The explosive growth of medical applications for smartphones, launched by the debut of the innovative Apple iTunes App store in 2008, promises to fundamentally change the physician’s tool set. While many specialties have always been heavily dependent on technology, such as radiology and cardiology, the ubiquity of these small, interconnected computers means that every physician will soon have access to a broad array of software and hardware to help them perform their daily work.
At iMedicalApps.com, we have been reviewing the most interesting medical apps on the market today as well as watching for trends in mobile medical technology. The most popular categories thus far have been clinical reference and utility apps. Some of the largest download numbers have been for apps that provide drug and disease reference information, such as the encyclopedic Medscape app, or medical calculators.
However, more targeted apps that are specialty specific are slowly coming on the market. Some early ones, not surprisingly, were reference and self-assessment apps for radiology. These include the popular Radiology 2.0: One Night in the ED, iRadiology and Radiopaedia apps. More substantively, mobile image viewing apps promise to liberate radiologists from their workstations, including the recently FDA approved Mobile MIM app for the iPad.
We are now seeing an increasing number of apps for surgeons coming to the app stores. Presently, this is primarily on the iOS platform although the popular ones will no doubt be coming to the Android platform. Below is a survey of notable apps currently available for surgeons. This article is concurrently published in the Journal of Surgical Radiology.
1. In The Office
Patients undergoing surgery are anxious and, even if they seem like they followed the preoperative counseling in the office, undoubtedly will have questions as soon as they leave. These two apps help patients navigate the informed consent process.
According to the developers of SurgAware, patients forget “70% of what is said in a doctor’s consulting room” within 24 hours. In order help them remember, SurgAware:
…puts all those risks into writing, in a format that can be emailed to anyone who needs to know. If you are a patient, you can either email the list to your doctor for discussion at your next appointment, or check to see that all topics have been covered. If you are a doctor or a nurse, you can use the list as a reference during the process of taking consent, email your patient, copy the email to yourself, and then have evidence of having disclosed the information.
Heart Surgery Risk
Coronary artery bypass grafting (CABG) is a commonly performed procedure. Despite the immense technical complexity, the risks to most patients are low. However, they are not the same for all patients. For patients to whom CABG has been recommended, HeartSurgeryRisk:
is designed to give patients and their families and friends an estimate of what the chances for complications or death are for a patient who is considering CABG surgery. The calculator is based on data from the Society of Thoracic Surgeons National Database© and the Online Risk Calculator©.
One of the most challenging aspects of communicating surgery with patients is explaining anatomy. Whereas, the names of anatomical structures are the lingua franca of surgeons, they are almost uniformly foreign to patients. Therefore, many apps are available to help bridge this gap. One such series is available from OrcaMD which makes patient counseling apps for orthopedics and plastic surgery. Some surgeons also use general anatomy apps, such as the well known Netter Flash Cards. According to the ShoulderDecide MD’s developers:
The purpose of ShoulderDecide is to educate the non-medically trained patient about their shoulder problems. It aims to enhance understanding of common conditions of the shoulder area while answering in an informed, practical guide which conditions may require surgical treatment.
2. Surgery Planning
Once the decision for surgery is made, then the real preparation work begins. For many patients, it is important to anticipate how their existing medical conditions could possibly complicate surgery and anesthesia. Preoperative testing could range from a basic history and physical all the way to invasive cardiac testing. In many surgeons’ offices, what constitutes adequate pre-surgical testing is based more on local tradition than evidence. According to the developers of PreOpEval, it helps guide testing:
… based upon the guidelines on this topic from the American College of Cardiology & American Heart Association of 2007 and 2009, the Institute for Clinical Systems Improvement of 2006, and the American College of Chest Physicians of 2008…
The app addresses such common questions as:- who needs bloodwork before surgery?- who needs an EKG or a CXR?- how do I handle patients on Warfarin, Aspirin, and Clopidogrel?- which patients are recommended to get perioperative B-blockers or statins?- which active cardiac conditions preclude surgery?- how long after MI should a patient wait before surgery?
For surgical sales reps, managing inventory of implants and trays can be challenging. Although not intended for direct use by surgeons, iTraycer is an interesting solution that helps these very mobile reps manage and locate their equipment by:
providing tracking and real-time tracing of medical trays, devices and implants, including lot numbers, part numbers, from manufacturer to patient.
3. Night Before
Reading up on tomorrow’s case is not just for residents, reviewing “old” texts often brings forth new appreciation even for practicing surgeons . Now, with the availability of major surgical textbooks in app format, these resources can be available anywhere. For general surgeons, the Zollinger series is a well known reference, covering almost every major abdominal procedure and hernia repairs. According to the the app publisher, the Zollinger apps:
…allow you to access step-by-step instructions and superb line drawings for numerous general surgical procedures. Many procedures also include fully-narrated, slideshow presentations outlining each step in the procedure, from Intro and Indications through Post-Operative Care.
For orthopedic surgeons the most ubiquitous surgical technique text is undoubtedly Campbell’s Orthopedics. Now in its 10th edition and still going strong, it was one of the early textbooks to be adapted to app format. That also allowed multiple videos to be included, which contributes to the hefty 870Mb download. It does not include every procedure in the paper text but, according to the publisher, the app format allows user to:
- Navigate through 242 techniques and more than 1000 corresponding images with the flick of a finger
- View almost 20 high quality procedure videos
- Bookmark techniques for convenient reference
- Quickly locate any technique in the entire app using the comprehensive search index
Current Diagnosis and Treatment Surgery
For residents and students preparing for surgery and even for surgeons, this large volume contains information on diseases most likely to be treated surgically. According to the app publisher, it offers:
- Wide-ranging coverage that encompasses general surgery and all the important subspecialties including otolaryngology, urology, gynecology, orthopedics, plastic and reconstructive surgery, and pediatrics
- More than 600 informative photographs and illustrations
- Detailed treatment algorithms
- Completely rewritten chapters on Wound Healing, Anesthesia, Otolaryngology/Head & Neck Surgery, The Heart, Neurosurgery, Gynecology, and Orthopedic(s)
AO Surgery Reference
For orthopedic surgeons involved in trauma care, the principles of operative fracture management developed by the “AO”of Switzerland remain the benchmark. Their fracture classification scheme and treatment algorithms have been disseminated throughout the globe. Now they are available in two free apps. The AO Surgery Reference, according to the publishers, recognizes this important fact about surgeons:
The idea behind this service is the realization that reference in daily clinical life is often difficult. Frequently, there is little time during a hospital day to consult books or journals, or even to perform a literature search in order to gather evidence for a decision. The AO Surgery Reference allows surgeons to access much of the body of surgical knowledge for reference purposes during their clinical work.
A second app, the Müller AO Classification of Fractures – Long Bones, makes the sometimes complicated AO fracture classification scheme approachable by converting it into a series of simple screens and touch controls.