Healthcare spending in the United States continues to increase, accounting for over seventeen percent of the nation’s gross domestic product. Most experts consider this level of healthcare spending unsustainable. Health economists identify unnecessary diagnostic and screening tests as a primary driver of this spending.
Many patients request or receive ‘routine’ (but unnecessary) medical tests. There are many reasons for this: the current fee for service payment model; the lack of legal standing for a medical associations’ recommendations that can result in medical malpractice cases for not screening; and sheer inertia as “this is what we have been doing for years” and/or a feeling that testing meets an expected or ‘community standard’ litmus test.”
As a result, collaborating medical societies have identified lists of “top 5” tests or treatments that are commonly overused. The “Choosing Wisely” initiative, created by the American Board of Internal Medicine (ABIM) Foundation, has over 70 medical societies, associations and partner groups to list common medical tests/procedures that are often clinically unnecessary. For the busy primary care provider, deciding what test to order or not to order for various medical conditions can be challenging. Guidance about these types of decisions can be found piecemeal via the Choosing Wisely Campaign website.
The American Academy of Family Physicians for example does not recommend imaging for low back pain in the first 6 weeks unless the patient has red flags.
The Choosing Wisely initiative has partnered with Consumer Reports to create a website as well as videos and downloadable materials for patients and providers covering most of the Choosing Wisely recommendations. Additionally, they have launched an iOS app for patients to have easy access to these materials on the go. The app goes beyond just tests and procedures to include drugs too.
Evidence based medicine
Making Healthy Choices is based on the recommendations from the Choosing Wisely initiative of over 70 medical groups with a multitude of top 5 and top 10 lists of tests and procedures that may not be necessary or should be used more carefully. The evidence behind the Choosing Wisely recommendations for primary care have recently come under fire so we recommend carefully reading each recommendation to see the level of evidence upon which it is based.
What providers would benefit from the Making Healthy Choices medical app?
Patients, students, residents, mid-levels, physicians, nurses, any staff provider who cares for patients.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- The app brings the Choosing Wisely recommendations to patients.
- Helpful videos and PDFs for each recommendation.
- Includes information on drugs as well as tests and procedures.
- Requires an internet connection to view the videos and PDFs.
- Many of the Choosing Wisely recommendations are expert opinion based.
- Not available for Android.
The Making Healthy Choices app is a great addition to the app store as it brings the Choosing Wisely recommendations to mobile devices here in the US. Previously only the Choosing Wisely Canada recommendations were available as an app. The app combines the recommendations with Consumer Reports health data to provide a surprisingly comprehensive amount of data to consumers in an easy to understand format.
- Overall Score
- User Interface
Simple to use interface, but requires internet connection for much of the content.
- Multimedia Usage
Extensive hyperlinking within the app with quality videos and PDFs on each recommendation.
App is free.
- Real World Applicability
Unfortunately, I am not convinced that patients will use this app. Healthcare costs continue to increase in the face of the Choosing Wisely campaign. Nonetheless the app is the only currently available app that takes the Choosing Wisely information and makes it widely available to patients on their mobile devices. I will certainly encourage my patients to use it and will share the PDFs and videos with them.
- Device Used For Review
iPhone 6S running iOS 10.0.2
- Available for DownloadiPhoneiPad