How Mobile Apps Can Streamline Operations

Selected medical apps provide easy reference, patient education, remote EMR access, etc.

BY Lisa B. Samalonis

Among the plethora of mobile apps available, several medical and ophthalmology ones stand apart for their usefulness for quick reference, patient education and convenience.

In recent years interest in mobile apps — software programs that run on a smart phone, tablet or other portable device — has soared. In 2011, the mobile medical applications market reached $150 million and is predicted to grow 25% annually for the next five years, according to Kalorama Information.

“The worldwide popularity of the iPad has fueled the demand for eye applications that doctors can use in their practice,” says Robert Watson, president of Patient Education Concepts Inc., the Houston company that makes the Sight Selector App. Some doctors now wear lab coats with pockets specifically sized for carrying iPads. “Since we have over 1,000 3D images within our app, doctors can just pull the iPad out, go to the subject they wish to discuss and click on the appropriate 3D image and start talking and drawing with their fingers or stylus,” he explains.

Showing a video with professional narration makes a subject easier to understand and saves the doctor time, Mr. Watson says. “This makes the doctors happy, enhances the patient experience and leads to increased revenues from both a time management and an increased conversion to premium services perspective.”

Remote Access

Doctors can also use iPads or iPhones (or similar hand-held technology) to connect with the office when they are on the road. “The most important app I use today is the RDC (remote desktop connection) that securely connects remotely to our office computer system,” says Brian R.Will, MD, of Vancouver,Wash. “I can pull up a patient’s file just as if I am in the office.” He uses the JUMP Intuitive Windows remote desktop app when he is at home, at a meeting or on the golf course.

Users set up a password and firewall to meet HIPAA requirements. “Our EMR records run on PC and the tablets and othermobile devices run on iOS so we can’t run full versions of the EMRs,” Dr. Will adds. “RDP has 128-bit encryption, which is high-end encryption, and we use it from a satellite with our main server at the office. It is totally secure.” The apps for tablet and iPhone use the same level of encryption, and data does not transmit over the line. “We are only viewing what is on the terminal,” he explains.

Apps can deliver patient education resources, such as videos, brochures and product demonstrations, that save a doctor time.

Animated videos can make difficult-to-understand concepts, such as presbyopia, easier for patients to comprehend.

Reference Apps

For some of their reference needs, ophthalmologists are turning to convenient medical apps. Retina specialist Eddie Kadrmas, MD, PhD, of Plymouth, Mass., loaded Epocrates onto his iPhone and refers to it often. Many newer medications are available today, and as a subspecialist he has found Epocrates to be an invaluable resource for looking up drug interactions and side effects. “I use that app two, three or four times a day,” Dr. Kadrmas says.

Michael E. Migliori, MD, FACS, chief of ophthalmology at Rhode Island Hospital, in Providence, R.I., notes that Epocrates is the app he uses most. “My most common application is for looking up dosing for prescribing medications, looking up certain diseases, treatment options for diseases and checking drug interactions,” he says. “It has photographic identification of pills and a number of other tools and calculators with it.” He also uses the app to look up formulas, normals for lab tests and CPT codes.

Many overlaps exist between different medical apps, Dr. Migliori points out, and physicians can sample a variety to see which works best for them. He also has downloaded Skyscape, a free app from Skyscape.com Inc. on his mobile devices. It provides drug information, dosing calculators and selected formulary information. Other tools include Archimedes, a medical calculator with interactive tools organized by specialty, and MedAlert, which provides updates to trial results, clinical news, and drug alerts.

Dr. Will also notes he alternates between Skyscape and Medscape on his phone. Medscape, from WebMD, also provides prescribing and safety information for pharmaceuticals and dietary supplements. “I perform LASIK and a patient might ask for a prescription to Patanol, which I do not prescribe regularly. It is easy to look up the information quickly,” Dr.Will says.

‘Eye' Resources

Ophthalmology-specific apps are also convenient to have on mobile devices, say ophthalmologists. Dr. Will notes he periodically uses Eye Handbook, the smart phone treatment reference and diagnostic tool for eye-care professionals from doctors at the University of Missouri-Kansas City and Cloud 9 Development.

“I use the coding capabilities, so occasionally I look up a code for topography for the billing statement; it also has all the eye meds on it,” Dr. Will says. “The other thing that is really nice is that it has testing feature. So if I am sitting in a lane and I need an Amsler Grid, I can click that from the device in my pocket.”

Dr. Migliori reaches for Eye Handbook from time to time. “Sometimes it is a little quicker to go in there because I am only looking for eye medications, and I don’t have to get past cardiac medications, so it is just a little bit more compact,” he says. Eye Handbook also has an atlas with photos. “If I am walking from one exam room to the next, I can look something up quickly without having to go to my desk or my bookcase and try and find something,” he says. “The apps are very handy and efficient.”

Similarly, the Wills Eye Manual (available through Skyscape) provides specific ocular information. Dr. Kadrmas uses it on his phone as an easy reference (especially after hours) for things that are outside his specialty of retina. Additionally, he has downloaded an Internal Medicine app from Skyscape, which comprehensively covers the body and a wide range of diseases. “It is a good cross reference resource to check things when talking to the patient,” he explains.

Patient Point-Of-View perspectives allow patients see the benefits of lens enhancements, such as polarized sunglasses, during the lens purchasing process.

‘Eye’ Resources

Not all medical apps are must-haves. “I’ve been underwhelmed with the usefulness of most apps in medical practice, with the exception of Sight Selector,” says Joseph Tauber, MD, of Kansas City, Mo. He notes that this app offers more videos than other products.

Sight Selector is the second generation of software distributed through an educational grant from Abbott Medical Optics, Alcon Laboratories and CareCredit called the IOL Counselor and the LVC Counselor, Mr. Watson explains. These interactive programs helped patients “test drive” their vision by showing them realistic simulations of how they might see after their procedure with the various premium options offered by a practice.

“The Sight Selector App was based on the same principle behind the IOL and LVC Counselor, but we have now expanded the content to include general ophthalmic, cosmetic and optical topics,” Dr. Tauber says. Sight Selector Lite, a free application, provides access to more than 50 patient-education topics divided into eight categories — for example, Cataracts & IOLs — that can be purchased individually for about $14.99.

An App of Your Own

Physicians also can create personalized apps for their practice through the Doctor App by Cloud 9 Development. “Patients see that the surgeon and the practice are on the technology cusp. It is a very easy and unique way for patients to reach the practice,” explains Vinay Shah, MD, one of the Cloud 9 developers. He points out patients can easily share the app with friends.

In addition to increasing a practice’s visibility, personalized apps for the medical practice can be used for scheduling (and cancellations), patient medication reminders, directions, oneclick calling, practice and eye-care news, and patient education. “The doctor can have personalized patient education brochures or videos on the app,” Dr. Shah says. “When my patients come to see me, I do not give them paper brochures any more. They can download and read my app in the waiting area and when they go home. I am not wasting money on pamphlets. Before, we never knew how many pamphlets actually got to the car or got home with the patient, or if they would even read it.”

A practice can update the app at any time and also load relevant custom or prepared patient education media for a particular patient population to view. “This cuts down on chair time, it allows the patient to be more educated, and the patient can ask more educated questions when they are at the practice,” Dr. Shah says.

The app is available for free for the Android, and has a monthly fee $44.99 a month. For Apple users, the app costs $499 with a monthly $44.99 fee.

One Doctor’s App

Dr. Tauber, an early adopter of the Doctor App, says his Tauber Eye Center app enhances his practice in several ways. He particularly likes the ability to add videos to the app for patient education. “While not all of my patients use smart phones, enough rely on them to warrant the modest cost of the app,” he says. “We have seen a continuous increase in the number of patients who download our app, and we continue to update the content that we provide to our patients,” he says.

The app has also improved patient flow in his practice. “Directing patients to watch the videos in the app actually reduced the time my staff had spent on some rather routine patient instructions,” Dr.Tauber says. “The app ensures that my patients have the information I want them to have as close as their phones.”

Some patients use the app to communicate directly with Dr. Tauber, but the same challenges that constrain all Internet communications, namely confidentiality and digital security, affect this capability, too. “Patients also take advantage of the app for easy access to scheduling and billing information. It is as fast or faster than a phone call, and they do not need to remember or look up e-mail addresses,” he says.

Next Step: Apps and EMRs

With the implementation of electronic medical records and Meaningful Use, the future role of mobile apps looks promising. Ophthalmologist Peter J. Polack, MD, of Ocala, Fla., and author of the book, Navigating the EMR Jungle: 10 Steps to Ensure a Proper EMR Rollout, anticipates some exciting developments with EMR, such as the use of custom apps that integrate with a standard EMR platform. “The key apps in the future are going to be the ones that have one specific purpose and can give you the information that you need specifically, quickly and simply, and not have apps that try to do too much at the same time,” Dr. Pollack says.

A customized Doctor App is a unique way for patients to reach the practice.

He foresees consolidation and more standardization of EMR companies and systems in the future as companies work to stay on top of the phases of meaningful use. “It is impossible for the EMR companies to give their customers, the medical practices, every function that they need,” Dr. Pollack says. “They are trying to keep those major functions related to the practice of medicine: Seeing the patients, documenting the exams and meeting the meaningful use criteria.” He points out this will most likely yield a custom app marketplace.

Dr. Shah notes that Cloud 9 Development is looking into integrating the Patient Health Portal into the company’s apps, so in the future patients could have access through the Web. Because smart phones and other mobile devices are still not 100% HIPAA secure, this has not been implemented yet, he says. “Future integration with electronic medical records or the health portal for patients would be the next obvious step,” he says.

Apps that work with a smart phone or mobile device could serve as the “faceplate” for a practice with the EMR system, Web site, social media and the app all integrated into one area in which everything could be accessed. It would be simple, efficient and patient- and physician-