In the past few years, especially since the introduction of the iPhone and iPad, there has been an explosion of healthcare related mobile device applications (apps). Most physicians today have smart phones or tablets and are finding ways to integrate them into their daily practice beyond just checking their e-mails.
There are five classes of mobile apps available that can help improve cardiovascular practice. These include apps to check appropriate use criteria; patient education aids; remote access to electronic patient records and images; reference apps for drugs, tests, treatments, devices or reimbursements; and apps allowing interaction between patients and their doctors. This last category is currently the least used, but will likely play a major role in the coming years, as physicians attempt to meet healthcare reform requirements for increased patient interaction.
“I think this is a tremendous opportunity for healthcare to embrace this newer technology,” said American College of Cardiology (ACC) President William Zoghbi, M.D., FACC, FAHA, FASE, chair of cardiovascular imaging at the Methodist DeBakey Heart Center and director of the Cardiovascular Imaging Institute at The Methodist Hospital in Houston. “It can increase efficiency in general. I am really very excited about these new technologies and we can use them to help improve healthcare.”
He uses his iPad daily to better educate patients about their conditions and treatments, to look up drug information and to wirelessly access patient information on rounds.
“It helps immensely at the bedside to improve communication between the physician and the patient, and an informed patient is usually a more compliant patient,” Zoghbi explained.
Among the first and most successful smart phone apps created are those that access current drug information, including dosing and potential interactions. He said with new agents, indications, side-effects and warnings added to the pharmaceutical market on a regular basis, it is difficult to keep up, so the apps are a big help.
“It is very helpful and very important to confirm information on medications, especially with the large number of co-morbidities patients have today,” Zoghbi said. “Most physicians use an app like that because medications play a big role in treatments.”
Increasing Patient Engagement
Stage 2 meaningful use calls for physicians to more actively engage patients to make them part of the solution in their own healthcare. There are still questions of how this will be implemented, but it is a fair bet to say the massive proliferation of smart phones and tablets in the general public will play a key role. Two new apps that help fulfill this requirement include the ACC’s CardioSmart app and Carestream Health’s MyVue app.
The recently launched CardioSmart app is designed as both a cardiac patient educational tool and a way to engage the patient. The app allows doctors to send reminders to patients for such things as medications and follow-ups.
“A question physicians should be asking is ‘How do you want to engage patients?’” Zoghbi said. “It is important to have that engagement with patients beyond the office visit — we need to embrace this.”
Zoghbi is seeing many new cardiac-related apps geared toward patients, such as heart rate monitors and apps to help choose a healthier diet. He believes the future will include integration of these apps with electronic medical records (EMRs) to better manage patients.
“I think you will see more and more of this to increase interactions between patients and their doctors,” Zoghbi said.
Another way to increase patient participation in their healthcare might be to grant them open access to their images and medical records. Carestream Health’s new MyVue patient portal equips patients with secure online access via computer or iPad to their imaging exams and radiology reports. If patients choose to seek a second opinion, they can easily share the records with another doctor.
However, Zoghbi said it is not enough to just grant patients access to their EMRs, because the clinical language contained in these documents needs to be translated into layman’s terms to make it meaningful to the patient.
“Healthcare professionals — doctors and nurses — went to school to learn this language, so we still need to be able to help patients understand what they are reading,” Zoghbi said.
Appropriate Use Criteria
In today’s healthcare reform-minded environment, Zoghbi said apps that enable fast, easy access to appropriate use criteria (AUC) will become increasingly important. Physicians may be challenged as to why they ordered expensive or multiple tests, and AUC guidelines will help justify the use of the best tests for the job and better facilitate evidence-based medicine.
The ACC FOCUS campaign is a national quality improvement initiative designed to help cardiovascular professionals best use AUC and ultimately reduce inappropriate imaging. The program offers resources and applications to optimize AUC use. Among them is a free, Web-based app to guide physicians through the collection of patient data on appropriate use of cardiac radionuclide imaging (RNI). Blue Cross Blue Shield of Delaware (BCBSD) endorsed use of this app and is paying for cardiologists in the state to use it. The app allows for consistent application of AUC to determine when cardiovascular imaging tests are needed. Importantly, the program also provides feedback reports on the patterns of appropriate use to physician practices and health plans. FOCUS participants then use the reports to complete action plans and share best practices.
This agreement came after investigations by the Delaware Insurance Commission and the Senate Commerce Committee into reports of patients being denied access to diagnostic imaging. The investigations both affirmed the ACC’s position that pre-authorization companies not only increase administrative costs for physicians, but also increase the time for diagnosing patients.
Another area of need for AUC is implantable cardioverter defibrillators (ICDs). In January 2011, a National Cardiovascular Registry study showed 22.5 percent of U.S. ICD implantations did not comply with Medicare guidelines. Also, about 50 percent of patients who are qualified for an ICD do not get a device. Think Tank Medical developed the CMS ICD app for the iPhone and iPad, which enables a fast, easy screening to see if patients meet the evidence-based criteria for implantation. The app guides a doctor through a series of “yes” or “no” questions to evaluate eligibility. It has options to place automatic reminders in the device calendar to re-evaluate patients who fall into mandatory waiting periods and to send e-mails to schedule follow-up visits.
Mobile Device Adoption, App Prescriptions
Mobile device drug reference app provider Epocrates recently conducted its annual survey of cardiologists to uncover trends. More than one in three cardiologists use a tablet in practice. Of those who use a tablet, two-thirds chose the Apple iPad, and 45 percent are planning to purchase the iPad mini.
It is not just medications that are being prescribed to patients. The survey found about 45 percent of cardiologists now recommend mobile apps to their patients. More than 70 percent suggest patient education apps, with lifestyle change tools coming in at 55 percent. Patient apps such as calorie counters/trackers, weight loss trackers, fitness apps, drug information and other educational apps are among the top tools doctors suggest to their patients. Despite this, more than 50 percent of physicians say they are not sure which apps are good to share.
Details on These and Other Cardiac Apps
This article served as an introduction for a chart showing a variety of cardiology related apps and enterprise software used in tandem with smart phones and tablet devices. To see the chart, click on the "Comparison Chart" tab at the top of this website page. Participants in this chart include:
Abbott Vascular — www.abbottvascular.com
American College of Cardiology (ACC) — cardiosmart.org/Tools/Med-Reminder
Airstrip — www.airstriptech.com
Boston Scientific — www.cardioteach.com
Brit Systems — www.brit.com
Carestream — www.carestream.com
ECGSource — ecgsource.com
Epocrates — www.epocrates.com/mobile
Heart Rhythm Society (HRS) — www.hrsonline.org
Philips Healthcare — www.healthcare.philips.com
Society of Cardiovascular Angiography Interventions (SCAI) — www.scai-qit.org
ScImage — www.scimage.com
TeraRecon — www.terarecon.com
Think Tank Medical — www.thinktankmedical.com
Zoll Medical — www.zollonline.com