efficient use of clinical internet 87% · 38% of outpatient ipads • vre and pseudomonas on 10%...

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Primary Care in the Palm of Your HandEFFICIENT USE OF CLINICAL INTERNET

RESOURCES

Annual Review in Family Medicine Dec. 15-16th, 2014Shira Shavit, MDAssociate Clinical ProfessorFamily and Community MedicineUniversity of California, San Francisco

Health AppsOf 506 physicians surveyed: 87% use asmartphone or tablet in their work.1

95 million Americans used a health app in 2013(up 27% from 2012). 2

RWJF projects that in 2014-2015, 500 millionconsumers & providers will use a health app.3

1 Manhattan Research-Google Physician Channel Adoption Study 2 Manhattan Research’s Cybercitizen Health® Report 2013. http://manhattanresearch.com/News-and-Events/Press-Releases/mobile-health-95-million3 Robert Wood Johnson Foundation. Health Policy Brief: mHealth and FDA Guidance. 2013. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf409203

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Framework• Apps For Providers

• Apps For Patients

• Tips

• Resources

Disclosures…

for providers

• Drug Reference• Medical Calculators• Reference• Screening &

Prevention

• Billing• Medical Literature• CME• Treatment

Guidelines

Drug ReferenceEPOCRATES MICROMEDEX

• Pill ID

• Drug Interactions

• Formulary

• Drug Info

• Free• iPhone, iPad, Android


• Drug Interactions

• Dosage

• Contraindications

• Mechanism of action

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Epocrates: Pill ID for providers


Prevention


Guidelines

Medical CalculatorsCALCULATE by QXMD

• Features 150 medical calculators • Includes references with Pubmed

integration• BMI & BSA• Due date and gestation age• eGFR with CKS-Epi, Cockcroft-Gault &

MDRD• Framingham and Reynolds Risk Scores• CHADS2 and CHA2DS2-VASc score


MEDCALC• +300 relevant

formulas, scores, scales, and calculations

• Detailed bibliographic references

• Customizable list of favorite equations


OTHERSMedmathMedimathArchimedes from Skyscape

CALCULATE by QXMD

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for providers


Prevention


Guidelines

Reference

• Free with institutional “UpToDate Anywhere” subscription; $499/yr individual subscription

• iPhone, iPad, Android, Windows

• Access to +13,000 curated topics, guidelines, abstracts, & summaries

• Daily POEMsdelivered to email

• Fast drug reference tools

• Evidence-based disease reference

• CME courses

• No cellular connection required after download• Continuously updated (vs. UpToDate: quarterly)• Subscription is

cheaper• Less easy to use

UpToDate MEDSCAPE

ESSENTIAL EVIDENCE DYNAMED

• Same UpToDate, in mobile app form

• Free• iPhone, iPad, Android, Windows

• $85/yr• NOT a native app– used through browser

• 99.99 student; 149.95 Resident; 199.95 Liscensed Medical Practitioner; 395 Physician

• iPhone, iPad, Android

Medscape: #1 Downloaded App by Medical Doctors

Sample POEM delivered through Essential Evidence

CLINICAL QUESTION

BOTTOM LINE

STUDY DESIGN

SYNOPSIS

FUNDING

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for providers


Prevention


Guidelines

Screening and Prevention• Reference for international travel

vaccination recommendations• 30 full-color disease risk maps• Search by disease location, meds

CDC VACCINATIONS CDC YELLOW BOOKAHRQ ePSS• Immunization

recommendations from birth through age 18

• Catch up schedules• Adult Immunization

schedules

• Search for USPTF recommendations for a particular patient.

• Specify by age, gender pregnancy status, sexual activity, and tobacco use.

• Free • iPhone, iPad, Andriod

• Free • iPhone, iPad, Andriod

• Free Limited verison; Full version: $9.99• iPhone, iPad, Andriod

CDC Vaccine Schedules for providers


Prevention


Guidelines

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Billing

• Searchable ICD-9-CM, ICD-10 (CM, CA, WHO), SNOMED CT, MeSH, UMLS, HCPCS, CPT

IMO TERMINOLOGY BROWSER

• Searchable Complete 2014 ICD9-CM diagnosis codes and 2008 ICD9-CM procedure codes, with all subcodes

ICD9 CONSULT2014



for providers


Prevention


Guidelines

Medical LiteratureREAD by QXMD

NEJM

DOCPHIN

• Link your institutional account

• Customize a feed of journal articles

• Follow different journals and/or specialties

• Annotate articles• Send articles to colleagues

• Free• iPhone, iPad,

Android, Windows


Android, Windows

• Curate a feed of your favorite medical journals and news/media sources

• Receive articles related to your chosen specialties

• Also available on web• Access NEJM recent articles,

images, audio, and video

• Free• iPhone, iPad

This Week

for providers


Prevention


Guidelines

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CME• Practice questions & general info for

ABFM Maintenance of Certification

• Free• iPhone only

ABFM Exam Prep• Free CME credits from app activities• Medscape, MedPage also offer free

CME


Epocrates CME for providers


Prevention


Guidelines

Treatment Guidelines• Access to all ACP’s

evidence-based clinical practice guidelines

• Quick reference manual for OB.

• +50 sections of various pathologies, clinical situations, calculations related to OB

• Guidelines to diagnose & treat 21 STDs and sexual assault.

• “A Guide to Taking a Sexual History”

• Pocket reference for eye pathology in a primary care, urgent care, or ER setting

• Pictures & videos with short, concise explanations

Coming Soon: SAMHSA SUICIDE SAFE

ACP CLINICAL PRACTICE CDC STD Tx

OB GUIDE EYES HAVE IT• Free• iPhone, iPad, Android

• Free• iPhone, iPad, Android, Windows

• $1.99• iPhone, iPad, Android


FROM UNIVERSITY OFMICHIGAN PHYSICIAN

FROM WASHINGTON UNIVERSITY

EYES HAVE IT –from University of Michigan

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for your patients

• Nutrition• Patient Support• Addiction • For Parents & Kids• Pharmacy• Wearables

NutritionZIPONGO MY FITNESSPAL

• Get updates about discounted healthy grocery store items in your area


Android


Android, Windows

• Counts calories from 2 million food choices

• Tracks exercises • Syncs progress to

myfitnesspal.com

• Pulls up nutritional info from barcodes

• Grades foods on A-D scale• Offers healthy alternative


FOODUCATE

My Fitness Pal

for your patients


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Patient Support• Self-report data sharing between

patients with Crohn’s disease worldwide

• Patients track symptoms & treatments• Allows patients to connect and share

experiences

• Free• Web only

PATIENTS LIKE ME• Self-report data sharing between

patients with similar demographics or chronic diagnoses

• Patients can join diagnosis-specific groups: ALS, fibromyalgia, MS, Parkinson’s, HIV, mood disorders, etc.

• Free• Web only

CROHNOLOGYPatients Like Me

for your patients


Addiction• 21 day program to

quit smoking• Interactive tools to

track cigarette usage• Daily guided

mindfulness practices• Push reminders

throughout the day of personal goals

Based on intervention methods validated by Dr. Jud Brewer, UMass Amherst

Brewer, J. A., Elwafi, H. M., & Davis, J. H. (2013). Craving to quit: Psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions. Psychology of Addictive Behaviors, 27(2), 366.

STEP AWAY• Self-assessment of

alcohol addiction• Users select high-

risk locations for relapse

• Note supportive persons, who are contacted by app

• Record triggers & cravings

• Provides strategies for dealing with cravings & triggers

CRAVING TO QUIT

• $1 / day • iPhone, iPad, Android


From University of Alaska, funded by National Institute on Alcohol Abuse & Alcoholism

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Addiction: Craving to Quit

for your patients


POOP MD• Created by an

assistant professor at John Hopkins Pediatric Gastroenterology

• App analyzes pictures of newborn’s poop to tell new parents whether it’s normal or not

• FREE• iPhone, iPad, Android

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Parents & Kids• Self-management for kids with

asthma• Patients can input asthma

meds & triggers• Gives daily reminder to take

meds and avoid triggers

TEXT4BABY ASTHMA TOOLS4USAMHSA: KNOW BULLYING • Free text messaging service

for pregnant women &newparents

• 3 texts/week tailored to due date

• Appt reminders, immunizations, breast feeding help, developmental milestones, + more

• Tools for parents to start conversations with their children about bullying

• Describes strategies to prevent & recognize bullying

• Free • iPhone, iPad, Android

• Free • iPhone, iPad, Android

• Free • Any phone with SMS,

iPhone, iPad, Android

Unlike other apps:

• Low income participants

• Smartphone not required

Text4Baby• Over half of survey respondents

(N=943) had income <$16,000.

• At enrollment, higher percentage of participants lived in impoverished zip codes compared to the overall U.S. distribution.

• 63.1% reported that Text4baby helped them remember an appointment.

• 75.4% reported that Text4baby helped them remember an immunization that they or their child needed.

In a study done by the California State University San Marcos National Latino Research Center:

for your patients


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for your patients


Wearables• Worn around wrist as

watch• Links to Android phone &

displays texts & notifications• Logs physical activity• HR monitor & barometer• Continuous Bluetooth syncing• 1-2 day battery life

FITBIT ANDROID WEARJAWBONE• Vibrating alarms • Logs physical activity• Toggle to signify “sleep”• Continuous Bluetooth syncing • 5 day battery life• Third-party integration (with other

apps like MyFitnessPal & Pact)

• Vibrating alarms • Logs physical activity• Toggle to signify “sleep”• Continuous Bluetooth syncing• 7 day battery life• 3rd-party integration (with other

apps like MyFitnessPal & Pact)

• $149; $179 (with HR monitor)• iPhone, iPad, Android

• $300• Android

• $99.95; 149.99 (with HR monitor)• iPhone, iPad, Android

UP24 – UP3 Flex – Charge

App: • Manually log food, sleep,

exercise• Set goals & reminders for sleep

& activity• App integrated w/ Apple

HealthKit (potential to integrate with Epic EHRs)

App:• Manually log food, sleep, exercise• Set goals & reminders for sleep &

activity• Fitbit has stated it will never

integrate with Apple HealthKit

• Android Wear Moto 360• Apple iWatch – Spring 2015• Basis Band• Nike Fuel SE

OTHERS

LG G Watch R

FitBit App

Jawbone App

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Hacked Health AppsThe majority of healthcare apps have been hacked.1

• Mostly by hackers repackaging the app without its safety features and with the intention of gathering patient data.

• Placed in third-party app stores posing as the real app.• For Android users in particular.RECOMMENDATIONS• Do not buy apps in 3rd party app stores.• Warn your patients from doing this.

1 https://www.arxan.com/assets/1/7/State_of_Mobile_App_Security_2014_final.pdf

Wash your tabletSTUDY:1

• 30 iPads of faculty members tested at Northwestern University Hospital

• (N=30, 16 inpatient, 14 outpatient)

RESULTS: • MRSA: 64% of inpatient iPads

38% of outpatient iPads• VRE and pseudomonas on 10% total RECOMMENDATIONS2• Disinfect with Sani-Cloth 2% and Clorox wipes • DISCLAIMER: Apple does not recommend

disinfecting your iPad. May in fact invalidate your warranty. 1. Hirsch EB, Raux BR, Lancaster JW, Mann RL, Leonard SN. Surface Microbiology of the iPad Tablet Computer and the Potential to Serve as a Fomite in Both Inpatient Practice Settings as Well as Outside of the Hospital Environment.PLoS One. (2014) Oct 31;9(10).2. Howell, V., et al. "Disinfecting the iPad: evaluating effective methods." Journal of Hospital Infection 87.2 (2014): 77-83.

iMedicalApps: http://www.imedicalapps.com• Comprehensive & updated reviews by physicians of apps &

mobile technology

http://www.mhealthnews.com/• mHealth holds yearly conferences on the state of mHealth &

reports on mobile health industry

http://mobihealthnews.com

This field is constantly changing--- you can follow @iMedicalAppson Twitter/Facebook

Helpful Websites Annual Review 2014• ASCVD Risk Estimator by American College of Cardiology

• ACC Clinical Guidelines by American College of Cardiology

• UCSF MSK Exam Tutor: developed by UCSF physicianso +60 videos and interactive tools to learn MSK exam

• Provider Resilience by National Center for Telehealth & Tech o Burnout assessment tools & tips to avoid burnout for health providers in military settings

• SBIRT: Screening, Brief Intervention, & Referral to Tx o Detailed steps for providers complete an substance abuse intervention with patients

• Unstucko CBT app for self-management and emotional regulationPediQuikCalc (1.99) o best "all in one" app. Calculates med doses, BMI calculator, mid-parental height,

bilirubin phototherapy, blood pressure percentiles and IV fluid ratesPediStat (2.99) o focused on advanced life support (resuscitation algorithms, etc.), but also has normal

VS, fox, equipment, etc.BiliCalc (1.99) –calculates need for phototherapy, based on gest age, risk fx, hours of life

and Tbili level.

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Annual Review 2014Every Woman California: www.everywomancalifornia.org

Smiles for Life Oral Health: www.smilesforlifeoralhealth.orgProtecting All Children’s Teeth: www.aap.org/ORALHEALTH/pactPrEP Videos: http://www.sfcityclinic.org/services/prep.asphttp://www.projectinform.org/prep/https://ictrweb.johnshopkins.edu/ictr/utility/prep.cfm

efficient use of clinical internet 87% · 38% of outpatient ipads • vre and pseudomonas on 10%...

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