Top apps in my daily practice

By Evan Howe, MD, MPH, PhD

I learned in my medical education that while it was important to know the answers, it was more important to know where to find the answers that I didn’t know. This once meant exploring shelves of notable tomes. The portability of information has opened up new avenues for accessing the information that I need in order to get through my day.

Using my phone as an information portal to assist my work in my family medicine clinic has become part of my daily routine. Most patients appreciate the use of the technology to assist in decision making. There is a skill to using technology as a teammate alongside the patient-physician dyad rather than as an intermediary or, even worse, a barricade to prevent genuine interaction. I have learned to suggest to the patient that these apps enhance the treatment plan, not substitute for my judgment.

Here are 10 of my favorite apps I use on a regular basis in my daily practice, mostly on my mobile phone.

Epocrates

> Free app with subscription upgrade for iOS and Android
This is a well-known service with both web-based and app-based access points. I find it most helpful for checking medication dosages and drug interaction. There are disease-based monographs with bullet point information that identify priorities for diagnostic testing and clarify treatment alternatives. Other features include searchable databases of ICD-10 and CPT codes, and an antibiotic selection aid with information on local drug-resistance patterns.

Calculate by QxMD

> Free for iOS and Android
This is another mega app that contains far more information than I typically need. However, it is a very efficient repository of the calculations I need in a typical day such as CHADS2, CURB-65, TIMI, APACHE, FENa, Bishop score, Ottawa knee and ankle rules, Epworth sleepiness scale, corticosteroid equivalence, and peak flow prediction, among others. The peak flow calculator tops my list for office management. Calculators are organized within the app in categorical or alphabetical order.

BiliCalc

> $1.99 for iOS and $0.99 for Android
For those of us providing inpatient newborn care, this app makes quick work of calculating risk stratification and phototherapy threshold. It provides guidelines for next bilirubin check and a list of neurotoxicity risk factors. The app simply asks for information on birth time or age in hours, lab time, and bilirubin level, and calculates the next steps for you. This definitely beats the time I used to spend trying to find a bilirubin chart and plot these out on a graph where the boxes were too small to be certain that I was just below the curve.

E/M Coder

> Free with $39.99 upgrade for full version; iOS only
This app is a bit pricey for its function, but it has focused the time I spend documenting my encounters. It includes E/M calculators for all of the contexts in which family physicians provide care—office, hospital, nursing home, house calls, emergency department, and rest home. The user inputs the number of elements in each category, and the app provides tips on requirements to meet the next level of documentation in each of the history, exam, and medical decision-making components. This helps me identify where adding a bit of information (already collected, but often overlooked) can help me become eligible for reimbursement for care I am already providing. The app’s summary report also provides information on the associated relative value unit for each code, and reminds me whether I should code an encounter as a two of three or three of three.

Agency for Healthcare Research and Quality ePSS

> Free for iOS and Android
This app provides a mobile platform for accessing all of the AHRQ guidelines on current screening tests. While I might have the colonoscopy guidelines on the tip of my tongue (how many times a day do I have to run through that?), I don’t necessarily remember the frequency of other services. Additionally, the app provides the clinical reasoning behind the guidelines and recommended screening modalities. The app can generate a list of recommendations after inputting information on the age, sex, pregnancy status, tobacco use status, and sexual activity status. Within each recommendation are relevant tools and applicable risk calculators. This is another great app to use alongside patients to include them in shared decision making over health maintenance schedules.

ASCCP

> $9.99 for iOS and Android
Interpretation of Pap and colposcopy results was another area where I felt buried in stacks of papers and algorithms as I figured out which table came next in my evaluation. This app takes age, HPV status, pregnancy status, and Pap results into account when identifying where on the algorithm your patient lies. It even provides the opportunity to input colposcopy results and follow-up co-testing results. I use this app in a number of settings. When I receive the Pap or pathology reports, it is often handy to calculate quickly the next follow-up. I have also found it to be quite helpful during new patient encounters when I need to review recommendations with patients in real time during the visit.

American Academy of Family Physicians

> Free for iOS and Android
This is another multifunctional app that I’m sure each person uses differently. This mobile access point for your AAFP account includes links to job searches, residency and fellowship directories, meeting calendar, links to familydoctor.org, and the Family Practice Management journal. I mostly use this app for the legislative tracker with its easy link to send my representatives and senators an email stating my support for issues critical to family medicine and the AAFP.

ABFM Exam Prep

> Free for iOS and Android
This app helped me maximize my spare time waiting in line somewhere or before drifting off to sleep this past summer as I prepared for my board exam (passed!). It continues to be useful to keep me sharp and focused with exam-type questions that highlight some of those areas where I need to touch up. The app generates short, 10-question quizzes and enables a quick review of the reasoning for any incorrect answers.

Shots

> Free for iOS and Android; by the Society of Teachers of Family Medicine
This is a great app for keeping the up-to-date immunization schedules at your fingertips. It provides pediatric and adult immunization schedules, information on integrating combination vaccines into your schedule, plus helpful tips on the epidemiology, administration, and contraindications of each vaccine. As with most of the information relevant to the other apps listed above, there are paper charts that do this work, but this digital portal makes the same information ubiquitous.

ASCVD Risk

> Free for iOS and Android
This calculator contains all of the updated 2013 American College of Cardiology/American Heart Association recommendations including the 10-year risk estimator. This output serves as a teaching tool with patients to help them understand the impact of changing modifiable aspects of their risk profile. For example, when patients return to my office for discussion of lipid results, I use this calculator to explain the modifiable and non-modifiable risk factors for cardiovascular disease. It is easy to toggle through the independent risk factors to show the potential impact of quitting smoking or controlling blood pressure.

Dr. Howe practices family medicine in his hometown of Jefferson, Ohio.
This story originally appeared in the summer 2015 issue of The Ohio Family Physician and is reproduced with permission from the Ohio Academy of Family Physicians.