Learning a new skill can be an intimidating task for budding health care professionals – especially when it comes to learning medical procedures.  There is a difference, any doctor will tell you, between reading about a procedure and actually doing it.  Educators are beginning to take full advantage of new technology – like the iPhone/iPod – to help bridge the gap between comprehending and performing medical procedures.

Procedures – Hospital Collection is a new app that uses bulleted text, clinical images, and audio/video instruction to familiarize the learner with the preparation, relevant anatomy, and individual steps of common procedures in the hospital setting.

This app is not the first we have reviewed that offers instruction on performing routine hospital-based procedures. In many ways, Procedures – Hospital Collection is like the more expensive Procedures Consult – Internal Medicine App in its content.

So… how does it stack up to Procedures consult?  In this post we’ll do a full review of Procedures – Hospital collection, and use the Procedure Consult series as comparison

For $19.99 MeisterMed’s Procedures: Hospital Collection uses hi-resolution video clips that look in many ways like the Procedures Consult family of apps or the New England Journal of Medicine Clinical Medicine videos that may be familiar to many medical students, residents and physicians.

As the name implies, the content is most applicable to those users in the inpatient hospital setting.  Modules included are:

1. Arterial Line Placement
2. BiPap & CPAP*
3. Bone Marrow Aspiration and Biopsy*
4. Femoral Line Placement
5. Glidescope Intubation*
6. Internal Jugular Line Placement
7. Internal Jugular Line Placement with Ultrasound Guidance*
8. Laryngeal Mask Airway*
9. Lumbar Puncture
10. Orotracheal Intubation*
11. Paracentesis
12. Pulmonary Artery Catheter Placement
13. Subclavian Line Placement
14. Thoracentesis
15. Tube Thoracostomy (Chest Tube) – (Procedures Consult has Needle Thoracostomy)

* Not one of the 30 procedures included in Procedures Consult – Internal Medicine

Navigating the App

The user can search, return to previously bookmarked pages, or simply browse one procedure at a time.  Each procedure page has three menu items: Procedure Details, Images, and Watch the Video.

Procedure Details:

Under the Procedure Details menu, the user will find indications, contraindications, complications, equipment, step-by-step instructions, lab analysis (if applicable), frequently asked questions, coding, and references.  This format differs from the “Pre-procedure, Procedure, Post-procedure” layout of Procedure Consult.  Navigation through the menus is not as fluid or intuitive as we would have hoped – transitions between pages have a lag of a second or two, and it is often difficult to distinguish linked-text from plain text – but the depth and quality of information in the Procedures Details menu is definitely on-par with competing apps.

Images:

Hi-res clinical images and corresponding captions are found under the Images menu.  Clinical images from the bedside are very large, generally high in quality, multi-touch capable, and convey the key steps of the procedure.

Important anatomy concepts are shown in figures (e.g. Mallampati Classification, landmarks for LP), but are lower in quality and fewer in number than similar figures in competing apps.  We would have liked to see more high-quality anatomy figures in color.

The Images menu lacks integration with corresponding items in the Procedure Details menu, and is clunky to use.  The user cannot view the image and its caption at the same time, which makes for the tedious process of opening the image, returning to the Image menu, opening the caption, returning to the Image menu, then moving on to the next image.

If we were designing this app, we would prefer to see the Images menu scrapped, or at least better integrated into the Procedures Details menu.

Video:

Ok, here’s the bread and butter of any procedures app or online teaching tool – the video.

Most videos are 3 to 5 minutes long, from preparation stage to completion.  Video footage for each of the procedures is generally well done.  Some procedures are staged in lighting that is less than ideal, but in general the video is clear and effective in showing key steps of the procedure, with “down-time” edited out.  Close-ups of appropriate steps are included.  The narrator guides the user through each step, sprinkling in the tips and tricks of an experienced clinician. Audio clarity is good.

Users may find the narrator’s unscripted approach distracting.  We did.  A well written script for each video — and some editing-out of messy sentences — would have undoubtedly cut down on “um, ah um” and probably ensured that more relevant narrative points be included.

Key point: a major strength of procedural videos is missing from this app. Videos on this app lack intentional pauses to emphasize the clinical pearls, anatomical relationships, safety reminders, and key techniques that are most important for the learner to remember.  Other effective procedure video apps and online videos use on-screen text or overlaid anatomical figures to make key teaching points. To maximize the learning experience to the user, we would have liked to see this integration of text-based key learning points within the video.

Likes:

• All the information is there… you just need to know how to get it.
• References included, and generally up-to-date.
• CPT Coding information included (missing from Procedures Consult)
• Entire content downloaded to the device (no Internet connection needed)
• Fully searchable and bookmarkable.
• HUGE clinical images with multi-touch zoom.

Dislikes:

• Key information in the text is not highlighted (bolded or different color)
• Text size not adjustable
• Clunky process of clicking back-and-forth between images and captions
• Narrator “ums,” run-on sentences, and abrupt stops.
• Navigation of the user interface is slowed
• Lacks integration of video, images, text, and audio into one coherent learning experience
• Only 15 procedures (compared to 25 on Procedures Consult – Internal Medicine)

Notably missing Procedures:

• Incision and Drainage of Cutaneous Abscess
• Pelvic Exam/Pap Smear
• Phlebotomy

Conclusion:

At $19.99 Procedures – Hospital Collection is a good buy for residents and students who are somewhat familiar with each of the procedures, but who need a quick brush-up on the needed equipment or step-by-step process just before seeing a patient.

In comparison to the Procedure Consults – Internal Medicine app, users with no procedural experience – like many medical students – may miss out on many helpful “clinical pearls” and find the in-video learning experience to be lacking with Procedures – Hospital Collection.

But for half the price, this app provides more than sufficient information to learn the techniques and concepts behind the 15 included procedures, if only the user is willing to put up with a few more menu-clicks and less stream-lined audio and video quality.

This app succeeds in providing a comprehensive procedure learning tool, but fails to match the intuitive layout and high quality text-audio-video experience of the higher priced Procedure Consult App Series. And although Procedures Consult – Internal Medicine is twice the price, it also has almost twice the number of procedures.

Editor’s Addendum and comments

Our apologies, we needed to do a better job of distinguishing the procedures available in Procedures Consult – Internal medicine, and those in Procedures – Hospital Collection. We have updated the 15 modules we first listed for Procedures – Hospital Collection, labeling the procedures not included in Procedures Consult – Internal Medicine.

Also, the following procedures are available in Procedures Consult – Internal medicine, and are not available in Procedures – Hospital Collection: Atrial Blood Gas Sampling (In addition to Radial, Brachial and Femoral Approach included), Basic Airway Management, Cardioversion, Central Venous Catheterization: Femoral Approach, Cerumen Removal, Defibrillation, Epistaxis Management, I&D of Cutaneous Abscesses, Intravenous Cannulation, Local Anesthesia, Nasogastric Intubation, Pap Testing, Phlebotomy, Stapling Devices, Tick Removal, Transcutaneous Pacing, Transvenous Pacing.

I’d like to further stress the depth of the Procedures Consult – Internal Medicine app’s videos, text, and pictures. Although Procedures – Hospital Collection does show how to put in an a-line, Procedures Consult shows alternative approaches, with alternative in depth videos as well. The depth and breath of the video, text, and pictures in Procedures Consult – Internal Medicine are better than the Procedures – Hospital Collection app, as is the navigation and overall user interface.

But when making a decision on which app to purchase, look at the procedures offered by Procedures – Hospital edition that are not offered by Procedures Consult – Internal Medicine. If those extra procedures are key for you, and the extra procedures offered by the Procedures Consult app are not, than Procedures – Hospital edition would be a very good choice.

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Brett Einerson is one of our newest guest writers.  He is a fourth year MD/MPH student at Wake Forest University School of Medicine and the University of North Carolina Gillings School of Global Public Health.  He is a native of Minnesota and a graduate of Bethel University in St. Paul.

In the future he will be entering residency in Obstetrics and Gynecology. He is interested in evidence-based practice, comparative effectiveness research, physician decision-support systems, and practice guideline development.

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.

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*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.

Procedure apps appear to be all the rage lately in the mobile medical world, and rightfully so. These instructional apps are a valuable resource to those learning how to do procedures in the health care world. We reviewed another Procedures app recently, Procedures Consult-Internal Medicine, that covers a wide variety of procedures. However, this app focuses on one specific procedure, and is a fraction of the cost.

Procedures – Subclavian Line, is a $2.99 app produced by MeisterMed. You might remember one of our previous reviews on a MeisterMed app, PediDoser. We weren’t huge fans of that app (although to their credit, PediDoser has a 3.5 star rating in the App Store). Nonetheless, once I tried out this current app for this review I was definitely impressed.

I’ve had the opportunity to do a few subclavian lines as a medical student, and the experience is exciting and frightening at the same time. The best way to learn at first is to see, but unfortunately you don’t always have a good view, or the resident might not be the best teacher. Thats where this app comes in.

The navigation is pretty simple. When the app opens you have the option to view the procedure details or watch the full video. In the procedure details section you have a few different options, from step-by-step instructions to complications and coding numbers. There is also a toolbar at the bottom of the screen. It contains navigation tools, bookmarking, and an option to write custom notes. The bookmarking feature was not useful, but the custom note feature was a nice touch.

Video:

The video is approximately 10 minutes long and included within the app. You don’t need internet access to view the video. It shows the full procedure being done from start to finish. The audio component of the video is instructional. I found the audio to be layered nicely with the video. The instructions were concise, high yield, and the explanation of the procedure was excellent.

What I liked:

• Simple, easy to use
• Great Price
• Ability to take custom notes
• Video is standalone, no Internet access required
• The verbal explanation during the video is done well
• There is a separate text section step by step instructions.

What I didn’t like and Improvements that could be made:

• Overall video is great, but at 10 minutes in length, it would be nice to see the video broken into separate sections that are easy to access.
• It would be nice to see text inter-laid with the video on the crucial steps of the procedure, so you can view the video without always needing the audio
• The step by step text instructions only contain one picture. More pictures would be nice additions to this section.

Conclusion:

This is a great medical application for those learning how to do subclavian line procedures. It’s simple, easy to use, and easily accomplishes its goal of teaching how to put in a subclavian line. Like I’ve mentioned with past procedure applications, there is no substitute for getting lots of supervised practice before actually doing this procedure on your own. However, this app definitely reduces the apprehension felt when attempting this procedure for the first time under supervision. I could also see it helping speed up the learning time needed for this procedure.

The previous procedures app we reviewed, Procedures Consult-Internal Medicine, had 25 procedures explained(including subclavian line), but costs $39.99. We really liked that app, but if you don’t need access to all those procedures or don’t want to spend that much right now, then this app is a great buy at $2.99.

I’d definitely recommend this medical application as a must have for 3rd/4th year medical students, interns, residents, and other healthcare professionals who are learning to do subclavian lines.

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PediDoser, developed by MeisterMed and priced at $2.99 (“limited time only”), claims to be a fast and easy-to-use pediatric medication dosing tool. Since I was about to begin my outpatient peds rotation, I was really excited the new version (1.2) became available and figured I’d give the app a good run for its money. Currently, it’s ranked 17th in the top paid Medical apps category. I’m a bit surprised by this ranking, as you’ll see in the following review.

For me to spend money on a medical application, I feel it should do two basic things.  One, it needs to provide me a useful service. This app aims to do this by answering my medication and dosage questions when I’m working with a healthcare population I’m not extremely familiar with, pediatrics. Two, it needs to be easy to navigate through so I’m able to use it in a busy healthcare setting. Unfortunately, this is where this app and I disagreed.

When the app starts, it gives you the option of searching by name or by class. Suppose you choose by name. You are then greeted by an alphabetized list of medications as well as quick links at the top of the page to 10 sections of the alphabet. In theory this sounds great, but there is no easy way to just scroll to a portion of the alphabet, as you can do with your iPhone contacts. In fact, if you scroll down to say, Miralax, but you accidently tap on “Mineral Oil” (located right above it) and then tap the “back” button, you start right back at the top of the page. To make it worse, the back button doesn’t seem intuitively placed. It took me two weeks to realize a back button existed, it’s a left turn arrow at the bottom right of the screen. I expected a more intuitive button on the top left that said “back”, similar to what you’d find in Epocrates or Medscape Mobile.

Additionally, I’m not a fan of how the app asks you to input a patient’s weight via a scroll wheel. Although the current way allows you to round dosages easily, I rather type in a number and then let the app calculate the dose. Overall, it’s not easy to navigate. Say I choose a 200mg/5mL solution of Amoxil to prescribe, but once I put in the patient’s weight, I realize it’s too large of a quantity and I should be using something stronger. There’s no easy way to change doses, without backing out 2 steps and then re-scrolling to the weight again.

Overall, the app doesn’t feel very polished, and navigates like a website / power point presentation. The User Interface definitely needs improvement. To their credit, there is a “search” option that sifts through not only medication names but indications as well. However, the app is just too limited. For example, searching “asthma” pulls up just 4 medications. The application doesn’t even have information on Albuterol or Flovent, the most common asthma meds I’ve used this month. Needless to say, I was turned off of this app after multiple fruitless attempts at looking for a medication that it didn’t have information on (no ADHD medication information in a peds resource? really?). These deficiencies are even more glaring when I can easily find more information faster using a free alternative.

Should you get it?

No, unless you have 12 quarters in your back pocket that are just keeping you from sitting comfortably. I hate not being able to endorse this product because the concept is great, and I’d like for it to succeed. I would love to see future updates of this App that address its shortcomings, and I’ll be the first to write a review if there are significant improvements. Unfortunately, there are too many higher quality, less expensive (free), and more polished alternatives (MedScape, Epocrates) on the market. If this app was free, I’d say download it and give it a try. Sadly, in business, if you’re going to charge for something the competition does for free, you’d better be doing a much better job of it, and in this case, the diagnosis is that PediDoser fails to deliver.

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