Neil Canavan

February 19, 2014

NEW YORK CITY — There is a medical app for almost every situation in the emergency department these days, but for a novice user, choosing one can be a challenge.

The US Food and Drug Administration regulates only a small subset of mobile medical apps. Officials report that they do not intend to provide oversight of smartphones and tablets as platforms for healthcare apps. To take some of the guesswork out of choosing options for the emergency department, Graham Walker, MD, from the University of California at San Francisco, held a workshop highlighting tools to enhance patient care here at the American Academy of Emergency Medicine (AAEM) 20th Annual Scientific Assembly.

Dr. Walker said that one of his favorite apps provides treatment tips from the trenches. Paucis Verbis cards "were developed by Michelle Lin, MD, editor-in-chief of Academic Life in Emergency Medicine. This reference tool started out as a collection of 4 × 6 note cards to serve her practice needs. They've now been digitized." More than 120 topics are currently represented in the notes — everything from acute limb ischemia to central nervous system infection, croup, and ventilator settings.

Evernote, a free cloud-based app, can sync notes and materials, such as Paucis Verbis, across all platforms. "Evernote is nice because it syncs all types of information — images, PDFs, even handwriting," Dr. Walker pointed out. "You can take a picture of your notes, upload it, and it will be transcribed and will be searchable."

Dr. Walker said he also finds Google Translate very useful in the emergency department. The free Web-based app is not perfect, he noted, but "it works for the critical things you need to communicate, such as discharge instructions." Just type in the notes and select the appropriate language, and the translation appears on the screen for the patient to read. The message can also be translated into speech.

There is another option for medical translations. MediBabble is designed to get a rapid, detailed history from a non-English-speaking patient. Someone presents with chest pain? Click on chest pain and a language, and MediBabble will provide a series of yes or no questions related to the presentation of that condition.

A Digital Formulary

"I'm at UCSF, but I know Hopkins has an antibiotic guide, and Mayo might have one as well," Dr. Walker said. The app is a Web-based manual to antibiotics, and can be customized to the formulary of a given institution. "Let's say it's 3 AM, you can't get in touch with your ID colleague, and you just need to remember how to treat a particular uncommonly seen disease process." Just click on the disease state, and the treatment options for, say, endocarditis or a brain abscess will be presented.

Another app, the PediStat dose calculator, helps physicians calculate pediatric prescriptions. "If you have a critically ill child, there is no more stressful time for you to be calculating the dose for a medication that is desperately needed," Dr. Walker said. PediStat does that for you, and can calculate based on the average weight of a child at a certain age or by a known weight. "Certainly, I encourage you to have these doses in mg/kg memorized, but this allows you to double check your work."

Other options "are a bit futuristic but kind of fun, and could be where monitoring is headed," Dr. Walker noted. An app known as Vital Signs measures a patient's heart rate and respiration through the camera lens. "Every time your heart beats, your capillaries flush," he explained. "It turns out that a digital camera can detect heart rate from the resulting minute color changes in the skin." The imaged, rhythmic movement of a patient's shoulders and chest gauges respiration.

The possibilities are endless, but many physicians have raised concerns. "Technology already gets in the way of person-to-person interaction with most electronic health records," said Gary Gaddis, MD, who practices emergency medicine at St. Luke's Hospital in Kansas City, Missouri. "You have to strive for a balance," the chair of the AAEM workshop on medical technology told Medscape Medical News. "I have faith that in time the tools will become more user friendly."

Younger physicians are more enthusiastic and are probably earlier adopters of technology, said Dr. Gaddis. "I'm convinced that older physicians will come around, they just won't be in the first wave of implementation. I'm not an early adopter myself, but I've come to depend on my tablet and my iPhone for information that I used to keep in a notebook."

"I can think back 25 years ago, when I was in residency; we referred to the book we carried in our pocket as our ectopic brain," Dr. Gaddis reflected. How much easier and more efficient it is to carry an iPad.

Dr. Walker reports financial relationships with the MD+CALC and TheNNT.com. Dr. Gaddis has disclosed no relevant financial relationships.

American Academy of Emergency Medicine 20th Annual Scientific Assembly. Presented February 14, 2014.

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