There’s an App for That: Let Technology Do the Work for You
The array of online and digital resources aimed at emergency physicians continues to grow, and sorting through them can take more time and effort than most clinicians want to spare to get the best information, education, and communication, according to Christian Rose, MD, of Stanford University, Stanford, California.
In a presentation at the American College of Emergency Physicians (ACEP) 2022 Scientific Assembly, Rose, along with colleagues Carl Preiksaitis, MD, and Anastasia Markovtsova, MD, also of Stanford University, highlighted the types of digital resources that can be most useful to emergency medicine physicians in clinical practice.
The current world of digital resources as applicable to emergency physicians may be categorized in six groups, Rose said. These groups are the usual suspects of apps and question banks, but also include changing your device settings, as well some popular social media, news feeds, and radio/video shows/podcasts, he said.
Quality Control
First, as we have learned in a disinformation and misinformation era, you must assess the quality of a digital resource, Rose emphasized. The Academic Life in Emergency Medicine (ALieM) website offers a quality checklist for blogs and podcasts. This checklist is aimed not only at users, but also at the producers and editors of these digital products to help ensure current information, separate editorial content from advertising, and present disclosures.
News to Use
To keep on top of the news in a timely way, “read in a feed,” Rose suggests. The news/blogosphere is a giant news feed that can be curated, he emphasized.
Rose and colleagues recommended several feeds for various aspects of emergency medicine; for general knowledge, the ALiEM website; for critical care, EMCrit, a blog and podcast focused on maximally aggressive care, gets his endorsement. Other useful blogs and news sites Rose identified are PEMBlog Briefs for pediatrics, which includes practical advice for such procedures as performing a lumbar puncture on a fussy infant; and Dr. Smith’s ECG Blog, a blog written by Stephen W. Smith, MD, that describes itself as “Instructive ECGs in Emergency Medicine Clinical Context.” Other recommendations from Rose and colleagues: Radiopaedia.org, a free educational radiology resource; and the Poison Review for toxicology information.
Take a Listen
In terms of radio and video shows or podcasts, Rose and colleagues recommended EM:RAP, a monthly emergency medicine audio series with CME plus reviews and perspective. They also highlighted EMCrit; the Ultrasound Podcast, which features engaging, in-depth videos and discussions of ultrasound cases; and EM in 5, a series of 5-minute videos on high-yield topics such as croup and frostbite.
Question banks, such as Rosh Review and the questions on ALiEM are useful tools to prepare for in-service exams and written boards, Rose said.
Social Media
“Increasingly, Twitter is used to keep up to date on important health news, to learn of the release of journal articles, and even for CME,” said Rose. The choices of which experts to follow are many, but a few solid basics include @emcrit, @srrezaie, @smithECGblog, @emlitofnote, @PharmERToxGuy, and @EMSwami, he said.
To get the most out of Twitter, Rose advised curating the Twitter feed using features such as Twitter lists and the ability to turn off retweets, or to block and report them. Of course, if Twitter is no longer your thing, you might want to check out some of those same people on their Mastodon accounts, which operate similarly to Twitter.
There’s an App for That
Finally, medical apps have a variety of uses, including communication and education, with the advantage of easy accessibility on your phone.
“I remember having a professor in medical school who fawned over the ‘good old days’ when students memorized every little detail of practice,” Rose said in an interview. “To me, this never jived because another professor had said, “In 10 years, 50% of what you learn will be wrong, and in 10 years, you’ll forget 50% of what you learn. So, here’s hoping you remember the right 50%!”
In Rose’s view, apps in particular and digital tools and media in general are “a way to offload the things you don’t need to use on an everyday basis, as well as a way to obtain knowledge from some of the best educators in the world.”
In fact, “Practice patterns no longer rely on the single teacher you have at one institution, but rather the opportunity to learn from the world’s experience at your fingertips,” he added.
Some barriers to the use of apps and online resources in the emergency medicine setting include concerns about phone storage space and lack of internet access, Rose told Medscape. “These are legitimate concerns,” said Rose, who has worked on some development and implementation of emergency medicine apps in resource-limited settings. “You wouldn’t want to be sitting in the ED, waiting to give epinephrine to a pulseless patient because you were waiting for a page to load,” he said.
“Also, in a disinformation age, there is some risk in learning from people who either have the wrong interpretation of data, but who are popular, or in following a new research study’s proposal before it has been fully validated,” Rose emphasized. “There are some real risks to using apps and other resources that have not fully relied on peer review before they get into your hands,” and the questions remain as to who will be responsible for the quality of online resources, and will doctors be able to identify quality resources from those that are not, he added.
The role of electronic devices for emergency physicians in practice is an ongoing question, said Rose. “It makes little sense for an EM physician to memorize ever-changing antibiograms, or to carry around physical Advanced Cardiovascular Life Support (ACLS) cards when the rules change every few years. To me, apps are a way of getting critical information to a physician through a medium which most physicians have on their person at all times,” he explained.
Looking ahead, “I would like to see research in some of the ways in which we could use our phones that we are not currently employing and which might make our jobs even more safe and fulfilling. This could include augmented reality, artificial intelligence devices to scan ECG’s, direct methods of getting consultations, and more,” Rose said.
Upcoming Apps May Aid Communication
A new app in development, Pheme, is designed to improve and streamline communication between clinicians and pharmacists in a way that protects patient privacy and promotes safety.
“We found a simple solution to a big problem,” said Robert DeLeonardis, developer of the Pheme app, in an interview. “Doctor and pharmacist burnout has reached an inflection point. Pheme streamlines communication, improves efficiency, and drastically reduces time to decision-making; I can’t think of anything more important,” he said “Every day pharmacists and doctors play phone tag or wait on hold for long periods of time regarding crucial prescription details. By removing this communication barrier, clarifications are addressed in a time-sensitive manner. Patient care is streamlined and collaboration is fostered, which decreases workload and stress for the entire healthcare team on both the pharmacist and prescriber side. More importantly, we believe this will inevitably improve outcomes,” he said.
To encourage use of the app, DeLeonardis and colleagues designed Pheme to “mirror the most commonly used messaging apps; we then integrated HIPAA compliance, end-to- end encryption, and added some proprietary features created by pharmacists and doctors. No IT integration is needed, and we made it free, so as long as the user has a cell phone or a computer, they can use Pheme,” he said.
“Analytics from everyday use, and feedback from our users, especially in emergency situations, provide critical data to continually improve our application more quickly,” DeLeonardis added.
“In this age of rapid transfer of information and data to and from providers as well as to pharmacists, the need for security and privacy is of utmost concern,” said Robert Glatter, MD, in an interview.
“Using an app such as Pheme helps to ensure that protected health information is kept secure in the process of transferring important and confidential patient data,” said Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City and an assistant professor at the Zucker School of Medicine at Hofstra/Northwell.
In general, “Using such apps helps to protect patient data and increases the speed of data transfer in order to make important clinical decisions, and helps to reduce patient medication errors, ensuring the right drug, dosage, and mode of delivery,” he said.
“Medical providers are always concerned about protecting patients’ data and ensuring that it arrives safely when obtaining consults and second opinions. Using apps such as Pheme helps to instill a greater sense of confidence in this regard,” Glatter explained.
“Concern about transmission of sensitive patient data may potentially discourage providers from using such apps,” Glatter noted. “That said, with proper security and data protections assured, the barriers to adoption may ultimately be lowered. Trust in the use of such apps in the field of medicine is not easily attained, and must be earned by demonstrating its safety, security, and reliability.”
However, more research is needed in the form of a pilot study demonstrating the safety and reliability of using a communication app (such as Pheme) in an Emergency Department, outpatient clinics, or in the inpatient setting before it is ready for adoption, said Glatter.
“Evidence of reduced phone call volumes between providers and pharmacists and fewer near misses (such as drug-drug interactions) would provide real-world evidence of streamlined communication, and improved patient outcomes that argue for adoption of apps as form of provider to provider, provider to patient, and provider to pharmacist mode of communication,” he added.
Technology is Driving Healthcare
Technology is no longer just a tool for healthcare, but a driver for healthcare, said Amy Faith Ho, MD, MPH, of Integrative Emergency Services, Dallas-Fort Worth, Texas, in an interview. “Apps that help patients take ownership and command of their own medical information and empower them to ask questions and acquire more information are helping to drive healthcare to be more accessible,” she explained.
Apps can improve clinical practice by improving communication, said Ho. “Communication has always been a challenge in healthcare. Miscommunication and lack of communication are not only frustrating, but also are huge patient safety issues,” she said. “Streamlining that communication to catch up with the modern world improves patient care. Patients can clarify questions with their providers, which is key to their outpatient compliance. Prescribers can ask questions of pharmacists, which is key to leveraging the depth of knowledge our pharmacy colleagues have to avoid potentially serious medication interactions or other issues like polypharmacy.”
One technology challenge is the need for different platforms to have streamlined information exchange, said Ho, stressing that third-party applications need to be able to dock into the electronic health record (EHR).
“One of the barriers to third-party applications like Pheme is that the ability to connect to EHRs, whether to receive or send information, is usually nonexistent or severely limited, which makes clinical workflow more complicated and introduces difficulties in making sure all information is up to date,” she noted.
Research on patient outcomes is always the best, but is often limited by the difficulty in proving causality, said Ho. A study of whether medication apps have substantial impact on patient outcomes such as outpatient medication compliance, emergency department bounce backs or readmissions rates, or patient satisfaction would be interesting, she told Medscape.
The presenters had no relevant financial relationships to disclose. Glatter and Ho have disclosed no relevant financial relationships.
American College of Emergency Physicians (ACEP) 2022 Scientific Assembly: Presented November 4, 2022.
Heidi Splete is a freelance medical journalist with 20 years of experience.
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