With more and more mobile devices and apps coming onto the market, more and more information is available to rheumatologists on the go.
The role of apps in the clinic is bound to expand, says Salahuddin “Dino” Kazi, MD, a rheumatologist who is also the Chief Health Informatics Officer in the VA North Texas Health Care System in Dallas.
“As we practice less from experience and more from expert opinion and guidelines and checklists, and we start to put greater emphasis on quality and safety,” he notes, “we’re going to have to embrace tools, checklists, calculators, [and] other things that have been prepared by reliable resources that are part of our clinical workflow that we can easily access.”
Many rheumatologists still do not use apps frequently, he says.
“When I show these to other people on my phone—‘Hey, have you seen this, have you seen that?’—they haven’t,” he says.
Soon, though, all rheumatologists may have little choice—smartphones and their apps may become “so much easier to use or so much cheaper or so intuitive that there is no reason not to have it,” he says.
But which apps to use? Here are suggestions from Dr. Kazi and others for apps to use now and to look for down the road:
Mediquations (available on iPod, iPad, Android; $4.99)
This app includes 232 equations for medical scores and indices from mental health conditions to neurological episodes to, of course, rheumatology.
Rheumatology calculators include DAS scores, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the SLE Disease Activity Index (SLEDAI).
But the easy accessibility of other equations is also useful, Dr. Kazi says. For instance, a quick calculation of kidney function might be useful to see the effects of medications on the kidneys.
“When we deal in rheumatology with complex, multisystem disease, our diseases affect a number of organs, and so it’s very useful to have these things at your fingertips,” Dr. Kazi says. “Many of our patients will have secondary depression or they may have trouble with alcohol. And, if you just want to quickly do a depression scan or [a screen] for alcohol, it’s really nice to just have these handy.”
The app allows users to switch between S.I. units and U.S. units for each variable entered. Users can also keep a list of favorite equations, view equations by category, and copy notes from this app to note-taking apps.
“I think Mediquations is one of those that should be in everyone’s pocket,” Dr. Kazi says. “It’s so broad.”
Rheumatoid Arthritis Vital Education (RAVE) Mobile app (iPhone and iPad; free)
Just released in March, this app was developed jointly by the continuing medical education company DKBmed and the Johns Hopkins Division of Rheumatology.
Users get a single-screen overview for each patient, with key lab results, medications they’re prescribed, side effects, and notes. The chart can be printed or e-mailed directly from the app.
The app also includes an interactive checklist of comorbid conditions to help coordinate care between rheumatologists and other physicians, and provides disease-activity calculators. It also automatically calculates and reports each patient’s classification score according to the 2010 ACR/EULAR Classification Criteria.
iShould (under development for iPhone; cost to be determined)
This app, for recording range of motion in the shoulder, is not yet available to the public, but researchers at the Swiss Federal Institute of Technology (EFPL) in Lausanne anticipate that it soon will be, after a validation study is completed in about six months. When it is available, it will likely be the first app of its kind.
To use the app, the device is attached to the patient’s shoulder as the arm is moved. The app gives the patient instructions. It then calculates the angle of arm elevation and the functional score—comparing the healthy arm and the arm with disease—simultaneously.
Developers of the app say it could lead to more reliable information about shoulder movements in rheumatology patients.
“The app could contribute to a more widespread use of objective shoulder function measurement in clinics and research,” says Cyntia Duc, an engineer at EFPL’s Laboratory of Movement Analysis and Measurement. “Functional score questionnaires are difficult to answer for some patients, due to language or understanding issues. The app overcomes these difficulties by providing a fast, automatic, and objective outcome.”
Maura Iversen, PhD, chair of the physical therapy department at Northeastern University in Boston, where she works with rheumatology patients, and associate editor of The Rheumatologist—says the app could be a useful tool.
“The app is exciting because it provides real-time feedback about patients’ ROM [range of motion] to the therapist and to the patient,” she says. “This can be a powerful motivator for exercise. It is easy to use and the data is readily transferred to the PT [physical therapist] for review.”
Doximity (iPhone, iPad, Android; free); Sermo (iPhone and iPad; free)
These two apps let doctors gain access to physician-only online social communities in which doctors in dozens of specialties can talk about medical issues and get feedback on cases. Both come recommended by Joseph Kim, MD, MPH, president of Newtown, Pa.–based MCM Education, a medical communications company, and founder of MedicalSmartphones.com.
In Doximity, physicians use their real names, with dual passwords that app creators say are encrypted on both ends. They describe the app as a “HIPAA-secure” way to communicate. The app can also be used to send text messages and faxes—also described as HIPAA secure—to physicians and pharmacies.
With Sermo, doctors can post anonymously. They can easily take photos related to cases and post them for review and input from other doctors. They can also mark discussion threads and go back to read them later.
Dr. Kim says such sites are catching on and leading to real improvements to patient care.
“We are at the tipping point where we are seeing some meaningful adoption,” he says. “These platforms provide an effective way for clinicians to share information and collaborate.”
ACR Wiley app (iPhone, iPad, Android; free)
Not to self-promote (Wiley is the publisher of The Rheumatologist), but Dr. Kazi says this is a good app to have to keep up with the latest rheumatology information.
The app includes study abstracts, news articles, and more from the journals Arthritis & Rheumatism and Arthritis Care & Research, as well as The Rheumatologist.
It also allows users to easily e-mail articles and share them on social media sites.
“It’s a very nice app that allows you to quickly read an article or look up something very quickly on your handheld,” Dr. Kazi says. “If you want to look at guidelines or criteria or anything that’s going on … you have that available.”
Thomas Collins is a freelance medical writer based in Florida.
