Apple has made it clear that current iPhone apps will run on the iPad.  For many of the medical apps we’ve reviewed, its welcome news, but it won’t make the user experience of these apps any different.  However, there are a few medical apps currently on the iPhone whose user experience should be greatly enhanced by the iPad’s 9.7 inch 1024 x 768 pixel display.

The following are the top 5 medical apps we’re excited to see in action on the iPad.  This list is focused for health care professionals, and stay tuned for another list for medical students. Of note: These apps will only be great on the iPad if the developers port them over – basically, if the developers make a custom version of the app for the iPad.

(1) Blausen Human Atlas – When I think of the iPad in medicine, this app embodies one area in which the iPad could shine.  The Blausen Human Atlas includes 3D figures of human anatomy, an expansive medical glossary, over 1,000 still images, and a library of videos explaining common medical conditions like GERD and osteoarthritis.

Basically, everything in this app is designed with the goal of improving patient-physician communication. A provider who is trying to explain cholecystitis to a patient could access videos that explain the disease, still images to clarify any confusing points, and even 3D figures of GI anatomy to explain the corrective surgery.  The app performs admirably on the iPhone’s 3.5 inch display, but on a display more than twice this size – the iPad’s – it should shine.

Links: Blausen Human Atlas App Review
[iTunes Link]

How many of your patients, inpatient or outpatient, have skin lesions?  How do you approach these skin lesions?  With befuddlement, with a frantic search of Up-to-Date articles, with an almost reflexive dermatology consult?  Now there’s a point-of-care resource that promises to allow clinicians to generate a “visual differential diagnosis” for any skin condition we see.  Here we review VisualDx Mobile from Logical Images, Inc, a “visual diagnostic decision support system”

First and foremost, with any point-of-care tool, reliability is key and in addition to all of these This app is from a reputed developer that employs over 100 practicing physicians on its editorial board to update its digital medical image collection, which numbers over 18,000 on this app. Logical Images, Inc (Rochester, NY) is a reputed medical technology company that has developed the world’s largest digital medical image library that includes over 60,000 images of visually presenting diseases (18,000 on this app).  We previously featured a conversation with Dr. Art Papier, Co-Founder and Chief Scientific Officer of Logical Images (posted March 4, 2010).  As mentioned in this conversation, the NIH has awarded Dr. Papier a $2 million grant to develop a standardized lexicon for dermatology.  Moreover, VisualDx boasts of customers such as the Military Health System, Delaware Division of Public Health, Wyoming Department of Health, and many more. Long story short – we trust them.

As for the app itself, it is rather intuitive to use: the home screen (shown above) features two functions, aptly named “Build a Differential” and “Find a Diagnosis.”

With “Build a Differential,” the user can input as much specific data about a patient’s presentation as he/she desires: the entry fields include neonate/infant vs child vs adult vs elder, drug eruptions, single vs multiple lesions, lesion morphology, body location, “key findings” (patient appearance, time course), and “other findings” (exposures, labs, medical history, occupation, social history, travel, etc.).  The app takes the entered information and presents a differential diagnosis ranked by likelihood (on how many patient findings match) and displayed via titled high-quality images—the so-called “visual differential diagnosis.”

Upon finding and clicking on a condition in the differential (shown above), the user can access an image bank of the condition, as well as the ICD-9 and information such as diagnostic pearls, differential diagnosis, best tests, management pearls, therapy, and associated findings. All of this information is grouped together into one screen and indexed on the right side of the screen, allowing for easy navigation between sections.

The other function on the home screen is the “Find a Diagnosis” function (shown below), which allows a user to browse or easily search for one of over 1000 diagnoses to see the associated bank of images and reach the aforementioned information about the condition.

As a fourth-year medical student and soon-to-be internal medicine resident, I was very impressed with this app’s clinical utility, as it makes for a infinitely useful tool both in outpatient and inpatient settings.  It is quick-loading, intuitive to use, and can prove to be a powerful source of help for identifying the many skin lesions that one is bound to see in any setting.  The most useful facet of the program is, not surprisingly, the “Build a Differential” function that shines when one encounters a skin lesion.  Though I did not come across any unknown skin lesions this week (unusual), I employed it several times on patients of mine with known dermatologic conditions and was pleased to discover that it included the correct diagnosis among the first several conditions on its generated differentials. From there, the images were high-quality and helpful in proper diagnosis.  Moreover, it has great potential for patient teaching or interaction, especially for warning about drug eruptions or assessing transient or historical skin lesions.  Unfortunately, the differential diagnosis resets if one exits the app.  Nonetheless, I absolutely plan to use this app as a resident, especially for the many clinic patients I will undoubtedly see with dermatologic complaints.

Pricing: Current VisualDx subscribers can download this app at no cost. A free trial (of 15 days’ duration) is available for clinicians who are new to VisualDx.  After that, a one-year subscription to VisualDx costs $199 (or $49 on student pricing) for the Clinician Package, or $99 (or $29 on student pricing) for the Pediatrics Package, which limits the features to neonate/infant/child lesion(s).

Likes:

Ease of use, powerful visual differential diagnoses

Tremendous quality and quantity of images (over 18,000)

Breadth of dermatologic diagnoses, over 1000 at last count

Dislikes/Future Updates I’d Love to See:

If your institution does not subscribe to VisualDx, the high cost

Differential diagnosis is lost if user exits the app

No way to e-mail a visual differential diagnosis or illness information and images for a patient

Conclusion: A powerful app, almost a must-have in my opinion, with a tremendous user-friendly interface, for a medical student or resident to help evaluate dermatologic lesions in both inpatient and outpatient settings.

Amit Patel is a fourth-year medical student at Washington University in St. Louis, MO. He is a graduate of Duke University and will be entering an Internal Medicine residency this July. We are thrilled to have Amit aboard!

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This article is part of our HIMSS 2010 coverage. It includes a brief review of the iPhone medical app from Logial Images – Visual Dx Mobile – and a conversation with Dr. Art Papier, Co-Founder and Chief Scientific Office of Logical Images.

Although an unimaginable array of technology was demonstrated in the hangar-like exhibition spaces at HIMSS, one of the most impressive uses of technology from a physician’s perspective was in a small booth in far off corner. In it, the voluble and passionate co-founder and Chief Scientific Officer of Logical Images (www.logicalimages.com), Dr. Art Papier demonstrated a web and mobile based application that magically produces a sequence of high quality diagnostic images in response to user queries. Since Dr. Papier is Associate Professor of Dermatology at the University of Rochester School of Medicine, the application was originally dedicated to presenting high-quality images of dermatologic conditions.

This is fortunate in two respects. First, the most important findings in dermatology are visible to the naked eye and thus to a camera, second few clinicians (except for dermatologists) have more than the slightest familiarity with dermatologic conditions whereas skin conditions, according to Dr. Papier, account for 15% of visits to PCPs. The application has since also expanded to include radiology. An iPhone and iPod Touch version  was announced at HIMSS this week.

What Visual Logic has pioneered is a sophisticated structured search that allows the physician to sequentially enter more specific information about the patient’s presentation and be presented with a “visual” differential diagnosis. For example, a physician could enter that the patient is a veterinarian, has fevers and has a rash, and with each entry, the panoply of images on the screen would decrease in number until a match is made by the physician. For radiology, a mouse-over the chest xray conveniently highlights the abnormal portions of the lungs on the image. Dr. Papier has also been awarded a $2 million grant from the NIH to create a standardized lexicon for the field of dermatology.

The ten-year old web application has over 60,000 medical images collected from physicians and institutions showing that show dermatologic diseases along with their variations with age, stage, and skin color. The more than 100 editors of the collection include some of the distinguished academicians in dermatology, according to Dr. Papier. The textual medical content is obtained from peer-reviewed literature and includes treatment recommendations. There is also a consumer oriented version of the database at skinsight.com. In addition to dermatology,  Dr. Papier adds dentistry, endoscopy and pathology as other fields that are amenable to visual diagnosis.

Announced formally at HIMSS is the iPhone version of Visual Logic, appropriately named Visual Dx Mobile, contains over 18,000 images as well as text information such as next steps in management, diagnostic pearls, recommended tests, and ICD-9 codes. In the demonstration of the iPhone app, the image and text display could be seen to be smooth and rapid (see video). One cannot help but marvel at the impressive volume of clinical information now available in a small hand-held device (I wonder if the American Dermatology Association has pondered the implications of launching a small army of amateur dermatologists). The software is generally licensed by institutions but physicians can also buy it as modules, for example the pediatric module would cost $120 per year. According to the company, VisualDx is already in use at more than 1,300 clinical sites, including hospitals, public health organizations, government agencies, medical groups, and medical schools. Current VisualDx subscribers can download VisualDx Mobile for free at Apple’s App Store. Nonsubscribers can request a free trial or purchase a VisualDx subscription in order to access the app.

Dr. Papier emphasizes that the goal is to help physicians make a diagnosis. Much of where health IT intervenes in the clinical process has to do with treatment, such as clinical decision support systems that help physicians select the best or most cost-effective treatment. All of these resources are of little use if the diagnosis is wrong. This is especially relevant the treating physician may not be familiar with the patient’s condition, as is often the case with dermatology.  Even more relevant is that, while every disease has a “classic” or “textbook” presentation, in reality every disease also has innumerable variations. The ER physician, PCP or pediatrician cannot possibly memorize every variation, this is the advantage of specialization and the result of unconscious accrual of pattern recognition. The availability of large atlases is also of limited benefit, since they are invariably organized by diagnosis, which is of little help if you do not already know the diagnosis. With wider availability of sophisticated diagnostic tools such as VisualDx Mobile at the point of care, hopefully more patients can receive quicker and more accurate diagnoses in the future.