1. Top 10 Apps for your Smartphone or Tablet: Teaching and Learning in the Office
David Esho
Azadeh Moaveni
Andrew Sparrow
November 28, 2013
10:45 to 12:15

2. Faculty/Presenter Disclosure
Faculty: David Esho
Program: 51st Annual Scientific Assembly
Relationships with commercial interests:
NONE 2 2

3. Disclosure of Commercial Support
This program has received NO financial support
This program has received NO in-kind support
Potential for conflict(s) of interest:
NONE 3 3

4. Mitigating Potential Bias
N/A 4 4

5. Faculty/Presenter Disclosure
Faculty: Azadeh Moaveni
Program: 51st Annual Scientific Assembly
Relationships with commercial interests:
NONE 5 5

6. Disclosure of Commercial Support
This program has received NO financial support
This program has received NO in-kind support
Potential for conflict(s) of interest:
NONE 6 6

7. Mitigating Potential Bias
N/A 7 7

8. Faculty/Presenter Disclosure
Faculty: Andrew Sparrow
Program: 51st Annual Scientific Assembly
Relationships with commercial interests:
NONE 8 8

9. Disclosure of Commercial Support
This program has received NO financial support
This program has received NO in-kind support
Potential for conflict(s) of interest:
NONE 9 9

10. Mitigating Potential Bias
N/A 10 10

11. Overview The increasing relevance of apps to medical practice
App categories you might find useful in your work
Hands on Examples:
Apps you can use to help you in your clinical work
Apps that you can recommend for your patients
Apps that you can use with your learners
Q & A

12. What is an App
App or application is a program designed to run on a mobile device
Smartphones ( iPhone, Blackberry, Android devices, Windows mobile )
Tablets ( Apple, Samsung, Sony etc..)

13. Apps and Patients Smartphone use in Canada rapidly rising
Smart phone use increased by 40%
Tablet use increased by 100%
Canadians increasingly likely to get their health info from electronic sources
70% of Canadian internet users looked up medical information online
34% of app use related to health/fitness/wellness

14. Apps and Physicians Increasing adoption of apps by physicians
Fulfill multiple roles for a clinicians
Education Rx
CME
Reference
Tracking patient symptoms

15. App Categories that Every Physician Should Consider having:
Point-of-Care Reference
Drug Database
Note App
Textbook / eBook App
File Repository
Medical Calculator
Podcast/Video Player
Explain an example of what each of these are
P-O-C – Medscape / Epocrates – find and retrieve small piece of information while you are working – all within a minute. Synthesized evidence based medicine within 1 minute.
Drug Database – different doses, pediatric dosing, pricing, generics, pill picture, contraindications, adverse reactions, interactions, pharmacology etc.
Note App – something to easily file, edit and search for the nuggets of medical wisdom
Textbook / eBook App – replace your giant bookshelf sagging with medical texts
Calculator - …medical calculators, clinical prediction rules, risk stratificaiton, diagnostic criteria
Pod and video player: watching to listening to programs via your phone

16. Clinical Question
A 68yo M with gallstones and CAD is seen by a general surgeon and deemed too high-risk for cholecystectomy. He continues to have biliary colic despite dietary tx and analgesics. How well does Ursodiol work to dissolve cholesterol stones when surgery is relatively contraindicated?
Android: Skyscape "gallstone" - DynaMed. BMJ: no match. UpToDate

17. Point of Care Apps iPhone Android Blackberry Medscape
Dynamed (Skyscape; free from CMA)
Tarascon Family Medicine ($20)
UpToDate ($$)
BMJ BestPractice mobile site
Epocrates ($100/yr)
Skyscape 5-Minute CC ($99) or native app $99 or Epocrates
Skyscape 5-Minute CC ($99)
Wikipedia Apps
DEMO MEDSCAPE

18. Dermatology
You are working with a clinical clerk today. The clerk sees a diabetic patient with a new bullous rash on the shins. The clerk is unsure of the diagnosis. What app could you use to come up with a differential diagnosis of bullous rashes?

19. Dermatology Helper Apps
iPhone
Android
Blackberry
Google Images (free)
Google Images
VisualDx ($100/year for family practice; $50/year for peds)
Derm101 ($10/month; free 1 month trial) -
Derm101 ($10/month)
VisualDx (‘’)
Skyscape Dermatology Suite ($99 x1) – Fitzpatrick’s Color Atlas
VISUAL DX DEMO MARCO
Derm101 – online library for diagnosis and treatment of skin diseases.
VisualDx – allows you to enter visual findings, body location, and other findings in order to generate a differential diagnosis

20. Scenario
The clinical clerk you are working with has seen a 30 y.o man with uncontrolled asthma.
You would like to start Advair. Your clinic rooms are full, but your phone is in your pocket.
The same patient is also on lithium and ramipril. Do you have to worry about interactions?
(100mcg)
Drug Dosage Lookupe.g. adding Singulair to a patient with asthmaOpioid Conversione.g.
switching a patient from Percocet to hydromorphone
Rare Drug Side Effecte.g. a patient on lithium and ramipril has a history of non-pulsatile tinnitus for 3 months. Is it drug-related?
Drug Interaction Checkinge.g. a patient on warfarin is diagnosed in the ER with pyelonephritis. Check interaction for cipro, Septra DS -> cefixime 400 mg po qd x 2 weeks ok

21. Drug Dosage Apps iPhone Android Blackberry Medscape Epocrates
Micromedex
eCPS ($40/yr)
Skyscape: RxDrugs(free)
For Pediatric ER Drugs:
Pedi safe ($1)
Pedi safe ($4.50)
DEMO EPOCRATES
MARCO IS AN EPOCRATES LOVER
DOUG LIKES MICROMEDIX

22. Drug Program Comparison
Use Case
Best App(s)
Very quick dose lookup
Medscape, Epocrates, Lexicomp
Detail on adverse effects, monitoring
Micromedex, Lexicomp
Canadian-specific formulary
eCPS
Drug interaction checking
Epocrates, Medscape
Opioid Conversion
Opioid Converter (Android), Opioids Dosage Conversion (iOS), Opioid Morphine Equivalence Table (PSS)
Rare Drug Side Effecte.g. a patient on lithium and ramipril has a history of non-pulsatile tinnitus for 3 months. Is it drug-related?Drug Interaction Checkinge.g. a patient on warfarin is diagnosed in the ER with pyelonephritis. Check interaction for cipro, Septra DS -> cefixime 400 mg po qd x 2 weeks ok

23. Scenario
Ms. O’Brien is an 78 y/o new patient. She has a history of atrial fibrillation and COPD.
Your clerk has taken a history and notes she is not on anticoagulants for her A fib.
Ms. O’Brien has seen a cardiologist remotely but doesn’t remember why she is only on aspirin. What can you use to assess her risk of stroke on her current regimen?
Clinical Prediction Rule or Mediquation

24. Examples of Useful Calculators and Clinical Prediction Rules
CHA2DS2-VASc Score, HAS-BLED score, CHADS2 for Afib
Ranson’s Criteria
Pregnancy date calculator
Modified strep score / McIsaac
Well’s criteria / DVT Clinical Probability
FRAX

25. Calculator apps iPhone Android Blackberry Calculate by QxMD (free)
Archimedes (Skyscape; free)
MedCalc ($10; used to be free)
Mdcalc.com
Mediquations Medical Calculator ($5.13)
Mediquations Medical Calculator ($?)
Ob (Pregnancy) Wheel
FRAX app ($5.99)
Not available... CAROC.pdf
NO DEMO unles someone really wants to see it

26. Clinical Day Uptodate (membership connected)
Medscape (pharmaceutical funding)
MedCalc
Qx Calculate
DxSaurus
RX Files
Stat ICD 9
Insulin DM2
Figure 1

27. Patient Resources
A family comes in with a child with a fever. What handout could you give them quickly?
Your G1P0 patient anxiously presents with a number of questions regarding her pregnancy. What apps can help?
A type II diabetic sees you after a myocardial infarction and is looking for advice on lifestyle changes and disease management.
Doug

28. Techy ways to educate patients
iPhone
Android
Blackberry
WebMD
Aboutkidshealth.ca
BabyCenter
My Heart & Stroke Health
Diabetes GPS
Visual Anatomy
Smart phone to print to printers at the office
Direct to website
Direct to app
Wireless printing from smartphone
No reply
Consider setting up smartphone printing or using an outgoing no-reply address (as long as you warn about security implications)

29. Apps to use with patients
MindShift
DrawMD
ImmunizeON
Lose It
Pepid
MedSpeak
Twitter

30. First Night on Call
An elective med student resident is nervous about his first overnight call.
He is worried he won't know what to do in the middle of the night when he is paged by the nurse.
He is also nervous about having to dictate, since he has no idea what is expected in a standard dictation on this rotation.
• Standard Dictations• MD On Call

31. On Call Apps iPhone Android Blackberry MD on Call ($5) MD On Call
Standard Dictations
Medscape
Quick Lab Ref
ECG Guide by QxMd $~3
ECG Guide by QxMd $4.75
DEMO MD on call

32. Apps to use with your learners
SoundBuilder
Auscultate
ECG Guide
Resuscitation
MD on Call
Read
Podcasts

33. The Future of Medical Apps
The Wireless Future of Medicine: Eric Tolpol

34. Q and A How do I get started Which Apps are your favorites
Where can I find reviews of apps
Non medical apps you find useful

35. Getting Started with iPhone/iOS
iTunes
App Store
MARCO
2 BASIC WAYS
USE DEVICE ONLY WITHOUT USING COMPUTER AT ALL, EASIER
CAN DO WITH ITUNES AND SYNC UP, ONLY COMPLICATE IF CHANGE COMPUTERS
ICLOUD MAKES IT SEAMLESS
Apple ID & account

36. Getting Started with Android
Buy an Android 4.0-compatible smartphone, e.g. Samsung Galaxy S3/4
Set up a google account and gmail
Search and explore
play.google.com/store
Consider creating an outgoing account e.g.
DOUG

37. Getting Started with Blackberry
Download the following apps:
Skyscape Reader (
DynaMed for Skyscape (
Epocrates Rx (
Medscape (
Blackberry App World (appworld.blackberry.com) MemoPad (preinstalled) for note taking
Create quick home links to apps
DOUG

38. Azi’s Favorite Apps (so far!)
Qxcalculate
Epocrates
Evernote
CDC contraception 2010
BestPractice: as a website shortcut
AFP by topic

39. Andy’s Favorite Apps Lexicomp – drug resource
Figure 1 – Instagram for healthcare workers
LU Offline – Limited Use Codes
Read – Finding articles
CCS Lipids – CV risk scores to show patients
QxCalculate – medical calculators
Evernote – keeping track of info

40. Dave’s Favorite Apps Up to Date – Point of Care reference
MedCalc – Calculator Repository
Stat ICD 9 – Look up Dx codes
Pedi Stat – Genral Ped reference
DxSaurus – DDX generator
RX Files – Drug resource
iBooks – Storage of Pdfs

41. Useful Sites iMedicalApps.com cma.ca/k4p Dozens of useful articles
Top 10 lists for each platform
cma.ca/k4p
Knowledge for Practice
Links to free online resources
DOUG