Doctors across the hospital spectrum are using digital tools to support clinical decision-making, increase patient engagement and improve quality of care. More than half (51%) of recently interviewed healthcare professionals are using an app at the point of care, according to a new KLAS Research report. The graphic below shows apps are being used for a variety of other reasons:
"Providers are looking forward to adopting solutions that will positively impact clinical outcomes," KLAS concluded. "As purchasing moves forward, IT will continue to be at the forefront of app purchases, hoping to proactively solve problems around security and other areas of concern."
Emergency medicine and pediatrics are two areas where an array of apps are helping physicians do their jobs.
Apps for emergency physicians
Certain apps have become “almost indispensible” in the emergency room, says Dr. Robert Glatter, assistant professor of emergency medicine at Lenox Hill Hospital in New York City. The key defining aspect of all of them, he says, is that they provide on-the-go clinical decision-making support — something that is essential when you’re taking care of lots of patients and have to make decisions quickly.
Glatter provided Healthcare Dive with his list of go-to ER apps.
1. WikEM. An offshoot of the Wiki series, this app is loaded with evidence-based studies and material and algorithms that are useful when working on many different kinds of conditions. It’s up-to-date and provides a quick overview of a variety of possible issues facing emergency physicians. For example, if there’s concern about aortic dissection in a patient, the app will provide key aspects of the physical exam, the most up-to-date literature regarding imaging, as well as other blood tests or markers that might arise, Glatter explains.
2. Pedi STAT. This is another go-to app for the ER, where physicians need to be able to quickly determine dosages for children who may come in with an allergic reaction or other problem requiring medication. Based on the child’s age or weight, it provides a host of medications and the correct dosages to give them. The app contains the Broselow tape ability to measure medication, resuscitation guidelines, Glascow coma scoring and vital signs ranges, among other features.
3. EyeMD. Good for diagnosing different eye conditions, this app includes lots of visuals and enables physicians to see inside an eye and do virtual retinal exams via comparison to highly accurate images.
4. MediMath Medical Calculator. Plug in the numbers and get quick results. This app brings 144 of the most important medical calculations and scoring tools to the physician’s fingertips via their smartphone. “If you’re ruling out a pulmonary embolism, it gives you clinical decision rules like the Welles criteria or the PERC rule, for example. It gives you the ability to quickly calculate calcium based on their albumin level,” Glatter says.
5. PressorDex. Developed by the Emergency Medicine Residents’ Association, PressorDex is a comprehensive guide to use of therapeutics in critically ill patients. It tells physicians how to mix up quick drips for patients that are crashing, for example, and describes how much many milligrams or ccs are needed and how much diluent to add.
6. ERes. A Swiss army knife of apps, ERes is essential for emergency physicians because of the wealth of content it contains. In one location, physicians can find clinical decision rules, algorithms, key medications they might need to treat a condition and more.
7. SonoSupport. This mobile app provides all the information needed to perform ultrasound exams at the bedside. The user-friendly interface includes lots of images and tells doctors what kind of probe and transducer they need and the correct settings to use. It also walks the physician through how to do an ultrasound exam if they’ve never done one before. “It is pretty much the go-to, de facto sono app or imaging app that we use,” Glatter says, adding its content ranges from primer level to advanced.
8. Antibiotic Guide. Another EMRA app, Antibiotic Guide includes the latest developments in antibiotic use for virtually all types of infectious diseases. It not only give diagnoses and the correct type of antibiotics to administer for different infections, but also provides good differentials and includes questions to help rule out other possible diagnoses, according to Glatter.
9. UpToDate. This mobile app is chock full of evidence-based literature and offers clinical studies to support how different conditions are treated. Included are graded recommendations by more than 6,500 physician experts on the latest advances in 24 clinical specialties. “It’s the most up-to-date compendium of literature based on any condition,” Glatter says.
10. Epocrates. This app is a virtual pharmacopeia where doctors can search drugs, check for interactions, visually ID medications, get ICD-10 information, access guidelines, contact the manufacturer and more. It also includes calculators for dosing and a picture quiz. In a busy ER, physicians can quickly find medications and know they have accurate information on which to base treatment decisions.
Apps for Pediatricians
Mobile apps are popular with pediatricians, too, who use them to easily access child-specific clinical information and references. To learn which apps pediatricians are using, Healthcare Dive turned to Dr. Emily Webber, vice chairperson of the American Academy of Pediatrics’ Council on Clinical Information Technology and medical director of pediatric clinical informatics at Riley Hospital for Children, part of the Indiana University Health system. Webber’s digital toolkit includes Pedi Stat and four other apps with benefits for busy pediatricians.
1. American Academy of Pediatrics Red Book App. This is the infectious disease handbook for pediatricians, the go-to source on diagnosis and treatment, says Webber. It allows doctors to quickly access the latest information on diagnosis, treatment and management of over 200 infectious diseases. There is information on dosing, immunizations and plenty of images to cross check clinical decision-making.
2. Nelson’s Antimicrobial Therapy. Nelson’s Abx offers evidence-based recommendations from experts in pediatric antimicrobial therapy, and indicates the strength of each recommendation and references to learn more. The latest edition also includes new chapters on antibiotic use in obese children and prevention of symptomatic infection. The app also includes useful body surface area calculations for proper dosing.
3. Bilitool. Designed to help doctors assess the risks of hyperbilirubinemia, or jaundice, in newborns over 35 weeks gestational age, Bilitool calculates the child’s age in hours and total bilirubin and maps the bilirubin to the risk zone. The app includes AAP recommendations on treating hyperbilirubinemia.
4. Weight Converter. This is a general converting app that allows pediatricians to convert between kilograms/grams and pounds/ounces.
As more clinical apps are integrated into electronic medical records, Webber expects app use will expand. In addition to providing up-to-date information on a wide range of clinical issues, “the ‘app’ design philosophy is highly focused on intuitive usability, and that is something that gives physicians and other clinicians some much needed efficiency during a busy day,” she told Healthcare Dive.