iMedicalApps » epocrates

Premium version of Epocrates free for medical students if downloaded before August 31st ($159 value) [Update]

Iltifat Husain — Wed, 11 Aug 2010 09:26:11 +0000

[Update: As we suspected this deal is only good for those who have the iPhone/iPod Touch, Windows Mobile, and Blackberry. Those with Android and the Palm-Pre are out of luck since there isn't a premium version of Epocrates for these phones yet]

Epocrates Essentials, one of the premium versions of the Epocrates we’ve reviewed in the past, is now free for medical students as long as you download and register for it before the end of August. The website where you can register for the free version is located here.

Epocrates offers 3 premium versions of their software, Rx Pro, Essentials, and Essentials Deluxe. They are giving away the 2nd version, Essentials, a $159 value. The only thing the Essentials Deluxe version has on top of the Essentials version is ICD-9 / CPT codes and a medical dictionary – features medical students can get by without.

Epocrates is available for the iPhone/iPod touch, Blackberry, Palm, Android, and Windows Mobile. But, per their website, the Essentials version of Epocrates is only available for the iPhone/iPod touch, Blackberry, and Windows Mobile. Android and Palm only have the beta version – we’ll look into this further though.

Either way, if you’re a medical student, you should go to the epocrates website where you can register for this free deal as soon as possible – the deal ends August 31st!

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Epocrates files for $75 million IPO

Felasfa Wodajo, MD — Wed, 21 Jul 2010 11:32:18 +0000

Epocrates, which is planning on launching a mobile electronic health record (discussed on this site here) is planning a $75m initial public offer in a bid to be a publicly traded company. The company generated net sales of $24.3m last quarter, down slightly over last year.

Epocrates is one of the oldest and successful mobile medical software application developers and this IPO is a sign of the maturation and strength of this sector. [MassDevice]

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Will Healthcare Providers Shun or Embrace the iPad – Conflicting Surveys Send Mixed Messages [Updated]

Satish Misra, MD — Wed, 10 Mar 2010 21:30:15 +0000

Updated! This post has been updated below to include comments from the folks at Epocrates

The excitement and hype surrounding the announcement of Apple’s iPad have subsided for the time being, perhaps just a lull prior to the actual release in a few months. Here at iMedicalApps, we were certainly among the many believers and expected that the iPad could make significant contributions to healthcare, such as potentially replacing the physician’s clipboard or medical textbooks.

However, we did disagree at times on the extent to which the iPad could penetrate the healthcare market, for a variety of reasons. The folks over at Software Advice decided to try to get a feel for what the community at large was thinking through an interesting survey they performed. And for Apple, the results of this survey aren’t encouraging – if you believe the results.

Having spent nearly four years learning how to read medical literature, I decided to try to get a better sense of just how valid these results are especially considering the seemingly conflicting results of the Epocrates survey. Chris Thorman, who authored the article on the survey, was kind enough to correspond with me on details of the survey methodology. Here’s a look at the results and our take on what they really mean.

According to the Software Advice survey, the medical community wants a tablet, with a third of respondents saying that they are likely to purchase a tablet. For over half of respondents, the primary factor that would guide their purchasing decision would be ease of use, with a fifth identifying software as their guiding factor. Why do they want it? Over 75% of respondents identified diagnostics management (ordering/tracking tests), medical reference, clinical decision support, prescribing, imaging, and notes as tasks they would like to perform on their tablet. As you read this, an obvious question arises – these are all things the iPad could probably do well, so where does the survey go wrong for the iPad?

The survey also explores the must-have features for a tablet, with over 50% identifying Wi-Fi, durability, lightweight, availability of medical software, and fingerprint access as essential features. Fewer respondents also identified dictation capabilities, RFID reader, camera, and barcode scanning as must-have features. While the iPad clearly does fares well with regards to some of these criteria (weight, Wi-Fi, usability), it lacks most of these identified must-have features. And these are certainly features that many, including us at iMedicalApps, have discussed as notable deficits when it comes to the iPad in healthcare.

However, with any study or survey, the results are only as good as the methodology. Chris Thorman (the author) kindly shared with us the methodology for this survey which involved an online survey which was publicized through online media including blogs, LinkedIn, and other online platforms. The demographics indicate that out of a total of approximately 175 respondents, about half function in clinical roles (physician, nurse, student) and a little less than half function in management roles (IT, admin staff). I think knowing this is useful for a few reasons. First, if the respondents were all identified via online media, then this is almost certainly a tech-savvy group. So while that may inflate the “plan to purchase tablet” numbers a bit, it also suggests that this group is sufficiently knowledgeable to give feedback on what a tablet could be used for and needs to be successful. Second, it would be interesting to break out the responses of clinical and non-clinical healthcare staff – I could certainly imagine their responses being very different. Lastly, its important to note that a study of less than 200 people is certainly not sufficiently powered to accurately predict the sentiments of the healthcare industry as a whole.

Then there’s the Epocrates survey. Their survey of 350 clinicians suggested that 20% plan to buy an iPad within one year of release, with nearly 40% expressing interest but awaiting more information. So if clinicians are so excited, what’s the deal with the disconnect with the responses in the Software Advice survey. Well, Mr. Thorman suggests an explanation – clinicians are also electronics consumers, and electronics consumers are excited. So just because the regular consumer side of these folks are interested, the clinician side may not be. I’m waiting on more information from the folks at Epocrates on the methodology of their survey, and will update you all if any enlightening information comes forward.

All of that being said, these surveys are valuable because, whatever we predict, adoption or rejection of the iPad in healthcare is ultimately a decision that will be made collectively by hundreds of thousands of providers. So in reality, we’ll just have to wait and see what happens.

Update: 3/10/10

The kind folks at Epocrates shared the methodology of their survey with us. This survey was conducted using an established pool of clinicians – mostly MD’s, but also with PA’s/NP’s – who opt-ed in to participate in Epocrates surveys. From that pool, participants were randomly selected. So here again, we face similar issues with possible selection bias – these are folks who are fairly tech-savvy (if they are using Epocrates already). However, this probably incorporates a broader cohort than the population identified in the SoftwareAdvice survey, which used social media to recruit participants – Epocrates software certainly has broader adoption into the medical community, even the slightly less than tech-savvy folks. So overall, what I take away from all of this is that again we’re asking a group enriched in tech-savvy folks about their thoughts on a new device, but that the Epocrates survey is probably still more representative of the general medical community. Does this mean that the Software Advice survey is wrong? No – both surveys have their merits. What this survey implies to me is that its possible that the medical community, including the tech-wary, may be looking at the iPad with some interest, if I’m right that this survey population is more representative of the medical community. And maybe the “friendly” factor that contributes to the iPad’s appeal to this segment of the medical community will overcome the challenges identified in by the Software Advice survey.

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Nuance Brings Medical Dictation and Search to your iPhone: Dragon Medical Mobile Apps [Video]

Felasfa Wodajo, MD — Wed, 03 Mar 2010 11:54:33 +0000

In this video we check out two of the Dragon Medical Mobile Apps (releasing later this year) for the iPhone, Dragon Medical Mobile Dictation and Medical Mobile Search. We recorded this video from Nuance’s booth at the HIMSS conference

Nuance, the makers of Dragon Medical Dictation, a favorite dictation service among many physicians, announced at HIMSS they are bringing the same medical transcription service to the iPhone.

Many readers may have noticed the recent arrival of a free Nuance “Dragon” app in the App store. This simple app allows the user to speak directly into the iPhone and receive a nicely transcribed text document 15-30 seconds later, ready for email or for copy and paste.

At that time, Nuance did not specify their future intentions, but many speculated a medical version would be forthcoming. Indeed, at HIMSS, Nuance announced three new iPhone medical apps: Mobile Dictation, Mobile Search, and Mobile Recorder, all named with the prefix Dragon Medical (i.e. “Dragon Medical Mobile Dictation”, etc).

Dragon Medical Mobile Dictate

The medical app of immediate interest to physicians is the Mobile Dictation one, which is similar to the free Nuance application, except for the very important distinction that the back end is now connected to the very reputable Dragon medical transcription engine – highly optimized to transcribe doctor speak. Like the most recent version of the desktop Dragon Dictation application, the specific “training” time is required, although the application does learn the user’s voice over time.

Currently, the application only returns text into the iPhone, albeit quickly, and the physician is required to transfer the text into another app via email or cut & paste. We were told the Mobile Dictation app should be available by Q3 2010 (late summer). Pricing is not yet determined and it will initially launch on the iPhone but per Nuance, Android and Blackberry versions are planned.

Dragon Medical Mobile SDK

The real power of the application is the accompanying SDK (software development kit) that Nuance is previewing. This SDK will allow electronic health record (EHR) vendors to directly access the application from inside the EHR. For example, Epic’s Haiku iPhone app could allow dictation directly into a patient’s record in Epic without leaving the Haiku app.

Thus far, we are told that Eclipsys will be incorporating it into their nursing documentation module since they already partner with Nuance, although, having seen the demonstration, I would suspect the SDK will gain wide and quick adoption by the other EHR vendors. The other obvious future integration will be with the newly announced Epocrates iPhone based EHR – almost making the smart phone a complete doctor’s office.

Dragon Medical Mobile Search

The second application is called Dragon Mobile Search and is analogous to Google’s iPhone app in that it performs a search based on voice transcription. The difference is this app searches medical databases, such as Medscape, Epocrates, Medline or Google.

The search sites are displayed as a series of icons across the screen which the user can rotate through, described like a carousel by Nuance [reference above video]. It seems to work well enough but is hampered by the fact that the searches are presented to each site as a simple text query without the sub-categorizing that the Google app performs, which quickly allows the user to drill down to the actual item of interest. Perhaps if those databases exposed specific APIs for search, it would be more powerful. I would expect usage of this to vary on the individual level since its not always more efficient to say one word than it is to type it. Nuance has a solid release date of April 30 for this medical app.

Dragon Medical Mobile Recorder:

The third application, Mobile Recorder, acts as a catalogue for previous recordings and allows the user to identify recordings with individual patients, if there is integration between the application and the physician’s or hospital EHR. This recorder is designed for healthcare organizations that use Nuance’s enterprise dictation and transcription software, eScription, or the Dictaphone Enterprise Speech System.

The obvious advance for physicians will be use of Nuance’s SDK to integrate voice dictation dictation directly into EHR applications and thus make it seamless, rather than adding to the physician’s workflow.

In a separate announcement, Nuance also reported their advances in natural language processing. This consisted of two parts, the acquisition of a company named Language and Computing, described as a “a pioneering developer of clinical narrative processing technology” and a strategic partnership with Massachusetts General Hospital which had an internally developed natural language processing application they called “Smart Dictation”.

The vision is that a physician can simply dictate an encounter and, using natural language processing, the key parts of the note such as chief complaint, history, exam, etc. can be pulled out and used to populate structured data fields inside the EHR. Pretty ambitious.

Like every other vendor at HIMSS, Nuance proposes this could help healthcare institutions comply with “meaningful use” and thus qualify for HITECH (stimulus) funds. More reasonably, they also claim this could help healthcare organizations with “data mining, coding for billing, disease management and clinical decision support.”

Nuance’s announcement seems to have generated a fair bit of interest, judging from other websites and the traffic at the booth. I suspect this is justified as physicians are only too happy to get rid of their dictaphones and not have to sit in front of a computer microphone, not to mention paying for transcription. I’m also curious to see what other applications the SDK might find a home – reducing the need for keyboards, especially as a new generation of tablets starts to fan out into the health care field.

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Epocrates’s recently announced Electronic Health Record will utilize many iPhone features

Felasfa Wodajo, MD — Tue, 02 Mar 2010 21:14:00 +0000

I interviewed Robert Quinn, Senior Vice President of Engineering and CTO of Epocrates at HIMSS 2010, and he spoke candidly about the many features Epocrates electronic health record will have, especially related to the iPhone.

Yes, that’s correct. Epocrates, the mobile medical app that nearly has the distinction of being the one “indispensable” application for every physician’s smart phone, is going to have a big brother soon.

The ten year old company, based in San Mateo California, believes its base of more than 900,000 clinicians worldwide and its experience with mobile medical development gives it the wherewithal for understanding what physicians need and expect from a mobile Electronic Health Record (EHR).

They are targeting solo and small physician practices and with a price point that is expected to be very competitive. “This was a logical next step for Epocrates,” said Rose Crane, chief executive officer of Epocrates, when making the announcement.

Integration with the iPhone

I had the opportunity to speak with Robert Quinn, Senior Vice President of Engineering and Chief Technical Officer about the forthcoming product. They are planning a shipping target of Fall 2010. The product will have both a mobile iPhone app and web interface. They plan on integrating the features of the iPhone, such as the camera, as well as dictation directly into the app, an interesting feature especially in light of the announcement today by Nuance that they will be shipping a medical transcription application for the iPhone.

They will also utilize the iPhone’s Push Notification Service to alert doctors of important or timely information (and hopefully not overuse it). Given Epocrates’ depth of knowledge of pharmaceutical formularies, he said e-prescribing will “of course” be built in.
Although the mobile application will synchronize with the web application, it will continue working even when there is no internet connection. Data will be stored on the handheld device in a secure, encrypted manner and synchronize when a connection is available, a real issue for hospitals where there are many “dead” zones. There will be condition-based templates for easy entry of clinical information. The application will be written as a native iPhone application.

There will also be integration with a revenue-cycle platform so physicians can charge and submit codes, through a partnership with a “known” company, although Mr. Quinn would not say who that will be. Epocrates anticipates they will achieve CCHIT certification by the time of release. The EHR will be delivered as a software-as-a-service (SAAS) model, meaning the physician will effectively lease, not purchase it.

This could be an attractive low-cost product for solo or small group physicians who do not have complex office staff EHR integration needs. In particular, for the physician who already uses their smart phone for many work activities, the potentially painless transition to using it as the primary interface into their office EHR may be very appealing.

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Five iPad Accessories for Health Care Professionals

Iltifat Husain — Sun, 28 Feb 2010 09:22:25 +0000

It’s fair to say almost everyone has bought at least one accessory for their iPhone. My own collection consists of two items, a simple protective case, and protective case with a built in battery. I can’t emphasize how crucial my battery case has been, especially when I hit the 20th hour of a 30 hour on call shift and my iPhone’s native battery is about to die.

The Wall Street Journal recently reported on the development of iPad accessories, and how companies such as Griffin, Gelaskins, Sanho, and others are scrambling to manufacture products as fast as possible. Time is money in the accessory business, and the iPod/iPhone accessory business is big money — totaling 3.7 billion in 2009 alone.

Medical app developers have already mentioned how they will be customizing their products for the iPad. Epocrates and Macpractice are examples of two significant players who have already committed to the iPad platform — and there are more.

With that said, there’s no doubt some health care professionals will be using an iPad, whether for reading medical books or for EMR purposes. So then two key questions come to mind: What accessories do we want to see and whats already out there? The following are 5 key accessories:

1) Stylus

The iPad has a capacitive touch screen, similar to the iPhone, requiring the natural conduction ability of your body to register movement. If you have gloves on, your fingers lose their “conductive” ability, and a capacitive touch screen is your worst nightmare — you cant do anything.

To remedy this, a stylus is needed. Luckily, there’s already one available for the iPhone, called the Pogo Sketch. Since the iPhone and iPad both have similar capacitive touch screens, this stylus should work just fine with the iPad. Now if only the rumors of the iPad having a handwriting style keyboard come to be true…

2) Medical Grade Case

If you’re using your iPad with gloves, you better have a medical grade case as well. Many health care IT folk have complained the iPad could pose problems in the medical setting because it’s not “industrial” enough, and could be hard to disinfect. The solution to this is simple, develop a case that solves these issues and make sure it meets the requirements to be used in medicine.

3) Battery Case

One of my favorite iPhone accessories is my battery case(pictured below) that extends my iPhone’s battery by about 50% — helpful on those 30 hour shifts. Why not bring the same type of battery case to the iPad? Proportionally, the iPad is similar to the iPhone’s dimensions, and designing a bigger battery case for the iPad couldn’t be that hard.

The extra portable battery life would be especially key for health care providers who would be using the iPad for patient interactions.

4) External Camera and Video recording adapters

There are plenty of rumors swirling about the iPad and how its been built with the intention of having a camera and video recorder, but until this functionality is tangible, we’re hoping a 3rd party developer can step up to the plate and deliver on the goods. Granted, they’ll need permission from Apple to connect the hardware directly to the iPad — and that’s no easy task.

5) VGA / AV out adapter

It would be great to show patients interesting medical videos you might have on a bigger screen, such as video from the Blausen Human Atlas app. Also, if the #4 feature mentioned above comes to fruition, you could easily show pictures or videos of interesting pathologies on a big screen. Key for grand rounds or any other large gathering.

So there you have it, 5 accessories health care providers who plan to use the iPad in practice are sure to appreciate. I’m sure there are other accessories as well, and if any come to your mind make sure to let the us know in the below comments section.

Update: One of our commenters did an great job of explaining that the iPad will be shipping with the option to have the #5 accessory — awesome. Now if the #4 accessory mentioned, an external camera/video recorder is there, than having VGA/AV capability would be even more useful.

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Epocrates Rx for Android gets reviewed – Our first Android medical app review

Brett Einerson — Sat, 27 Feb 2010 07:30:35 +0000

Health care professionals have been patiently waiting for the expansion of the Android universe to hit the world of medical apps. With the exception of Unbound Medicine – who have done a very nice job in rolling their products into the Android Market – users of Android mobile devices have thus far been relegated mostly to the world of medical calculators and dictionaries. For Android owners, the release of Epocrates could not have come sooner. If you are in the field of medicine, you are probably familiar with Epocrates. We reviewed Epocrates on the iPhone before. And for health care professionals and students, Epocrates, honestly, needs no introduction. From the short-white-coat student to the tech-savvy clinician, Epocrates has, for years, been an essential tool in refreshing those synapses you made in pharmacology class (or didn’t make). The field of pharmacology is ever changing. Epocrates helps many of us stay on top of it all, and improve care for patients.

Keep in mind, the version of Epocrates Rx currently available and reviewed here is still in BETA. So many of the richer features available on other platforms are still missing for Android. Also, one of the difficulties in reviewing any app for Android is the potential for variability in user experience between OS versions, and from phone to phone. This review is based on the HTC MyTouch, which runs on Android OS v1.6.

Epocrates downloads from the mobile-based Android Market. Total application size is 6.48MB. This is fairly large – by comparison, Google Maps with Navigation is only 5.22MB. Users who do not see Epocrates in the Market are probably running an older version of the Android OS. Epocrates runs on v1.6 or later. This is a problem for many Android owners who bought phones before Fall, 2009. Unfortunately the only viable solution (that I know of) is to write your phone manufacturer with pleas for OS updates. A free Epocrates online account is necessary to run the app.

Layout and Navigation

Don’t let the poor-quality screenshots fool you, the app looks great on the MyTouch. Epocrates opens quickly, and does not slow phone function while it runs. The app runs well and looks sharp in both portrait and landscape orientations. On T-Mobile, you can even search Epocrates while on a phone call. Can your phone and your network do that?

The main menu contains:

Search Epocrates
A self-promotion banner (“Start using Pill ID now”)
Favorites Menu (including Interaction Check and Pill ID)
Tools Menu (including Drug Reference, Tables, and Med Math)
Other Menu (including History, and Help)

Every screen in the app contains the “e” button, which brings the user back to the main menu in one click. Those familiar with Epocrates on other platforms will find the user interface and navigation very familiar. New users of Epocrates on Android will be able to navigate the very intuitive UI with little effort. The “Add to Favorites” button located at the bottom of the page allows you to put almost any drug or table in the Favorites Menu. This is a great function for the wards – particularly for those services where there are only a handful of drugs commonly used. On a Cards rotation, med students could put diuretics, beta-blockers, ACE inhibitors, and statins right on the front menu. The History menu creates a log of your navigation through Epocrates, and allows a quick return to previously viewed sub-menus and pages.

Other features

Like Epocrates on the iPhone, the Android BETA version has many useful features that run very well on Android. Briefly…

Interaction Check: Some clinicians have an encyclopedic memory of drug interactions. For the rest of us, this feature allows a quick check of interactions – benign or deadly. Up to 30 drugs can be added to the interaction list. Very useful for those middle-of-the-night calls about changing Mr. Johnson’s antibiotic.
**Interactions can also be viewed for each drug, or added to the Interaction Check List from an each Drug Reference page
Pill ID: A standard feature of Epocrates. For identifying the ambiguous round pink pill that the patient in the clinic or ED sort-of remembers taking. Photos of each pill can be enlarged with a click.
Drug Reference: Browse by Drug Class. For example, Cardiovascular –> Antiplatelets –> anagrelide. Extensive drug information with open-and-close menus, including:
- Adult Dosing
- Peds Dosing
- Blackbox Warnings
- Contraindications/Cautions
- Adverse Reactions
- Drug Interactions
- Safety/Monitoring
- Pharmacology
- Manufacturer/Pricing
- Pill Pictures (same as the Pill ID menu)

Tables: An under-appreciated feature of Epocrates with helpful clinical suggestions, guidelines, and protocols.
Looking for the Beers Criteria of potentially inappropriate drugs for geriatric patients?
Walk into a code – patient in Asystole/PEA – and don’t remember which IV drug to give?
This menu has those answers, and many more too numerous to mention here.
MedMath: Over 40 clinical calculators. A nice add-on feature with many commonly-used medical calculators, but not nearly as comprehensive as other medical calculators like Skyscape’s Archimedes (another free app available on the Android Market).
Help: A minor menu containing Abbreviation List and Epocrates Support information.

Likes

All the features of Epocrates, running well on Android. Fantastic, as expected.
Attractive and user-friendly UI.
Extensive and relevant information.
A very useful tool for clinicians at the point of patient care.

Dislikes

Screen sensitivity was uncharacteristically unresponsive on the MyTouch. This problem was usually fixed after flipping through a few menus, and coming back to the problem area. A mild annoyance if this is a “beta issue”, but a major problem if not resolved in future versions.
Only available for Android Operating System v1.6 and newer.
The banner below the search bar announcing features of the app. Not needed, and consumes valuable screen property.
We patiently await the arrival of premium clinical features in future.

Conclusion

The newest member of the Epocrates family is a long-awaited and warmly-welcomed addition to the Android OS. While still in Beta, this free version of Epocrates Rx performs well (with the exception of some screen insensitivity problems that may be specific to the MyTouch), and lives up to what health care professionals and students have come to expect from Epocrates. Epocrates Rx (Free) is a must-have app for Android owners in the medical field. And you can’t beat the price tag. We look forward to future releases of other Epocrates products (including Rx Pro, Essentials, and Essentials Deluxe). Our readers can expect a continued and extended review, complete with more screenshots, when these versions are introduced to the Android Market.

Link to Website and Download: http://www.epocrates.com/products/android/

Editors Note: This is the first medical app review we’ve done for the Android platform. We’re excited that Brett will be providing the site reviews of Android medical apps, along with iPhone medical apps.

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Epocrates app now available for Android Smartphone – Medical professionals with Droid and Nexus One rejoice

Iltifat Husain — Tue, 23 Feb 2010 19:27:30 +0000

Google’s smartphone operating system – Android – has been around for well over a year, yet the marketplace continues to lag behind Apple’s App Store with its meager collection of useful medical apps. The biggest player in mobile medical reference software is now changing this perception. Today Epocrates announced the availability of a free beta version, Epocrates Rx, for the Android platform, officially making it an android medical app. [We recently did a full review of Epocrates, including Epocrates Rx, for the iPhone].

This is exciting news for health care professionals who have Android phones – because their numbers are growing. Google recently announced 60,000 Android handsets are shipping each day, coming out to 5.4 million handsets per quarter. As a reference, Apple sold 8.7 million iPhones last quarter.

With this proliferation of Android phones, especially the Droid and Nexus One, many in the medical field can now feel more confident in buying the Droid or Nexus One. That’s how big of an affect Epocrates has. Almost one million healthcare professionals rely on Epocrates as a medical reference, and for most who have smartphones, its the first app we download. I’ve had multiple friends with Android phones they love, but their only complaint is they don’t have Epocrates – not anymore.

Epocrates is taking a similar approach to releasing the software as they did for the iPhone: release a free beta version, Epocrates Rx, and then release the premium versions later this year. Our guess is the premium versions will mimic the ones available for the iPhone, Epocrates Rx Pro, Epocrates Essentials, Epocrates Essentials Deluxe. In our review we take a look at the features included in each of these versions.

There is one issue many Android users might gripe about: You need a device with Android v1.6 or higher. If you bought an Android phone even a few months ago, there is a chance you might have Android v1.5. This issue is one we’ve highlighted in the past, the lack of compatibility with different versions of Android.

Here are some details on the free Android version of Epocrates Rx.

Features:

Drug Information – Ability to access thousands of brand and generic drugs, with indications, contraindications, retail pricing, mechanism of action, and lots more
Pill ID – Identify a drug based on the color, shape, or imprint code
Drug Interactions – One of the most popular features Epocrates offers. Can check the interactions for up to 30 drugs at a time, especially useful for your geriatric patients. Hopefully they aren’t on 30 drugs though.
Tables and Calculators – Includes MedMath, a feature rich calculator we mentioned in our review of Epocrates.

Heads up: We’re going to do a full review of this Android version later this week.

Update: Palmdoc.net has a great article about how Epocrates for WebOS is coming “real soon”. [Web OS = think Palm Pre]

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Top 10 Free iPhone Medical Apps for Health care Professionals

iMedicalApps Team — Mon, 15 Feb 2010 15:44:42 +0000

If you’re a physician, medical student, or in any other health care related field, trying to find the best free medical apps for the iPhone is a hassle. Apps such as “Dream Meanings”, “Relax Ocean waves”, and “Stool Scanner Lite” dominate the Top Free Medical Apps list in the App Store.

Our top 10 iPhone medical apps list contains no such app, and this isn’t a re-hash of the top downloaded free medical apps either. Rather, this list contains the top 10 free iPhone medical apps health care professionals and students can actually use on a day to day basis.

Also, remember to “Like” us on our Facebook fan page – we give our tons of free medical apps on our Facebook wall and you can find interesting commentary there as well: http://www.facebook.com/iMedicalApps

1) Medscape

We mentioned this app when it was released in the summer of 2009. At the time I doubt many thought it would ever eclipse Epocrates in the top free medical apps section of the App Store, but with significant recent updates it’s accomplished this feat.

This app always had a great drug reference section, with over 6,000 generic, brand, and OTC drugs, along with a drug interaction checker. But with recent updates, Medscape now has a Diseases and Conditions section, along with a Clinical Procedures section. These added sections aren’t just fluff, they actually contain concise and useful information, with videos and pictures to boot. We plan on doing a full review in the near future.

Links: iMedicalApps Review, Website, iTunes
Cost: Free

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STDMeister Medical App – STD Diagnosis and Treatment Information in Mobile Form [App Review]

Iltifat Husain — Sun, 14 Feb 2010 09:28:14 +0000

STDMeister is the first legitimate STD app made for health care professionals in the App Store. It was only a matter of time right? Although the proper phrase is STI, sexually transmitted infection, it’s safe to say the phrase sexually transmitted disease (STD) isn’t going away anytime soon – especially for those of us in the medical field. This STD app aims at helping medical personnel diagnose, manage, and treat STDs. The developer of this application is MeisterMed, and we’ve reviewed some of their prior medical apps before, with mixed results. This might be a unique application at a low price point, $3.99, but how useful is it for health care professionals? Hopefully at the end of this review you’ll be able to tell.

When you open up the application you’re presented with a funky looking monster/bug cartoon that I’m assuming is supposed to represent an STD. Underneath the freaky STD cartoon, you have 5 buttons to choose from [2nd picture].

The three key navigation pathways on this page are Topic Index, Treatment Algorithms, and Image Atlas. The topic index has a wealth of information on not only STDs, but ancillary topics, such as abstinence. Once you pick on your topic of choice, in this example, Chlamydia, you’ve given a link to pictures, diagnosis, treatment algorithms, and many other related subjects. If you want to skip directly to the pictures or algorithms, you can do so on the front page.

Once you click on algorithm, you’re taken through an interactive algorithm of treatment options [reference the pictures]. You’re asked the age of the patient, if they are pregnant or not, and then given treatment recommendations. You’re also given alternative treatment regimens in certain cases, with an option to view more treatment details. The algorithm feature is where this app shines, and where it could be utilized the most in clinic.

Throughout the application, there is a toolbar at the bottom of the screen. These buttons allow you to go to the home screen, search, bookmark your current page, write a custom note, or go back to the previous page.

The search function is severely inadequate. When you search for a pathology, instead of the most relevant options showing up, such as the beautifully done algorithm I mentioned above, you’re presented with a hodgepodge of pictures and other random topics related to your search, requiring you to scroll down until you hopefully find what you’re looking for.

The bookmark function is excellent. I found it most useful for saving treatment regimes that I reference the most.

The Image Atlas contains over 200 pictures related to STDs. The pictures were informative and there are even pictures of histology slides, a nice touch. I included one picture, and left out of the more “intense” pictures in case anyone is reading this at Starbucks or any other public place [if you can give the diagnosis of the picture I included leave it in the comments section. You’ll win some respect - no prize].

What I liked:

Current Price point of $3.99 is nice
Good amount of information on STDs – Not too long, but concise
Multimedia – pictures are useful
Treatment algorithms are fantastic, and the highlight of this application
Bookmarking feature – Very useful, you can bookmark key treatment algorithms!

What I didn’t like and What I’d like to see in future updates:

Navigation and User Interface – There is no arguing apps produced by MeisterMed contain great information, but we’ve griped about the navigation in previous reviews. Maybe it’s because we’re used to the iPhone’s fluid interface, but simple things could make this app better – e.g, Search function that returns more relevant results, back button placed on the traditional left side, etc.
Delayed opening of app, on account of STD cartoon showing up – minor, but when I want to look up information ASAP, those extra 2 seconds are frustrating
Search Feature – mentioned issues in the navigation and user interface section above
Would be nice to see references from literature or medical texts

Conclusion:

Overall, STDMeister is a great medical app for the iPhone and iPod Touch. There are definitely issues that need to be worked out, such as the navigation, search function, and other user interface problems, but the other features of this app definitely makes up for those shortcomings. The interactive treatment algorithm alone is worth the low $3.99 asking price for the app. This fantastic feature allows you to quickly pull up the treatment options, and offers alternative treatments with detailed explanations as well.

This app would be most useful for those working in STD clinics and primary care settings where there is a high rate of sexually transmitted diseases. Physicians, Physician assistants, and nurses could definitely make use of this application in those settings.

View Customer Reviews on iTunes »

Download Now on iTunes for $3.99 »

Visit the App Website »

*Note to readers: this is obvious, and even somewhat mentioned when the app opens, but when using apps offering treatment options or any medical suggestions, make sure to use your own clinical judgment. Apps such as Epocrates and Medscape have robust databases that get updated when standard of care changes occur – always be up to date on these changes through your own research.

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iPhone Security Risks and How to Protect Your Data

Iltifat Husain — Fri, 12 Feb 2010 01:25:11 +0000

The iPhone and iPod Touch platforms have gained huge popularity with medical providers, with Epocrates saying over 100,000 physicians are actively using the medical reference app on their iPhone – and this was back in July of 2009.

Many healthcare providers feel comfortable with the iPhone because of its fluid operating system, and the extra functionality it offers, in the form of games and a variety of other apps. This added functionality is missing with more enterprise-based smart phones, such as the Blackberry platform. However, this added functionality comes with a price, and exposes the iPhone to security risks.

Nicolas Seriot, a researcher from the Swiss University of Applied Sciences, has found some alarming design flaws in the iPhone operating system that allow rouge apps to access sensitive information on your phone.

In this fantastic piece published by CNET, he mentions how these rouge apps can be hidden within an innocent looking game app. The CNET piece goes on to say:

“Basic information these apps could access would be your mobile phone number, address book data, and a notes section of the address book, where some people store bank account and other sensitive information…..

To make his point, Seriot has created open-source proof-of-concept spyware dubbed “SpyPhone” that can access the 20 most recent Safari searches, YouTube history, and e-mail account parameters like username, e-mail address, host, and login, as well as detailed information on the phone itself that can be used to track users, even when they change devices.

SpyPhone can be used to track the user’s whereabouts and activities. It offers access to the keyboard cache, which contains all the words ever typed on the keyboard, except for words entered in password fields, effectively acting as a keylogger,” he said.

One would think the extensive App Store screening process prevents malicious apps from getting approved, but that’s not always the case – several apps have been pulled from the App Store for this very reason. An example mentioned is Aurora Feint, a game app that was stealing users’ contact library on their phones.

These security risks are substantial for everyday users, but become heightened if your phone contains sensitive data, in the form of patient information, and when your phone is used for patient care. Over at iMedicalApps.com, we are not fans of medical apps that enable you to input patient data, and there are several out there. But we also have peers who have patient contact information stored on their phones, patient information in their calendars, or are accessible to their patients via e-mail. You can even e-prescribe using your iPhone.

Since the iPad will have essentially the same operating system as the iPhone, and much hype has surrounded the iPad’s potential implementation in healthcare, a need to address these problems becomes even more evident.

Seriot does offer some basic tips on how to protect your data. I have included detailed instructions on how to perform these tasks:

Basic steps for protecting your data, with detailed instructions:

1) Clean your browser’s recent searches: Go to Settings > Safari. You should periodically clear your history, cookies, and cache
2) Clean your keyboard cache: Go to Settings > General > Reset > Reset Keyboad Dictionary
3) Change or delete your declared number: Go to Settings > Phone > My number. Delete your number, and put a random string of numbers here.

He also mentioned that professional users, such as medical staff, should run only trusted applications. If you’re utilizing your iPhone as more than a medical reference, and using it for actual patient care, than follow the above tips – and make sure you only download apps you trust. Protecting patient data is absolutely critical, that “cool game app” you just downloaded might be doing more than just entertaining you, and HIPAA won’t be far behind.

Originally published on our MedPage Today blog

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Epocrates Essentials App Review for the iPhone – Does the legendary medical app live up to the hype?

Iltifat Husain — Tue, 09 Feb 2010 16:21:44 +0000

The first app I downloaded on my iPhone was Epocrates. I didn’t think twice about it, and in a way I assumed it was my obligation to do so before I saw patients in the hospital. Such high regard for this medical app elicits thoughts of a deep history, but it really burst onto the scene in the late 90s on the classic palm PDA platform. Epocrates quickly gained market share because it offered key functions for free, unlike its competitors. This tactic of offering some functionality for free has not changed over the years.

Unlike its arrival to the Palm PDA platform, Epocrates is considered the first medical application for the iPhone and iPod Touch platforms. The free version of the application is one of the most heavily downloaded medical apps in the App Store.

There are four different versions of Epocrates you can have on your iPhone or iPod Touch. Each version offers different features and subscription fees. The default application in the App Store is free, but in order to get the premium versions you can upgrade either online or through the app.

Epocrates Rx (Free)
Epocrates Rx Pro ($99 per year)
Epocrates Essentials ($159 per year)
Epocrates Essentials Deluxe ($199 per year)

In this article, I’ll review Epocrates – Essentials, the second premium level offered, and also go through the key features offered in each level of subscription. This is the largest medical app we’ve reviewed to date, content wise – so there will be lots of pictures!

Navigation:

When the application is opened to the home page you’re presented with quick hitting health care facts, summarized literature, or suggestions on how to optimize your Epocrates experience. From here you’re given the option to select the tabs on the bottom, “interactions”, “Pill ID”, “MedMath”, and “More”.

On the home screen, there is a comprehensive search button where you can search in Diseases (Dx), Drugs (Rx), Infectious Diseases (ID), Lab Tests (Lab), Resource Centers (RC), and Tables (Tbl). Most of these sections of search will only yield readable results if you have the premium versions of the app

The application is definitely quick, and the user interface is extremely clean and easy to use.

In this article, I’m starting from the most basic version of Epocrates available to the most premium version – the more premium versions contain all the features mentioned in the less expensive versions, along with extra features

Epocrates Rx – Free Version – Key Features:

Drug Interactions – This features is one of the most popular offered by Epocrates and is a crucial tool used by health care providers at the point of care. Very useful with geriatric patients who can be on multiple drug cocktails at one time.

Pill Identifier – Pill pictures: One of the coolest features offered by Epocrates. This feature was getting huge amounts of hype when the first iPhone 2G was released. My own peers in the medical field were contemplating getting an iPhone for this innovative feature alone – they didn’t – but that’s the type of excitement it generated.

Drug Info – Information on thousands of drugs. This includes mechanism of action, pharmacology, drug pricing, ability to add custom notes, and all the other basic drug info you could possibly want.
MedMath – When the free version of Epocrates first rolled out this feature was lacking in functionality. We’ve reviewed other medical calculators, and although this portion of the app does not contain the same volume of equations as other calculators, the equations it does have are more than satisfactory. Some key equations I’ve found useful are the dosing calculator, Osmolarity, and the Parkland Burn formula. There’s even a formula for number needed to treat!

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Harrison’s Manual of Medicine App: Translation of Famous Medical Text to Mobile Form [App Review]

Iltifat Husain — Tue, 12 Jan 2010 21:34:25 +0000

I was introduced to Harrison’s Manual of Medicine via Access Medicine back in my first year of medical school (most academic centers have a subscription to Access Medicine). I needed to find a good resource for my PBL(Problem Based Learning) small group sessions and it seemed the easiest to read for a kid fresh out of undergrad. Later on I found resources such as UpToDate and eventually developed the ability to actually understood research papers, but Harrison’s Manual of Medicine was great to read early on. Not only is it great to use in Medical School, but It’s a textbook you’ll often find in the clinic setting and is read and referenced by practicing providers.

It would then only seem natural to have the full text or even the online version (via Access Medicine), translated to a mobile application. When you search for Harrison’s in the App Store you’re presented with 3 Apps! Inherently, I thought I’d only have one option. There is a version by Unbound Medicine, Skyscape, and MedHand. The price to access/download each is $59.99, the key difference is that the MedHand version does not require a yearly subscription. You pay the flat rate of $59.99. Also, the MedHand version is a stand alone application, not requiring you to access the internet, unlike the others. Because of these advantages, the MedHand version was chosen for a full review of Harrison’s Manual of Medicine(17th edition).

When you open up the application you are presented with a list of common topics, ranging from organ systems, such as Cardiology, to topics such as Care of the Hospitalized Patient. I can’t imagine anyone thumbing through these individual topics, and the best method to proceed is to use the search option provided.

The search function is the highlight of this application. For the purpose of this review, I’ll be looking up endocarditis. You are given a list of pertinent articles based on your search. However, the beauty of the search function is you are given a tab to narrow your search down based on what you’re looking for, e.g., you can refine the search based on image, tables, and treatment options. I found this to be extremely useful because finding key tables, in this case, the Duke Criteria related to Infective endocarditis, can be very useful.

Once you’ve found what you’re looking for you can click on your topic of choice, and you’re given an abridged version of the content you would find using Access Medicine or the actual textbook (the disappointment in this will be explained later)

What I liked:

No Subscription required
Stand Alone application! Does not require a connection to the internet
Search feature is robust and the highlight of this application
Ability to Bookmark topics, and a History section is present
You’re given instructions on exactly where to find more detailed info within the full Harrison’s manual at the end of sections

What I didn’t like so much, and what could be improved upon:

You have to go into your settings menu on the iPhone to change text size! And even then, you’re only given 3 options, Small, Normal, Large. There is no ability to change text size within the application. When using this app you have to use it with a small text size, otherwise you’ll find yourself scrolling entirely too much.
Overall User Interface is not clean and seamless, especially when compared to other applications, such as the Merck Manual series. Icons and navigation menus are gaudy and not clear at times.
The biggest knock on this application is it doesn’t include the full text that you can find using Access Medicine.

Conclusion:

Overall, the team at MedHand did a decent job of bringing the abridged version of Harrison’s Manual of Medicine to mobile form. The User Interface and navigation needs to be made more seamless. With all the aesthetically pleasing medical applications out right now, you would hope this application would follow suite soon.

The biggest knock on this application was mentioned above, the lack of full text (look at the pictures in this section to see the difference in content size). I don’t know if MedHand wasn’t able to bring the full because of contract rules, but I found this to be bothersome. The reason many medical professionals read Harrison’s Manual is for a detailed explanation of etiology, pathologies, and treatment options. Harrison’s Manual is not the first thing you turn to if you want to look up a topic you can read quickly. For that you use UpToDate or Epocrates. Rather, Harrison’s has traditionally been great because of the detailed knowledge it provides.

This being said, if you want an abridged version of Harrison’s Manual, that has a great search feature built in, than you can try this application. This application is unique in the App Store because it doesn’t require a subscription, like the other Harrison’s Manuals in the App Store, and is stand-alone(not requiring an internet connection). But if you want the full text, like most would, than your best option is to use the mobile form of Access Medicine when you’re at your academic center or practice. Also, the Merck Manual – Professional Edition is a fantastic alternative reference application that offers the same set of features as well, just not the iconic name of “Harrison’s”.

View Customer Reviews on iTunes »

Download Now on iTunes for $59.99 »

Visit the App Website »

Addendum:

One of our commenters made a great point that I was unaware of. There are two versions of Harrison’s: Principles and Manual. Its odd because the edition numbers are the same, and the branding method seems odd and confusing. Nevertheless, this app is Harrison’s Manual, which is an abridged version of Harrison’s Principles. The overall review pointed out the app is an abridged version of the text you find via Access Medicine, which still holds true.

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The Best Wikipedia App to Use for Finding Legitimate Medical Literature [App Review]

Iltifat Husain — Wed, 06 Jan 2010 04:11:41 +0000

The medical apps section on the iPhone and iPod Touch has a lot to offer, this is apparent from the medical app reviews we’ve done on this site. When I think about my most heavily used medical apps, one that comes to mind has to be my Wikipedia app. Obviously, Wikipedia is no complete substitute for reference applications such as Epocrates, or the Merck Manual Professional Edition. But if used properly, it provides a great service.

The problem is finding a suitable Wikipedia app to use. I’ve tried a number of free Wikipedia applications and have found one that really helps me find the medical information I’m looking for the best.

Its no secret that Wikipedia has been used extensively by those in the medical community to look up medical information and understand topics better. I use it most when I begin researching a topic or if I need to find the mechanism of action for a drug. The reference section is my favorite part of Wikipedia. It’s a great way to find excellent journal articles and other medical resources. The best way to utilize Wikipedia is to read up on the legitimate reference articles provided. Clearly, you don’t want to use Wikipedia for actual clinical decision making, rather as a portal to finding articles from reputed sources.

There are three main Wikipedia apps that are free. Wikipedia Mobile, Wikiamo, and Wikipanion. Wikipedia Mobile is actually made by the Wikipedia people so one would think they would do a better job than these other two apps, but not so. I’ve tried all these Wikipedia apps extensively, but my favorite Wikipedia application has to be Wikipanion. Many of the other free Wikipedia apps offer the same features as Wikipanion, but Wikipanion’s fluid user interface is why it’s the best.

Key features that I use the most:

Ability to to E-mail out current article, Search Within the Page, Bookmark, and other comprehensive choices for each Wikipedia entry. Often I’ll bookmark key articles to view later when I’m out of the hospital or clinic.
Application opens to the last screen you were viewing before you close the app.
The Contents page provides a great summary of the Wikipedia entry, making it significantly easier to navigate and get directly to where you want to go. In this case, looking up the mechanism of action via the Pharmacology section.
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The references are properly linked within the article, and clicking them opens up safari, often providing you a peer reviewed source of data. In this case, a paper on the side affects of Statins.

This layout of Wikipedia is somewhat emulated by UpToDate.com, often considered a legitimate medical source. Just a word of caution, UpToDate is almost always on point, but sometimes the references they use can be from questionable articles, so just like any source, make sure the information you’re using is synthesized from a reputable article or book.

That said, UpToDate is a great source for medical providers and I’ve definitely used it plenty of times in clinic and in the hospital. You can use it on your iPhone or iPod touch via mobile form if your academic institution or private practice has a subscription. They’ve done an excellent job of making their site compatible with the Safari browser in the iPhone OS. At the end of the day though, its fair to say we’re all waiting for a legitimate UpToDate app, much like the Wikipedia apps for the iPhone that have been mentioned above.

The development team at Wikipanion also offers Wikipanion plus, for $4.99. This version allows you to download entries directly to your iPhone and other features. Although these add ons are nice, I’ve found the free version to be sufficient for everyday use.

WikiPanion Website

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