease treatment guide to identify the appropriate therapy for a patient’s viral condition

• Hundreds of diagnostic and laboratory tests that enable physicians to accurately interpretation the lab results and appropriate diagnose their patients

• Information on more than 600 alternative medications so physicians can quickly check for interactions between herbal therapies and prescription medications, which can often cause harmful interactions or impact the drugs effects.

• Medical calculators for quick access to commonly referenced formulas such as Body Mass Index, which the physician can do right at a patient’s bedside. 

What health care professionals are saying

“Epocrates Essentials for iPhone is an incredible time-saver, allowing me to quickly and easily access critical information right at a patient’s bedside. I love that the application takes advantage of the iPhone’s touch-screen interface, allowing me to easily and effortlessly gain access to the information I need most. Best of all, using Epocrates on the iPhone allows me the freedom to carry just one device with all of my important information and applications in one place.” (Travis Sherer, PA-C)

“This is a great time to be a physician with all the information available at the touch of a finger. Now that my iPhone is fully-loaded with the Epocrates Essentials software, I have everything I need to take care of my patients in the safest way possible.” (Dr. David Sperling)

A subscription service

Once again, Epocrates Essentials is a renewable subscription service, unlike the free basic Epocrates download from the App store. (Review in the last issue of iPhone Life magazine.) For more information visit the Epocrates Web site (epocrates.com/products/iphone). The Epocrates iPhone can be downloaded for free from the iTunes App Store.

Skyscape updated for 2009

imageSkyscape is another app I use frequently on my iPhone. The free version is available on the App Store and includes Outlines in Clinical Medicine, Archimedes Medical Calculator, RxDrugs, and MedAlert. In addition to those, you can add over 300 subscription-based medical resources, which are available on the developer’s Web site (Skyscape.com). All of these references can cross link to one another within the iPhone app. Their huge “crosslinkable” library continues to give Skyscape a unique place in the mobile healthcare content arena.

Skyscape also offers nursing-specific resources, including the recently released 21st Edition of Taber’s Cyclopedic Medical Dictionary with audio pronunciation and Davis’s Drug Guide for Nurses. Skyscape gives healthcare providers a link to real electronic medical textbooks and the tools they require for day to day practice.

 

 

 
 

Some of the Skyscape medical resources I keep on my iPhone

Many more apps to come

imageIf you glance at the two Home screen pages shown above, you quickly can understand why I call the iPhone and iPod touch aimage “black bag” of resources for healthcare professionals. I’m a full time practicing OBGYN, and I need and use tools you see on these two pages. In fact, with so many apps in development, I’ll eventually be using many more Home screen pages for them. I hope that Apple increases the number of Home pages you can have (we are currently limited to ONLY 7)—the way things are going in the medical app field, I think I’m going to need them!

 


 

 

 

 

Some of the Skyscape medical resources I keep on my iPhone

iChart EMR

• 

• 

By Edward M. Zabre...

imageDo you need help moving into the 21st Century of Electronic Health Records? iChart EMR ($139.99) claims to be able to help you with that. Developed by Caretools Inc. to be an all-in-one tool for the busy physician or health care provider (PA, nurse, chiropractor, etc.), iChart helps you track patients and manage what they call the “Chart, Bill, and Fill,” process.

imageAll patient data is entered on the iPhone app, or from a desktop computer via the bundled Web application, and a data synchronization feature makes sure that data is securely synced between both. This allows you to use the iPhone app in the absence of an Internet connection, to access and modify patient data. (Tip: You’ll be carrying sensitive patient data on your iPhone, so be sure to activate the iPhone’s password lock to protect it—and to avoid huge HIPAA fines and other penalties.)

The health care professional starts by selecting a patient from a list based on the location of the user’s practice, the encounter type (clinic visit or inpatient), or by a specific patient identifier. Once you have a patient selected you can then access their medical records via tabs at the bottom of the screen. 


 

 

To access medical records in iChart, select the individual
from the Patient list (above left and right images Figs.)

 


The iPrescribing feature lets you manage drug lists, check ADR’s,
and electronically transfer prescriptions to the pharmacy (right).

 

Chart, Bill and Fill

 

The Notes tab allows the user to create various types of documents, including SOAP notes, H&Ps, procedure notes, consult notes, etc. imageWhen a note is created on the device, it pulls in what’s known about the patient so it can create med lists, recent labs, currents problems, and past medical history automatically. You can then select a section of the note and add information to it using various forms of input. You can create a narrative description using a set of menu trees. These menu items list common questions and responses to a specific problem or complaint. The existing library of templates can be modified and new templates created on line using the bundled Web application/account that is furnished to each user.

 

You can also enter data using real-time voice recognition, which displays results in a matter of seconds! The system uses a third-party voice recognition engine that runs across the Internet. It is speaker independent and highly accurate for medical jargon. You can also create dictations and transfer them to the Web at a later time for transcription, which is returned within 24 hours. This is a huge advance over any mobile app and device I have used in the past. Notes can also include preset images that can be annotated on the iPhone such as body maps and diagrams. You can also include ad hoc photographs taken with the iPhone camera. Images and annotations are all included in the final note.

 



iChart lets you can create chart notes
using complaint-specific “picklists” and/or voice input.

 

The iBilling component of the app uses a built-in billing code capture tool. This allows you to capture billing codes from a Favorites list or from the entire library of CPT4 or ICD9 codes that are loaded on the device. All billing codes are transferred to the Web application for reporting and/or export. Caretools also offers a billing service option that will seamlessly check for correct coding, submit, and manage the electronic billing process via the bundled Web application

 

iPrescribing is another key feature of the app. It allows you to manage medication lists, and create new iPrescriptions, and have them electronically transmitted to the desired pharmacy with a few taps. Drug interaction checks, drug dosing options, and drug monographs are all integrated and preloaded.

 

imageiChart also has an iLab feature which allows you to review recent labs in the convenient “stick” form. You can enter in any new labs directly, or receive electronic lab feeds as an add-on option.

 

The cool thing about this application is that it takes advantage of the iPhone touch user interface and is quite simple to use without complex screen navigation.

 

Connectivity to the Internet

 

Once you have added new information to a patient’s record on the iPhone, this information is stored locally on the iPhone database and is then synchronized to an iChart Internet account using HIPPA compliant technologies. At the same time any updates entered to the Web account are downloaded into the users device. These items include any new patient information, scheduled visits, or in box items such as prescription requests, lab alerts, or patient call back requests. Management of the Web account information is enabled through a Web application written for use by the physician or his front office staff. This Web application has similar features to the iChart iPhone application and includes an Outlook style scheduler, message inbox and screens for reviewing and printing patient prescriptions, chart notes, and uploaded billing codes. In essence, it’s a Web based lightweight EMR that synchronizes to the iChart iPhone application.

 

The iLab feature lets you review labs, enter new labs,
and receive electronic lab feeds as an add-on option.

 

Robust, reasonably priced solution

 

Everyone is struggling in these difficult economic times, including health care professionals. iChart is a very robust solution for medical offices looking to transition to a very reasonably priced electronic health record with options for billing and prescribing tools included. The basic product is priced at $139.00 for the first year with an annual renewal subscription fee of $99. Optional add-ons are available for electronic lab retrieval, electronic prescription transmittal, and electronic transcription. More information can be found the developer’s Web site (caretools.com).