Adding Apps to Your Practice

September 23, 2010

Here’s what you need to know about the booming medical apps market

Check out our list of top seven smartphone apps for docs.
Patients frequently come to see Melinda Rathkopf, a pediatric allergy and immunology physician in Anchorage, Alaska, without their inhalers and aren’t sure which ones they use. Or they forgot the name of their medication, remembering only that it’s a small, yellow pill. No problem.

Rathkopf pull out her iPhone in the exam room, opens the Epocrates app, and keys in the description. In seconds, Rathkopf and her patient can identify the pill or inhaler.

“I use it multiple times a day,” Rathkopf says of her smartphone, which is chock full of medical applications. She frequently looks up dosages and interactions for her pediatric patients, and keys in descriptions of medications and inhalers to identify the right one.

“I don’t go and pick up a book and look up something anymore; it’s always my phone or computer,” she says.

Rathkopf is among a growing number of physicians turning to their smartphone apps for answers, both in and out of the exam room. From simple references to calculators to EHR access, apps are increasingly finding their way into physicians’ work flow, making some tasks quicker and easier.

But not all apps are created equal, so before raiding the app store, here’s some guidance on navigating the emerging market.

Expanding app use

About 72 percent of physicians use smartphones, according to Manhattan Research, and that number is continuing to rise, projected to reach more than 80 percent in 2012. The tasks performed on smartphones will also expand. Most physicians are using mobile devices to access clinical information and perform quick tasks, researchers found, but soon half of users will be accessing the devices for administrative functions and patient care.

“It’s a real phenomenon,” says Joseph Kim, a physician trained in internal medicine who blogs about smartphones and medical technology, as well as nonclinical jobs.

Physicians recognize the need to be connected, Kim says, and in the last few years, smartphones have become cheaper and easier to use. Plus, the push for EHRs and health IT has added fuel to the fire for the latest mobile gadgets and applications. Most apps are developed across platforms, so whether you’re tethered to your iPhone, loyal to your BlackBerry, or trying any other smartphone technology, the chances are good that the app you are looking for will be available for your device.

Physicians and other healthcare providers are turning to their handheld devices for several reasons, Kim says. First, there are the medical apps, such as databases and calculators. Second, the smartphones are proving particularly useful simply for their connection to the Internet, Kim says.

“Today, they are just going right to the search engines, pulling up things like a journal article, and within 30 seconds they can look it up on their device via a Google search,” he says, adding that there’s a movement away from just downloading any old app, and instead relying on Internet searches and a few oft-used apps.

As for those popular apps, there are hundreds to choose from, promising assistance with drug interactions, textbook reference, converters, and algorithmic tools for various specialty-specific needs. Physicians are also finding apps useful for CME, Kim says.

Among Rathkopf’s favorite apps on her iPhone 4 is one that allows her to conveniently get CME credit. She downloaded Cisco Systems’ WebEx app, which lets her connect remotely and listen to a live presentation of her journal club at the University of Washington School of Medicine, where she is on faculty. She can plug in and view the slides in the early morning while at her spin class at the gym. “I can sit there with headphones on for an hour and get CME, she says” Rathkopf also listens to podcasts through ReachMD’s apps, which also earns her some CME credit.

Larry Berman, a solo-practice primary-care internist in Charlotte, N.C., turns to his BlackBerry Storm (he’s upgrading soon to a Droid X), six to eight times a day and has been using the Epocrates app for years.

“It has really saved me hours,” he says. “In primary-care medicine, there are so many drugs or doses or interactions, it’s impossible for me now to do my job without having the help of an assistant device or a program to look for interactions and look at the dosages and contraindications and side effects.”

Before his smartphone adoption, Berman would have to rely on monthly mailed information on multiple drugs, and shuffle from room to room to find the right reference material. Now, that information is usually right at his fingertips. For more complex discussions or diseases, Berman says he’ll retreat to a computer.

In the exam room, the common cell phone or smartphone etiquette doesn’t seem to apply. Rather than exercise discretion about becoming absorbed in the tiny screen, many physicians use it as a tool with the patients. It’s a great conversation piece, Rathkopf says, as so many people are toting their own smartphones and are eager to exchange app ideas.

Berman also stays in the exam room to look up the information, incorporating the exercise into the visit. “I just tell them I am going to my brain,” Berman says. “I take out the smartphone and we look together. I make it part of the visit.”

The learning curve is minimal, Berman says, and really, physicians have to get on board with smartphone apps. “With the current state of primary-care medicine in the U.S., we are being essentially forced into seeing more and more patients in the same amount of time,” he says. “I haven’t met anyone opposed once they got the smartphone and downloaded an application that would be applicable to their practice. It’s an essential part of running a successful practice for the future.”

More sophisticated tools

But just because apps abound doesn’t mean they are all appropriate tools.

Although the buzz around apps has reached a fever pitch, “it’s still very, very early in the development process,” says Derek Kosiorek, a healthcare technology consultant with the MGMA Health Care Consulting Group.

“You can picture this as a land grab for the market,” he says. “[App developers] are putting anything they can out there, hoping something will latch on… They are getting something on to the market and worrying about improving it later on.”

That means that often physicians are downloading an app, but then finding they don’t like it and stop using it.

Far less ubiquitous now are apps that connect physicians directly to their electronic health records, and it’s these apps that are really proving their value, Kosiorek says. As more vendors begin developing these apps, more physicians will be adopting them. Right now, only a handful of vendors have created such apps.

“I think we will see a shift toward the use of smartphone apps dedicated to the actual [EHR] itself,” Kosiorek says, adding these apps are more useful for providers and administrators than apps that provide drug references or calculators. The EHR sister apps interact with the database to allow users to complete tasks such as check schedules, review messages, e-prescribe, and review results, he says.

Chris Thorman, senior marketing manager at Software Advice, which researches and reviews software and helps match providers with products, agrees that EHR-related apps were the “next step” for smartphone tools. “That’s where things are moving,” he says.

And it won’t just be EHRs that will have a mobile connection, he adds. Other software, like the practice management system, will likely also have mobile apps that provide users with more advanced functionality. These will trump the one-trick pony apps that do little beyond send out a notification or define a term.

But these apps that align with a software suite are also being used a bit differently than the standard apps, experts say. Rather than serving as a tool during the patient visit, the EHR apps can allow providers to access patient information remotely.

Rathkopf uses her EHR iPhone app to access problem and medication lists, review lab results, and refill prescriptions, for example. She can log into the full EHR from home, but if she’s not near a computer, she can just look up certain information from her iPhone.

“It bridges the gap,” she says. “It’s a convenience factor.”

If you’re concerned about patient privacy, experts say don’t be - at least not more than you always are. Privacy is always a concern, Kosiorek concedes, but with these EHR-related smartphone apps, there should be enough protocols in place to protect sensitive patient information. And there’s no patient information stored on your phone, so there’s minimal risk of breach of patient data, Kim notes.

But what happens if you lose your smartphone or it gets stolen? Someone might not be able to hack into the EHR through your phone, but unless it’s password protected, you’d still be opening up some information. If you’re carrying around a smartphone, you must make sure it’s password protected, Kim says.

Some words of wisdom

Before hitting the app store for the medical app du jour, users and experts have a few words of advice:

First, use your smartphone. Get used to navigating the tiny keyboard and screen. Learn about the apps already on the phone, such as the map or weather feature, and how they can work in your day-to-day life. “If you don’t have that grounding, that foundation of being able to use the device and know what it can do, then there really is no use doing anything further,” Kosiorek explains.

Read app reviews. Spending some time reviewing what other users who downloaded - and used - a certain app will help you decide how it can fit in with your current work flow. “That will give you a strong indication of whether it’s useful or not,” Kosiorek says.

Don’t spend a ton of money. Many smartphone apps are free, and more sophisticated ones tend to have a free “lite” version. Start there. Rathkopf says she used Epocrates’ free version for three years before finding a need to upgrade. Her rule? Never pay more than $10 for an app. Once you have a better idea of your smartphone use and app need, then you can graduate to a more advanced, and perhaps not free, app. Thorman notes that some of the larger reference apps can be costly, and it’s a good idea to stick with a reputable or familiar company, so you can have confidence in your information.

Download a few and try them out. Every app is different: some e-mail you alerts; others have pop-up notifications; some will update automatically; others won’t. Check the functionality and the settings for the apps, and just give them a whirl. “The idea is for them to be convenient and useful,” Rathkopf says, adding that it’s also a good idea to see which ones require Internet access, as opposed to just a cell phone signal, so make sure you’ve got a connection. “If you try them and don’t like them, you can delete them.”

Be patient. Incorporating smartphone apps into your daily routine will take some getting used to, says Thorman. He likens smartphone use to EHR adoption, which tends to be slow because technology can dramatically shift a physician’s work processes, and both need a certain amount of patience. “It’s not just a change in method,” he says. “It’s a transformation of practice, how things are run, how work flow is performed.”

Sara Michael is senior editor at Physicians Practice. She can be reached at sara.michael@ubm.com.

This article originally appeared in the October 2010 issue of Physicians Practice.

In Summary

Physicians are increasingly turning to medical apps on their smartphones to assist them in their day-to-day practice operations. With hundreds of medical apps on the market, here are a few things you need to know:

•Many physicians are tethered to their smartphones simply for the Internet connectivity, where they can quickly look up articles and information.

•Medical apps come in the form of calculators, reference tools, CME applications, and more.

•More sophisticated apps will continue to emerge, as more vendors develop apps that connect physicians directly with their EHR.

•Before downloading an app, first become familiar with your smartphone: check out user reviews of the apps before you commit.