family medicine residency...iphone •has the largest selection of applications available at the...

Keith Sinusas, MD Associate Director Middlesex Hospital Family Medicine Residency

Dr. Bones McCoy in

the original Star

Trek TV series with

his tricorder

It is estimated that 72% of U.S. physicians

use a smartphone

The number has climbed rapidly from

50% in 2007, then 62% in 2009

It is projected that the number will hit

81% in 2012

However, it is unknown how many are

using it for more than just a phone

Discuss the smartphones currently available

Report on ratings of the smartphones and the cellular service providers

Describe where to get smartphone apps List the top 10 apps for the family

physician List some other interesting medical

applications Review the next big wave: the iPad

iPhone – 55%

Blackberry – 22%

Android – 15%

Palm – 4%

Windows – 3%

Unknown – 1% iPhone

Blackberry

Android

Palm

Windows

Unknown

iPhone – will remain solid

Android – climbing steadily

Blackberry – falling quickly

Palm – R.I.P.

Windows – has a chance of surviving

What should you do when shopping for a

smartphone?

Coverage is always an issue “Can you hear me know?”

Existing contract might limit choice

Data service • Good data service is critical to when searching

such as in Google or in MDConsult

• Many medical smartphone apps reside entirely on the phone so data service is less critical

• 3G vs. 4G – currently the difference is not too great regarding speed

Provider Boston

Overall

Score

(1-100 scale)

Boston

Data

Rating

(1-5 scale)

New York

Overall

Score

(1-100 scale)

New York

Data

Rating

(1-5 scale)

Verizon 76 3 72 4

Sprint 73 n/a 69 3

T-Mobile 70 n/a 69 n/a

AT&T 60 1 57 1

Phone choices are often limited by each

wireless provider

Until recently the iPhone was only

available on Verizon

The following tables are based on

information from Consumer Reports

Phone Cost

Over-

all

score

Dis-

play

Ease

of use

Phone

rating

Web

rating

Cam.

rating

Batt.

life OS

Samsung

Infuse 4G $200 79 5 5 4 5 4 5

Motorola

Atrix 4G $100 76 5 5 4 5 3 5

HTC

Inspire 4G $100 74 5 5 4 5 3 3

Samsung

Captivate $50 74 5 5 4 5 3 4

Apple

iPhone 3GS $50 68 4 5 4 4 3 3

Blackberry

Torch $50 66 4 5 4 4 3 3

Phone Cost

Over-

all

score

Dis-

play

Ease

of use

Phone

rating

Web

rating

Cam.

rating

Batt.

life OS

Motorola

Photon 4G $200 77 5 5 4 5 3 3

Samsung

Epic 4G $100 72 5 5 4 5 2 3

HTC

Evo 3D $200 72 5 5 4 5 3 3

HTC

Evo 4G $50 70 5 5 4 5 2 3

Samsung

Nexus S 4G $30 70 5 5 4 5 3 3

Phone Cost

Over-

all

score

Dis-

play

Ease

of use

Phone

rating

Web

rating

Cam.

rating

Batt.

life OS

Samsung

Galaxy S 4G $100 78 5 5 4 5 4 5

T-Mobile

G2X $150 76 4 5 4 5 4 4

HTC

Sensation 4G $200 75 5 5 4 5 4 4

Samsung

Vibrant $150 75 5 5 4 5 3 4

T-Mobile

Sidekick 4G $100 75 4 5 4 5 3 5

Blackberry

Bold 9780 $130 63 3 4 4 4 3 4

Phone Cost

Over-

all

score

Dis-

play

Ease

of use

Phone

rating

Web

rating

Cam.

rating

Batt.

life OS

HTC

Thunderbolt $250 74 5 5 4 5 4 3

LG

Revolution $200 73 5 5 4 5 3 3

Samsung

Droid Charge $300 73 5 5 4 5 3 2

Motorola

Droid 3 $200 73 5 5 4 4 4 4

Motorola

Droid X2 $200 73 5 5 4 4 4 4

Apple

iPhone 4 $200 71 5 5 4 4 3 3

iPhone • Has the largest selection of applications available at the iTunes

App Store

• There are >4,000 medical apps

• Seemless integration with a Mac computer, but still can be used with a PC

Android • Has a smaller selection, 1,000 medical apps

• However, most of the good medical apps are available for Android

Blackberry

• Very limited selection of medical apps

• This seems to be preferred by business users because of the tighter security features

• The keyboard is also a plus for many users

• This one is marginal for use by doctors

iPhone http://www.google.com/search?sourceid=navclient&ie

=UTF-8&rlz=1T4RNWE_enUS331US335&q=itunes

Android

https://market.android.com/apps/MEDI

CAL

Blackberry

http://appworld.blackberry.com/websto

re/category/78?lang=en

Click on the App

Store

Search for app by

name

Click on Install

Enter iTunes

password

Even though the

app is free you

have to open an

iTunes account

and enter a credit

card number

Skyscape now

appears on your

homescreen

Tap on it and you

are ready to use it

Your Skyscape

home page will

open and you are

ready to use it

The process is very

similar

Tap on Applications

and run a search

Connection to the 3G or 4G • Using it depends on signal

strength

• It is also costly, since you pay by the MB of data transfer

Connection to local wireless • You need a local wireless

network and the password to connect

• It costs you nothing to work on it

• It is usually faster than 3G/4G

MediBabble Medical translator which

asks the questions for you Cost – Free, includes Spanish Also available

• Chinese – Cantonese and Mandarin • French • Haitian Creole • Russian

It helps you ask the questions, but can’t help you understand what they say

ICD-9

Quick way to find ICD-9 codes

Cost - Free

AFP by topic

Complete listing of all articles

in American Family Physician

in the last several years

Great if you remember there

was an article on a specific

topic, but also easily

searchable

Cost - free

PubMed Mobile

Searches all of the National

Library of Medicine

Some articles are full text

Most articles have the abstract

MD Consult Excellent search engine for

medical info • Full text of several major textbooks • Full text of the Clinics series • Journal articles • Patient ed info

Its not really an app, it is a database accessible on Internet

Cost – free for most with a U Conn affiliation, otherwise there is an annual fee of $395

AHRQ ePSS

Complete listing of all the

recommendations of the U.S.

Preventitive Services Task

Force

Easily searchable

Cost - free

AAA screening

CDC Vaccine schedule

Complete schedules for

children and adults

Catch up schedules also

included

Cost – free

There is a similar app from

STFM which is just as good and

is also free

Medscape

Searchable database with • Medications, including OTCs and

herbals

• Disease information

• Procedures

Cost - Free

MedCalc

Catalog of >200 medical

formulas, such as • BMI

• Peak flow

• Framingham heart risk

• Units converter (e.g. lbs to kg)

Cost - free

Epocrates Easy to search database of

prescription medications Info on

• Dosing

• Adverse reactions

• Drug interaction

• Cost

• Pill pictures

Cost - Free

This is the most essential smartphone

app and it is available on all platforms

I use it many times everyday

Upgraded version at cost of $199/yr and $299/2 yrs

Includes • Basic Epocrates • Disease information from BMJ • Billing codes • Inf Dis guidelines • Alternative medicine info • Calculators

It is expensive, but it might be worth it For me, free version of Epocrates plus free

Medscape gets you a similar package

DueDateCalc EFM Guide Qx Calculate ABFM Exam Prep Micromedex Procedures Consult NEJM eePlus Mobile Skyscape Sanford Guide to Antimicrobial therapy Hopkins Inf Dis manual

Eye exam • Eye charts

• Color blindness exam

Ophthalmoscopy • Device connects to iPhone camera

• Records image of retina

A phone

As a phone they actually are not quite as

good as dedicated phones, but still

adequate

Since they are connected to a computer,

you can enter contacts via data files

A pager

It is possible for a paging system to just

contact you with text messages on your

phone

Study reported in Journal of Hospital Medicine – 2010

Toronto General Internal Medicine inpatient service gave Blackberries to all the residents

Instead of beeping, they were texted or e-mailed

The residents all preferred it to the old system

The nurses found that it reduced the time required to contact the resident from 27.6 to 11 minutes

Clinicians can e-mail

or text photos as a

consultation

Recent case of shingles

texted to me at home

while on call to help in

decision making to

admit or not

Track 3 Diabetes Planner • Tracks blood sugars

• Tracks medication, especially

insulin dosing

• Calorie counter

• Exercise log

• Restaurant planner – e.g. you can find out the

calories in a Big Mac or a Subway turkey

footlong

Meta-analysis in Diabetic Medicine

reported in 2011

22 Clinical trials in which mobile phones

were used by patients and clinicians to

monitor care • Reduced Hgb A1C by 0.5%

• Seemed more effective in Type 2 compared with

Type 1

iPregnancy • iPhone app with information about pregnancy

• Tracks OB visits

• Posts information on Twitter and Facebook

• Baby name lists

Text for baby • Serviced sponsored by Johnson & Johnson

• Weekly text messages are sent to a pregnant woman with information about what she should do at a given week of pregnancy

• Text message fees are waived for this service

The iPad

This year Yale University School

of Medicine “gave” each of its

students an iPad • iPad2 (64 GB WiFi/3G) plus

keyboard and apps worth a total

of $900

• All texts will be on iPad

• Claim to be going green

to eliminate paper

Perhaps next year’s CAFP will include a

lecture on tablet computers

I welcome your questions I am also interested in

learning about how you use your smartphone

Do you have any other favorite apps to share with the audience?

Please return your ARS clicker