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The Best Medical Apps EBM tools for Clinicians Allan Platt PA-C, MMSc Faculty, Emory University School of Medicine, Physician Assistant Program [email protected] How do you keep learning? • Passive Learning (Lecture) does not work as well as Active (Doing case basedlook-ups) learning • Lectures do nothing to change practice • This lecture is worthless unless you do the “Play list” • - Bluestone J, Johnson P, Fullerton J, et al. Effective in-service training design and delivery: evidence from an integrative literature review. Hum Resour Health 2013;11:51 doi:10.1186/1478-4491-11-51 [PMC free article Best Learning is Active learning • Self directed learning is active and changes practice • Every patient can tell a story • Review each patient’s problem list and do active 2 min look-ups to refresh your brain and practice • Could have had a EBM (Evidence Based Moment) http://current.effie.org/winners/showcase/2008/2366 Why Smart Phone or PDA • Mobile reference available anywhere at anytime ( Maybe not in surgery…) • Wear it so you will use it. If it is not fast, easy, helpful and accessible you will not use it. • Provides your communication and contacts (Voice, email, texting…) • Provides scheduling, reminding, planning • References that are continuously edited and updated. References Help, but….. • Never will they replace a thinking brain with clinical reasoning looking through experienced eyes and filtering the patient’s unique circumstances. • Learn medicine first and use the references to keep up to date and to jog your memory. • Learn from every patient you see. • Do not let it interfere with interpersonal communication like body language…. • Read, then read some more, then some more….. What is Evidence Based Medicine or EBM? • "...the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." (Sackett, Richardson, Rosenberg, and Haynes, Ed. "Evidence-Based Medicine: How to Practice and Teach EBM." 1st edition, Churchill-Livingstone, New York, 1997. page 2.) Evidence Sources • • • • • Colleagues “What do you think?” Textbooks – may be too old, down the hall…. Journals (Pubmed, Medscape) Guidelines (www.Guidelines.gov) Appraised evidence (Dynamed, Uptodate, Essential Evidence, Pepid, BMJ: PDA or Web) • Internet – Google #1, Wikipea #2 - Not GREAT (there are better sites) • E-textbooks– Harrisons Practice, 5min Clinical Consult…. Dr. Google • • • • Multiple signs and symptoms: “Headache, fever, tick bite” Hard to find in references Google searches for web pages with all the words • Lots of things to sort through Google Results • Look for .gov, .edu • Pub med • nih.gov CDC web page WebMD iTriage Journals with research results Review articles with meta analysis PubMed, Medscape Guidelines www.Guidelines.gov Current E-textbooks: 5minCC, Harrisons Best Evidence Pre-Appraised Evidence Products – DynaMed, UptoDate, Best Evidence must be: • • • • • • • Portable and accessible Updated frequently Cost effective (Free is for ME!) Quick and easy to use Credible Incorporated into daily routine Solution – PC/Internet in every room or PDA/smartphone on every hip Practicality • Read the chart before seeing the patient and do a quick disease look-up to refresh • Read your references between the Hx and PE while patient is getting undressed • Read after the PE while patient is getting dressed and you are writing your note. • Read during breaks, lunch, train, between patients. • Multiple 2- 5 minutes chunks of enlightenment Too many apps - Help me PLEASE! • Medical App Reviews – iMedical Apps at http://www.imedicalapps.com • App Evaluation Studies – Pub Med A Review • Evidence about the Evidence • Prorok JC, Iserman EC, Wilczynski NL, Haynes RB. The quality, breadth, and timeliness of content updating vary substantially for 10 online medical texts: an analytic survey. Journal of Clinical Epidemiology. Vol. 65 (12) December 2012, Pages 1289–1295 • Point of care information services: a platform for self-directed continuing medical education for front line decision makers Lorenzo Moja1,2 and Koren Hyogene Kwag2 Postgrad Med J. 2015 Feb; 91(1072): 83–91. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 4345919/ EBM Apps Best Resources Top 6 Evidence Based PDA Medical Apps in rank order PDA Based Timeliness Breadth Quality Cost 9/14 1. DynaMed 1 3 2 $395 2. UpToDate 5 1 2 $499 3. BMJ Best Practice/Epocrates Essent 3 4 7 100/$159 4. First Consult 9 5 2 Free 5. Medscape Mobile 6 2 9 Free 6. PEPID N/A 6 10 $299 1 = Best 10 = Worst Prorok JC, Iserman EC, Wilczynski NL, Haynes RB. The quality, breadth, and timeliness of content updating vary substantially for 10 online medical texts: an analytic survey. Journal of Clinical Epidemiology. Vol. 65 (12) December 2012, Pages 1289–1295 Trial yes yes yes iThings Free yes 2016 Review • Med Internet Res. 2016 Jan; 18(1): e15. Published online 2016 Jan 19. doi: 10.2196/jmir.5234 • Point-of-care information summary rankings with providers listed in alphabetical order. Quartiles according to 2014 rankings for volume, editorial quality, and evidence-based methodology: black, bottom dark gray, low intermediate; light gray, high intermediate; white, top - Best Top 3 : BMJ (Epocrates) Dynamed UpToDate New Dynamed app • Easier to navigate and search • For iThings and Android UptoDate UptoDate Cost • If you have a VA/ Institutional UpToDate login – it may allow the mobile App to work (download from the app store for free and use your username and Password) • $199/year Student price Epocrates Essentials • Disease information is BMJ Best Practice (good EBM) • Drug information • Lab Reference • Multicheck drug interactions • Best Dose Calculator • Best formulary information • Best pill picture identification system • Infectious Disease app – Bug/drug • Calculators and Tables Epocrates Essentials Emory does not cover this • There is a $100 Education discount when using your @emory.edu email to register • • • • • • • • To get started with your Epocrates subscription, please click this link for $49.99: https://www.epocrates.com/referral.do?p_r_name=EMORYUNIVPA If you do not have an Epocrates account Click on ‘Register Now’ and follow instructions to create your account If you already have an Epocrates account Login to your Epocrates account. The product will be added to the shopping cart automatically. Your total should be $49.99 (plus any applicable tax). Click the ‘Check Out’ button. Click ‘Confirm’ and click ‘Continue’ on the following screen. When complete, follow the on screen instructions to download and install. Epocrates for Free • • • • • • • Drug information Multicheck drug interactions Best Dose Calculator Best formulary information Best pill picture identification system Calculators and Tables Missing Disease information, Herbals, Lab, ID Medscape Mobile • Free on all devices Best ID resource • Clin Infect Dis July 1, 2012 vol. 55no. 1 114-125 Free at http://cid.oxfordjournals.org/content/55/1/114.full Johns Hopkins Antibiotic Guide Lab Values • ARUP Consult (iThings) • Quick Labref (Android) • Mayo Medical Lab (iThings) • Evidence Based Primary Care(iThings) American Family Physician – AFP by Topic Diagnose • Likely hood ratios for signs and symptoms PubMed Free Medical Calculators • MedCalc • Calculate QxMD • Epocrates Tools Prevention – ePSS - Free • Electronic Preventive Services Selector from AHRQ • http://epss.ahrq.gov/PDA/index.jsp Skyscape • Register for free at http://www.skysc ape.com/sml/ Free Drug, Merck medical reference, Calculator, news Specialty books Skyscape -Omnio Best Emory SubscriptionsMobile Resources http://health.library.emory.edu/resources/clinical/mobile-resources.html Emory Resources • • • • • • Dynamed U -Central Access Medicine Full Text Journals via Pub Med – Web Textbooks – Web (Theime Series) ClinicalKey UCentral Unbound Medicine • • • • • • • • • E Books updated 5min EM consult 5min Peds consult Baby Bates - PE JH- ObGyn JH – Abx guide JH – Diabetes JH – HIV Medline Access Medicine • Full Medical e-textbooks • Need internet connection • Pay by the book/yr Access Medicine App • Quick Medical Diagnosis • Tests • DDx with Giagnosaurus • Derm book ClinicalKey – Web based • Search by topic • Results: articles, Elsevier books, guidelines • Internet based • Save as PDFs Thieme e-books • http://ebooks.thieme.com.proxy.l ibrary.emory.edu/bookshelf Equipment links • • • • • EKG: http://www.ecgcheck.com/ Pulse oximetry – iHealth Otoscope - www.cellscope.com BP cuff - iHealth Weight scales -Withings WS30 Equipment • Dermatoscope • Microscope • Glucometer More Equipment • Ophthalmoscope • Finger pulse rate monitor • Ultrasound - http://www.mobisante.com/products/product-overview/ Apps that can help • • • • • • Cloud storage – iCloud, Digital Dropbox, Box Evernote, Good Reader Documents to Go Dragon dictation WritePad – handwriting recognition Kindle Bottom Line • Best device: any iThing or Android you wear • Best EBM- Dynamed • Best free drug interaction check with herbals Medscape mobile or Epocrates Essentials • Fastest free Drug dosing calculator, formulary and pill picture identification Epocrates Rx • ICD 10 codes - Dynamed The Future • Wearable sensors and point of care diagnostics • The $10M Qualcomm Tricorder XPRIZE • Nokia Sensing Xchallenge - 1 drop of blood http://sensing.xprize.org/teams/competition-2-teams To Do – Action Plan • Get Dynamed, Access Medicine, Ucentral, and all the Emory sponsored apps for Free • Get Epocrates Free at the App store • Get the Free Medscape Mobile at the App store • Play!