American College of Physicians: Internal Medicine — Doctors for Adults ®

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Apps for newbies

If used wisely, technology can help new hospitalists

From the July ACP Hospitalist, copyright © 2012 by the American College of Physicians

By Beth Thomas Hertz

Mobile devices put more resources in the palm of your hand than the world's biggest, most powerful computers offered a few decades ago. Numerous applications, or apps, further increase the information at your fingertips. But sorting through the ones that are useful to a hospitalist can be a challenge.

“It is easy for any new hospitalist to get overwhelmed, and technology is not an exception,” said Elizabeth Farrell, MD, ACP Member, a hospitalist at Boston's Beth Israel Deaconess Medical Center who created her own medical app. “There are so many resources available and you can't use them all.”

Photo by Thinkstock.

Photo by Thinkstock.



However, she and other technology experts offered advice on how both new and experienced hospitalists can make the most of mobile technology.

Device selection

Having some sort of mobile device has become a necessity for hospitalists today, according to Steven Spadt, ACP's vice president of digital products and services.

“The continued increase in adoption of mobile devices by hospitals/systems, colleagues, and even patients will mean that new hospitalists will have little choice. The good news is that the potential of this technology to improve efficiencies and the overall quality of care is already so evident that physicians themselves are driving the movement,” he said.

As for which device to use—phone, tablet, etc.—hospitalists should consult with their facility's information technology department before making any decisions, several experts said.

“It is very hospital-dependent,” said Brian Ahier, who manages health information technology for Mid-Columbia Medical Center outside of Portland, Ore. and frequently tweets about technology issues in health care. “Find out what they will let you use, especially in terms of compatibility and connectivity, and don't try to step beyond that.”

Many hospitals that offer their employees mobile devices choose tablets such as iPads, but phones are probably easier to use on rounds, he said. Smartphones are small enough to fit in a pocket and more versatile, with capability to call, text or page, and access the Internet, he added.

That situation may be changing, however, according to Dirk Stanley, MD, chief medical informatics officer at Cooley Dickinson Hospital in Northampton, Mass. He has recently seen lab coats being made with pockets big enough to hold a tablet.

In general, he added, most mobile devices are good for consuming data, but their small screens and minute keyboards make them not ideal for entering it. Extensive documentation still requires a traditional desktop computer, he said.

More advanced clinical decision support that involves navigating a full patient record or retrieving data displayed in a table with many rows and columns will come more naturally on a tablet, Mr. Spadt said.

“While tablets and smaller laptops or netbooks share similar screen sizes/resolutions, the touch-based user interface prevalent on tablets is preferable for one-handed uses like standing in hallways or accessing information on the move, common situations for hospitalists,” he added.

Apps

Regardless of the device that's chosen, use of certain apps can improve the care hospitalists deliver at the bedside, the experts said.

Apps that provide quick answers to specific questions with minimal input yielded the highest praise, as they deliver information without becoming a major distraction to the flow of the doctor-patient encounter. More “bells and whistles” are not necessarily better. “Patients need to see that you are focusing on them, not looking down all the time,” said Dr. Farrell, who created her Medicine Toolkit app to enhance teaching during rounds.

Fitting the bill, said Dr. Farrell, are medical calculators such as MedCalc. It provides easy access to complicated medical formulas, scores, scales and classifications without having to open a search engine repeatedly, she said.

Another app she finds useful is UpToDate, a clinical decision support system that uses current evidence to answer questions quickly. ACP's evidence-based clinical support tool PIER, the Physicians' Information and Education Resource, also offers information on diseases, screening and prevention, procedures, pharmaceuticals, quality measures, complementary and alternative medicine, and ethical and legal issues.

ACP members can earn CME credits using the PIER Point-of-Care tool. Physicians record their clinical questions in a “diary” and document the location of the answers in PIER. An updated version is due to be released in the fall.

DermAtlas is another app recommended by Dr. Farrell. It displays photos of skin problems that can help make an accurate diagnosis and educate the patient about the condition.

Dr. Stanley recommended Epocrates, which provides access to drug, disease, and diagnostic information. But “having a particular app is not as important, in my opinion, as learning to use one well to access information on a timely basis,” he said.

The most effective apps for hospitalists may be ones that are tied in to a hospital's health information system, according to Mr. Ahier. “Many EHRs have a mobile app,” he said. “See if yours does.”

Another facility-specific issue with apps is the availability of Wi-Fi. Some apps are Web-based, requiring Internet access to use them, and others are native apps that enable offline use. If you work in a facility with limited access to Wi-Fi, the native apps could prove more useful, Mr. Spadt said.

Use caution

Although technology can be your friend, it can also be your enemy, the experts said. Be sure you understand the potential legal pitfalls of managing private patient data on your devices.

“If you leave your iPhone in Starbucks or something, if the device isn't locked down, you can find yourself with a lot of legal problems,” Dr. Stanley said.

Don't have work e-mails sent to your personal account, especially if you ever access that personal account from a public kiosk or other shared device, and don't use the same password on all of your accounts, the experts added.

Avoid audible e-mail alerts, too, Dr. Farrell said. “It was constantly dinging while I was on rounds and it was distracting. It pulled me away from my work as I was curious to see what had come in. We get hundreds of e-mails a day, so it was happening a lot. I had to turn it off,” she said.

The future

Hospitalists are likely to see increased reliance on mobile technology in their workplaces in the future, the experts agreed.

“This is an exciting time with so much development going on,” Dr. Stanley said. “I believe that even better integration, more maturity and more standardization lie ahead.”

Mr. Spadt said physicians, especially hospitalists, will remain at the forefront of maximizing mobile technology. “Doctors push the envelope on mobility more than many other professionals because they sit at a desk so rarely,” he said.

He also thinks technology will become even more mobile. “People don't want to choose a phone or a tablet. They want both. Technology needs to be versatile or it will become obsolete.”

Beth Thomas Hertz is a freelance writer based in Copley, Ohio.

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ACP offerings

ACP offers access to apps that include continuing medical education and maintenance of certification, but also has point-of-care clinical references. Many do not require ACP membership, although non-members may have higher charges.

ACP JournalWise (formerly ACP Journal Club PLUS) allows users to store articles in personalized folders, peruse the tables of contents of more than 150 medical journals, and set up alerts that deliver the latest research matching one's filters. Meanwhile, the ACP Immunization Advisor app helps doctors find the right vaccines for patients by age or underlying medical circumstance. ACP's flagship journal, Annals of Internal Medicine, is also available as an iPhone app, and a much richer iPad app is launching imminently.

Soon, the College will offer MKSAP 16, its maintenance of certification and board preparation product, to replace the current MKSAP 15. Digital access will be available Jan. 31, 2013, including via a range of smartphone and tablet apps. Using this product, physicians can answer multiple-choice questions from anywhere, even offline, and save their results; they do not have to complete them all at one time.

PIER, the ACP's clinical decision support reference, will also get a complete redesign and relaunch later in 2012.

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