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How Your Mobile Digital Device Can M ake Y ou a Smarter Doc

This presentation discusses the use of mobile digital devices and medical apps to improve patient care. It explores the benefits, barriers, and tools available to healthcare professionals. Learners will gain practical skills in using digital resources for clinical questions and selecting relevant medical apps.

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How Your Mobile Digital Device Can M ake Y ou a Smarter Doc

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  1. How Your Mobile Digital Device Can Make You a Smarter Doc Nancy J. Baker MD James Beattie MLIS University of Minnesota

  2. Disclosure The presenters have no conflicts of interest to disclose

  3. Learner Objectives • By the end of this session, participants will • Recognize how digital resource apps can help with patient-related “information management” • Practice using digital apps to answer clinical questions to enhance patient care • Select 3-5 medical apps to install on a mobile digital device

  4. Why use digital medical apps? • Doctors and patients have questions • Mobile digital devices are commonplace and portable • Mobile devices can help us find and manage the wealth of new information • The IOM suggests they may help decrease the risk of diagnostic errors • Time is precious

  5. Mobile devices (and apps) can be accessed almost everywhere

  6. How much time does it take to find an answer? • 1995 BMJ editorial posited that a general practice physician would need to read 17 original articles/day to keep current • 1996 study found the average MEDLINE search takes 27 minutes • 1/5 patient encounters generate an unanswered question • Critical factors in resource selection are speed and trust • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124538/

  7. Barriers to the use of apps • Inexperience • Android vs. iOS vs. tablet compatibility • Verifying content is up-to-date & accurate • User friendliness • Patient perception(s)

  8. Not all devices are created equal; they can be used for many purposes

  9. A word (or two) about EBM • Information mastery • POEMS vs. DOES • Levels of evidence, SORT taxonomy • Filtered vs. unfiltered resources http://www.ebmpyramid.org/images/pyramid.gif • Background vs. foreground questions http://www.bumc.bu.edu/busm/2013/11/05/introducing-busms-finding-information-framework-fif-–-conceptual-algorithm-practical-web-based-tool/ Shaughnessy , Slawson, Bennett JFP, 1994, Vol.39(5), p.489-499

  10. Case 1 • 51 yo married white male, small business owner, presents for a CPE What preventive health services should be discussed and offered? What tools can help you find the answer?

  11. AHRQ ePSS app

  12. Case 1 • 51 yo married white male, small business owner, presents for a CPE • What preventive health services should be discussed and offered? • Daily ASA • Colorectal Ca screening test • B/P monitoring • HIV screening • What tools can help you find the answer? • ePSS AHRQ/USPSTF

  13. Case 2 • 62 yo man with >4h of altered mental status, last known to be well 3 days prior • 4 days ago, he fell on stairs and hit his head/neck, refusing care from EMS on scene • Can we clear his C-spine? • What are his GCS and NIHSS scores? • What tools can help you answer these questions?

  14. ✪ Requires radiography QxMDCalculate app

  15. QxMD Calculate app NIH Stroke Scale from StatCoder

  16. Case 2 • 62 yo man w/>4h of altered mental status… • 4 days ago, he fell on stairs and hit his head/neck… Can we clear his C-spine? • Requires Radiography What are his GCS and NIHSS scores? • 14, it depends on his neuroexam What tools can help? • NIH Stroke Scale from StatCoder (Free, iOS) • QxCalculate (Free, iOS, Android)

  17. Case 3 • 62 yo AA woman with HTN and type 2 DM presents for routine f/u; non-smoker • Meds: HCTZ 25 mg Metformin 1000 mg BID • SBP=120; Total Chol=170/HDL=41 • What is her 10-yr risk of CVD? • Should she be on a lipid lowering agent? • What tools can help you find the answer?

  18. CVRisk Assist App

  19. Case 3 • 62 yo AA woman with HTN and type 2 DM ; non-smoker • Meds • HCTZ 25 mg q day • Metformin 1000 mg BID • SBP=120; Total Chol=170; HDL=41 • What is her 10-yr cardiac risk of CVD? • 14.6% • Should she be on a lipid lowering agent? • Yes • What tools can help you? • CVRiskAssist

  20. Case 4 • 72 yo man w/prostate cancer metastatic to spine & pelvis w/uncontrolled pain • Meds • Hydromorphone 4 mg q 4 hrs • Dexamethasone 4 mg q day • Gabapentin 300 mg q hs • You’d like to convert to methadone. What dose? • What tools can help you answer this question?

  21. OpiodsConversion app

  22. Case 4 • 72 yo man w/prostate cancer metastatic to spine & pelvis with uncontrolled pain • Meds • Hydromorphone 4 mg q 4 hours • Dexamethasone 4 mg q day • Gabapentin 300 mg q hs • You’d like to convert to methadone. What dose? • 5 mg TID or 7.5 mg BID • What tool can help you? • Opiod dosage conversion (SCVMC)

  23. A typical day for a primary MD • 30 yo w/+ UPT • When to order an US? • 28 yo w/abnl PAP • Repeat PAP vs. colp? • 15 mo old for vaccines • Vaccine schedule? • 72 yo pre-op for TKA • Perioperative B-blocker? • 62 yo woman w/HTN • Med/side effects/dose? • 21 yo w/chlamydia • 2015 CDC Tx guidelines? • 67 yo w/lung ca, near death, w/inc. agitation • Tx of terminal delirium? • 16 yo w/rash • Atypical features? • Pt self-management • Wt. loss, BS, meds?

  24. How to assess if it’s a “good” app • Authority • Veracity • Currency • Cost/value • Does it do the job?

  25. Brancel Prenatal OB app

  26. Dynamed app

  27. ASCCP abnl pap app

  28. ASCCP abnl pap algorithm app

  29. STFM SHOTS app

  30. ACP Immunization Advisor app

  31. Pre-op Eval app

  32. Epocrates app

  33. EMRA & Sanford Antibiotic guide apps

  34. CDC STD Tx Guidelines 2015

  35. Palliative Care Fast Facts app

  36. VisualDx app

  37. MyFitnessPal app

  38. Blood Glucose Monitoring app

  39. MyMedSchedule Mobile app

  40. We live in a time of technological innovation

  41. Summary • It’s OK to say “I don’t know but let’s find the answer” • Your time is precious • Mobile digital apps are portable & at your finger-tips • Digital apps can help access point-of-care clinical information • QxCalculate • ePSS AHRQ/USPSTF • Pre-op assessment tool • A medication app • Digital apps are also a potential resource for patients

  42. New & old tools make us smarter docs

  43. References • Mosa ASH et. al. A Systematic Review of Healthcare Applications for Smartphones. BMC Med Informatics & Decision Making. 2012;12(67):1-31. • O’Brien BO, Teherani A. Using Workplace Learning to improve Patient Care. Acad Med. 2011;86:e12. • Schafani J et. al. Mobile Tablet Use among Academic Physicians and Trainees. J Med Syst. 2013;37:9903. • Shaughnessy A et. al. Becoming an information master: a guidebook to the medical information jungle. JFP. 1994;39(5): 489-499. • Walsworth DT. Medical Apps: Making Your Mobile Device a Medical Device. FamPractManag. 2012;19:10-13.

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