keeping smart with a smartphone
DESCRIPTION
Lecture given at the 2010 Philippine College of Physicians annual conventionTRANSCRIPT
Iris Thiele Isip Tan MD, FPCP, FPSEMMS Health Informatics (cand.)
Clinical Assoc. Professor, UP College of MedicineSection of Endocrinology, Diabetes & Metabolism
Philippine General Hospital
Keeping Smart with a Smartphone
conflict of interest
No
Adverse events
2.9%Colorado
& Utah
3.7%New York
Medical Errors
50%Ooops 44,000 -
98,000 deaths/year
To Err is Human: Building a Safer Health System
Institute of Medicine 1999
6.6-13.6% mortality
New Competencies for Health Professionals
Utilize informatics
1
2 3
4 5
Provide patient-centered care
Work in interdisciplinary teams Employ
evidence-based practices
Apply quality improvement
Health Professions: A Bridge to Quality
Institute of Medicine 2003
“... in the next century, the study of informatics will become as fundamental to the practice of medicine as anatomy has been to the last.”
Coeira E. Guide to Health Informatics, 2003 (2nd ed)
Health Informatics
Study and application of methods to improve management of• patient data
• medical knowledge
• population data
• other information
relevant to patient care and community health
Information is the essence of medicine: we create it; we collect it; we search for it; we
adapt it; we drown in it; and at times, we ignore it.
“Information is often not available to those who need
it when they need it.
As a result, patients often do not get care they need or do
get care they don’t need.”
Kohn et al. To Err is Human: Building a Safer Health System (2000)
“Mobile technology has the potential to revolutionize how physicians practice medicine.”
Burdette et al Clin Inf Dis 2008;47:117-22
Smartphone
No industry standard
definition
More than basic cell phone capabilities
SMS MMSVoice callsPhonebook
Miniature computer with phone capability
Wikipedia
6%9%
16%
26%
43%
Smartphone Platform Market Share
RIM
Apple
Microsoft
GooglePalm
comScore Feb 2010 (US)
36%
64%
36%
27%
37%
US Physicians Using a Smartphone
Blackberry
iPhone
2009 Manhattan Research Survey “Taking the Pulse”
No smartphone
40% of adverse
drug events (ADE)
lack of critical
patient and drug
information
at time of prescribing,dispensing,
administering medicines
Leape et al JAMA 1995
Point of care
PhoneSma!
iPhone/iPod touchBlackBerry
Palm
AndroidWindows Mobile
Epocrates
Prescription medication
OTC drugs
Pill ID
Drug interactions
Medical calculator
Free
iPhone/iPod touchBlackBerry
MedscapeInternet access
not required
6000+ drugs
1000+ OTC
1000+ Herbal supplements
Interactions between drugs,
herbals & supplements
Free
ABXGuideJohns Hopkins
Organized by diagnosis, drugs,
pathogens, management and
vaccines
Renal dosing guide
Diagnostic criteria
Treatment regimens/algorithm
$24.95
iPhone/iPod touchBlackBerry
Palm
AndroidWindows Mobile
Symbian
“Good information is the best medicine.”
Michael E. DeBakey, MD
Today’s experienced physician needs close to 2 million pieces of information to practice medicine.
Denekamp Y. IMAJ 2007;9:771-6
Evidence Cart
CATsRedbook
Best EvidenceJAMA Series
CochraneMEDLINETextbooks
Simulscope
Used 98x in 1 month
81% affect
diagnosis/treatment decisions
71 successful searches23%
correctedprevious
diagnostic test/treatment
18% led to additional
test or new management
decision
Sackett et al, JAMA 1998;280:1336-8
PubMed on Tap
Advanced search (AND, OR, NOT)
Full text/free full text (via Safari)
Order full text via Loansome Doc
Retrieve/store pdfs in personal library
Email references
$2.99
iPhoneiPod touchiPad
free lite version
DocGuideArticles & abstracts
from 2000+ peer-reviewed journals
Dispatches from top national &
international conferences
Forum
Multiple specialties & interests coverediPhone/ iPod touch
Free
OrkovSearch PubMed
Retrieve full text and PDFs
Keep notes
“Jump” to navigate
Zoom in on figures
Find related articles
Built-in browser for viewing documentsiPhone/ iPod touch
Free
PLoS Medicine
Created by Center for Biomedical Informatics
(Harvard Medical School) with Public
Library of Science
PLoS is a leading open-access
medical journal
View online or get pdf
Favorite & shareiPhone/ iPod touch
Free
Harrison’s Manual of Medicine
Derived from Harrison’s
Principles of Internal Medicine
Diagnosis & therapy (emphasis on patient care)
Free 1-year access to Harrison’s on the WebiPhone/ iPod touch
$59.95
Oxford Handbooks
Clinical Medicine
Clinical Specialties
Critical Care
General Practice
Endocrinology & Diabetes
iPhone/ iPod touch
$59.99
Clinician’s Pocket Reference(The Scut Monkey Book)
Pocket reference for house staff,
medical students & interns
iPhone/ iPod touch
Free
Auscultation40+ Sound Study
questions featuring heart murmurs,
lung wheezes and stomach aches
Timed exam
Graphical performance statistics
Bookmarks
Personalized notesiPhone/ iPod touch
$2.99
2 unanswered questions for
every 3 patients seen
40% fact
44% medical opinion
MDs pursue only 30% of
their questions
Denekamp Y. IMAJ 2007;9:771-6
Most Common Obstacles
Doubt about existence of
relevant information
Ready availability of consultation
Lack of time to initiate a
search
Question not that
importantUncertainty about where to look for
info
Prevents pursuit of questions
Obstacles to finding answers
Relevant topic not
included in resource
Resource does not anticipate ancillary
info needsEly et al JAMIA 2005;12:217-24
MD Recommendations
Ely et al JAMIA 2005;12:217-24
Answer clinical queries directly
Tell MD what to do even
when evidence lacking
Summary with bottom-
line recommen-
dations
Anticipate likely
clinical questions Emphasize
detailed treatment
recommen-dations
Comprehensive information
Can a smartphone
help?
5-minute Clinical Consult
Diagnosis & management of
over 900 medical conditions
New in 2011: 22 topics & 14
treatment algorithms
Offered by SkyScape, Unbound Medicine &
Lexi-CompiPhone/ iPod touch
$79.99
Diagnosaurus DDx
More than 1,000 differential diagnoses
Disease, symptom or organ system
searching
Personalized favorites
Extensive links to related entriesiPhone/ iPod touch
$0.99
CliniPEARLS
Condensed versions of clinical
guidelines by the British Columbian
Guidelines & Protocols Advisory Committee (GPAC)
Search for specific guideline, topic
or keyword iPhone/ iPod touch
Free
ACC Pocket Guidelines
American College of Cardiology
Adapted from ACC/AHA Practice
Guidelines
Installs into Skyscape Medical
Resources Environment
iPhone/ iPod touch
Free
STAT Asthma NHLBI Guidelines
Expert Panel Report 3 (EPR3): Guidelines
for the Diagnosis and Management of
Asthma
Interactive tool
Check off data - symptoms, nighttime
awakenings, SABA use, lung function
results etc.iPhone/ iPod touch
Free
STAT Adult Immunization
Full updated 2009 CDC
Recommended Adult Immunization
Schedule
Includes all adult age groups &
vaccine schedule based on medical
& other indications iPhone/ iPod touch
Free
STAT Framingham Heart Age
Based on Framingham Risk
Score
Estimate a person’s ‘Heart Age’ which
could be higher than their
chronological age
iPhone/ iPod touch
Free
STAT Cardiac Clearance
ACC/AHA 2007 guideline on
perioperative CV evaluation and
care for non-cardiac surgery
Step-by-step cardiac evaluation
& care algorithm
Free
iPhone/ iPod touch
Medicinal Herbs
Information on many traditional
herbs & botanicals used in
complementary & alternative
medicine (CAM)
Not evidence-based
iPhone/ iPod touch
Free
Nearly impossible to stay up-to-date!
Medical knowledge doubles every 19 years
Body of knowledge increases by
at least 400% in a 38-year career
Smith, Richard. BMJ 1996, www.bmj.com/cgi/content/full/313/7064/1062
Skyscape Medical Resources
Archimedes: medical calculator
& decision resource
Outlines in Clinical Medicine
RxDrugs: includes drug
dosing calculators
MedAlert iPhone/ iPod touch
Free
Pri-Med Mobile
Watch concise expert presentations
Solve real cases from real doctors
Compete in compelling medical
challenges
Earn free CME credits
iPhone/ iPod touchAndroid
Free
AF Guide: The Atrial Fibrillation Reference
Management of acute & chronic atrial fibrillation
Estimate stroke & bleeding risk
Warfarin dose calculator
Quick access to drugs & dosing in
acute setting
Free
iPhone/ iPod touch
Joslin CME
Diabetes-focused
certified CME
Audio and slides
Alerts for new programs
Keyword searches to find CME
you wantiPhone/ iPod touch
Free
ECG Guide
ECG reference
ECG library: over 200
high resolution sample ECGs
100 MCQs to test your knowledge
iPhone/ iPod touch
$0.99Sale
iRadiology
Quick review of classic radiology
cases
Lieberman’s iRadiology Classics
Collection: >500 unique images
Toggle image labels on and off
Zoom, pan & rotate images iPhone/ iPod touch
Free
Wirdy Medical
Save PDFs to read off line
Search medical news and research
papers
Landscape & portrait mode
supported
View full color eBooks and PDFs
iPhone/ iPod touch
Free
PandoraBox
App Store has 10,000+ apps
100+ apps on sale & 300+ free apps
everyday
Receive the latest information about
new apps
Find about free or discounted apps
Track your favorites iPhone/ iPod touch
Free
iTunes U
Learn anything, anytime, anywhere.
A powerful distribution system for everything from lectures to language
lessons, films to labs, audiobooks to tours
http://www.apple.com/education/itunes-u/
Patient Communication
Body Area Network
Pharma/Clinical Trials
Public Health
Access to Resources
Point-of-Care Documentation
Disease Management
Education Programs
Professional Communication
Administrative Applications
Financial Applications
Ambulance/EMS
mHeal"http://www.mobih.org
http://www.endocrine-witch.info
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