Looking back on my medical internship, there are a few things I can point to as critical to my survival – a limitless supply of coffee, 24-hour availability of cheese fries, chewable antacids, and UpToDate. Whether I needed to know how to manage a patient with a pulmonary embolism or was trying to figure out what Takotsubo cardiomyopathy was, UptoDate was a go-to resource for practically any clinical situation. In fact, it became a verb among interns, as in “I have no idea, let me go UpToDate it.”
The one downside was that it required a desktop or laptop, unlike other important resources like Medscape and Epocrates. And although technically there is a mobile version — in webapp form — it’s not ideal by any means. As announced on their website though, that is no longer the case as UpToDate is finally available via a native iOS app. However, before folks rush to download it, the release comes with several important caveats which are quite informative in understanding some of the hurdles mobile health faces.
With 9,000 clinical topics maintained by 5,000 physician-writers, UpToDate is an incredibly comprehensive and useful resource, as represented by the fact that they have 500k subscribers. According to Vicki Brown, VP of Marketing at UpToDate, the iPhone app release is the start of a broader mobile strategy. This release is for individual subscribers only. By the end of the year, they plan to launch iPad and Android apps as well as versions of these apps that are entirely local (around 1gb) with intermittent updating. You can actually sign up to “get notified” when the offline version of their iPhone app releases on their website.
However, institutional subscribers (myself included) have a longer wait ahead of them. There is not a clear timeline yet for launch of mobile solutions for institutional subscribers. The problem, according to Ms. Brown, is significant variability in how UptoDate is implemented. For example, in some institutions, it is integrated into an EMR, which raises issues regarding data security. There are additionally uncertainties about the process for deploying across an institution as the enterprise component of mobile health is still in its early stages.
And herein lies a key distinction. Much of mobile health, particularly apps for mobile devices, are directed at individuals for a variety of reasons including technology, market forces, and so on. However, as these products become increasingly integrated into day-to-day practice for a growing number of healthcare providers, there will be a growing push to deploy across hospitals, healthcare systems, and other groups. And the calculus for all involved is very different in these two markets. For example, with the individual, revenues are increasingly from third-party advertisers whereas institutions have deeper pockets and may be willing to pay the premium to exclude these advertisers.
In any case, the launch of the UpToDate iPhone app is great news, likely to be welcomed by many healthcare providers. While residents, fellows, and medical students will likely have a longer wait ahead of them, its nice to know that things are moving in that direction.
We’ll be doing a full review of the app in the coming week.
The iPhone app should be showing up in the App Store at any moment.