Medical Apps

A new online tool can help seniors with advanced heart disease decide between two possible medical interventions - Coronary Artery Bypass Graft surgery or Percutaneous Coronary Intervention, a.k.a. angioplasty.

To use the tool, seniors enter in their age, gender, diabetes status, tobacco use and heart disease history. The tool then calculates a predicted five-year survival rate, based on outcomes of similar patients who underwent these procedures. These predictions are derived from data extracted from the medical records of more than 100,000 Medicare patients, and analyzed using a model recently published in a study led by Mark Hlatky, MD, professor of health research and policy and of cardiovascular medicine at Stanford.

I had the pleasure of working with the amazing team of health researchers and programmers who developed this medical decision tool in a little under a month. For me, it was a sneak preview into the future of personalized medicine, where a person can review surgical outcomes of real-world patients with similar health histories, to reach an informed decision on a treatment plan with their physician.

“Studies usually focus on the results for the average patient, and not on how much the results vary among individuals. This model is a step towards personalizing treatment recommendations, based on each individual’s unique characteristics,” Hlatky told me. “The other exciting thing about this new methodology is that with relative ease, it can be applied to other medical conditions such as cancer and stroke.”

Hlatky will present his model and findings at the Institute of Medicine workshop “Observational Studies in a Learning Environment,” which can be viewed via a webcast on April 24-25.

Previously: Is stenting or surgery better for diabetics? New study provides answer, New test for heart disease associated with higher rates of procedures, increased spending and To stent or not to stent: not always an easy answer
Illustration by Dawn Johnson/iStock

Here’s an interesting mobile health app in development. Researchers at the University of Washington are collaborating with Seattle Children’s Hospital to devise a smartphone app to check the health of your lungs when you breathe out at your handset.

The app could prove useful to patients suffering asthma, cystic fibrosis or other lung conditions. Developers say frequent testing at home could detect problems earlier, potentially avoiding emergency room visits and hospitalization. Technology Review reports:

Recently, a group at Shwetak Patel’s lab at the University of Washington figured out how to measure exhaled breaths using the microphone on a smartphone.

The SpiroSmart app estimates the volume of air exhaled by the sound waves recorded as you breathe out. The goal was to create a home lung health test, like a pocket glucose meter, [lead researcher Shwetak Patel, PhD,] explained in a press release. In experiments with the iPhone 4S, the system seemed reliable and comparable to home spirometry tests. The group presented that at the UbiComp 2012 conference in September last year.

The team is now adapting this concept—reading lung function from recorded audio of deep breaths out—to create a system that could turn any phone into a reliable indicator of lung function.

But don’t expect to find the app in the iTunes store anytime soon. Researchers say more testing is needed before the app will be available for consumer use.

Previously: Stanford AIM Lab launches patient exam iPad app, Stanford medical residents launch iPhone app to help physicians keep current on research and Stanford-developed iPARS app available for download

Smartphone ownership among U.S. health-care professionals has grown from 81 percent in 2010 to 91 percent in 2012. To gain a better understanding of how mobile phones and computer tablets are being used by these professionals, several Stanford researchers - Olufisayo Ositelu, an MD/MBA joint-degree candidate; Bassam Kadry, MD, an anesthesia instructor; Joshua Landy, MD, a visiting scholar; and Alex Macario, MD, an anesthesia professor - launched a study to measure the prevalence and types of uses of smart devices among resident physicians at Stanford Hospital & Clinics.

The study, which involved residents from across seven different specialties, revealed that participants’ top two uses were communications, such as exchanging patient care-related text messages, and obtaining pharmacy or medication-related information. Other common uses were: medical reference, textbook or study aid; obtaining information on evidence-based medicine and treatment algorithms; and keeping up with medical literature.

Interested to know more about the research, I contacted Ositelu to discuss his motivation for examining this area and to get his thoughts on the significance of the findings. He responds to my questions below.

What was the catalyst for completing this study?

As a medical student on clinical rotations, I noticed a great number of physicians using smart devices, including Apple and Android phones and tablets, for a wide range of health-care delivery activities. Interestingly, different specialties, such as internal medicine versus pediatrics, seemed to use their smart devices for different clinical purposes. These observations coupled with the numerous literature on high smart-device ownership among physicians led our team to realize smart devices were changing health-care delivery and had important implications for patient care. We set out to quantify smart-device ownership among Stanford hospital residents and get a snapshot of the activities performed on them. We chose resident physicians (trainees) as the focus of our study because the cohort has come of age using these technologies and [because] they represent the future of patient care.

What findings did you find most surprising?

One of the goals of this study was to find out if there really were inter-specialty differences in smart-device usage. We were able to demonstrate this. For example, the percentage of pediatrics residents that reported using their smart devices to obtain pharmacy/medication information “very frequently” was higher than that of anesthesia and internal medicine residents.

Residents want user-friendly electronic medical records (EMR) access on their smart devices. Given the mobile nature of patient care and the need to have the right information at the right time and place, this is not necessarily surprising. However, our study showed the use of smart devices by residents to view electronic medical records (EMR) was low across all specialties. It is unclear whether this was due to a lack of awareness about the existence of the EMR application or the cumbersome nature, such as too many logins, of the current offering. Additionally, the study revealed important insights on possible ways to leverage EMR functionalities on smart phones and tablets. For example, some residents wanted the ability to put in “basic patient orders” and get push notification or retrieval of patients’ lab values in real-time on their smart devices. It is worthwhile to note that a majority of these devices are personal devices, which means they were purchased by residents not Stanford hospital. It is surprising that residents did not express wanting a separation of personal and professional use of the smart devices. This fact has important implications for patient privacy and device security.

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This week, the Stanford Anesthesia Informatics and Media Lab (AIM) released a new iPad application as part of the Stanford Medicine 25 initiative, a series of hands-on workshops teaching 25 essential techniques for examining patients.

Abraham Verghese, MD, who designed the Stanford Medicine 25, invited the AIM Lab to collaborate on the medical app for the initiative. The app was developed by AIM Lab director Larry Chu, MD, and Kyle Harrison, MD, clinical assistant professor of anesthesia. Chu and Harrison note in the app description that the educational tool is meant to be used as a reference tool rather than a replacement for the Stanford Medicine 25 curriculum:

The Stanford 25 consists of hands-on sessions in small groups—you can’t substitute for that, and we don’t try to. This app simply provides a place where our students and residents can go to remind themselves of what they learned, or are about to learn in a hands-on session.

The app is available for free in the iTunes store.

Read more about how the Stanford Medicine 25 curriculum was created and why the hands-on diagnostic skills are imperative in examining patients in this past Stanford Medicine article.

Previously: Stanford medical residents launch iPhone app to help physicians keep current on research, School of Medicine alumni association partners with Doximity to test first-of-its-kind smartphone app, Stanford-developed iPARS app available for download and Stanford anesthesia lab launches educational iPad app

Have an idea for a mobile device application that would increase patients’ compliance in taking prescribed medications? Now could be your chance to turn that app concept into a reality.

The National Institute of Drug Abuse is currently seeking proposals for just such a tool. According to an institute announcement:

NIDA seeks to develop and test a prototype mobile/tablet technology-based application to provide a low-cost, highly personalized, interactive patient-centric medication adherence tool that improves upon currently available mobile technology-based medication adherence applications.

The submission deadline is Nov. 13 at 5 p.m. Eastern. Full detail are here (.pdf)

Previously: Outfitting pills with microchips to monitor patients’ medication use and Report shows over 60 percent of Americans don’t follow doctors’ orders in taking prescription meds
Photo by Lia Steakley

Obesity rates among children in the United States have more than tripled in the past three decades. Researchers around the country are working to develop ways to curb the childhood obesity epidemic, including a team from the University of Southern California that will be presenting later this month at the Stanford Medicine X conference. The inaugural conference takes place this Sept. 28-30.

During the three-day conference, USC researcher Donna Spruijt-Metz, PhD, will present findings on an interactive, mobile game designed to teach children gardening skills and encourage them to eat healthily. An abstract on the Medicine X site describes the game, titled “Virtual Sprouts”:

Virtual Sprouts has the potential to revolutionize Science, Technology, Engineering, and Mathematics (STEM) education on obesity, promote healthy food choices and decrease obesity rates in youth. In their web-based garden, children and families will learn to select what crops to plant, plant their own garden, watch it grow, tend the crops, harvest them, and prepare them as part of a healthy diet. Our goal is to positively influence dietary intake and prevent/treat obesity in minority youth through meaningful play. Virtual Sprouts brings a novel combination of technology and teaching to bear on pediatric obesity in urban Los Angeles, and will employ interactive, mobile game techniques, rich narrative, a pedagogical agent, and experiential learning to achieve the aims of the program. To date, we have employed extensive iterative playtesting methodologies to determine optimal game mechanics, and community participatory research techniques to ensure that content and form are optimized to fit community and research needs.

For more information on the conference or to register, visit the Medicine X conference website.

More news about the Medicine X conference is available in the Medicine X category.

The National Institutes of Health has launched a new mobile application offering women guidance on maintaining a healthy lifestyle and tips for identifying health risks for themselves, as well as their families.

The app is based on the Office of Research on Women’s Health publication A Primer for Women’s Health: Learn about Your Body in 52 Weeks. Available for free in the Apple App Store or via Google Play, the app provides a year’s worth of research-based health information highlighted week-by-week. According to an NIH release:

Questions to ask health care providers, a glossary of health terms, and health screening information and links to additional information from NIH institutes and centers expand the mobile app’s offerings.

Key features of the app are:

• a personal health section for recording medications, medical conditions, and disabilities
• a journal feature
• a personal goal-setting section for health and lifestyle details

A variety of different skins can be applied to personalize the app, and it can be password-protected to help ensure health information remains confidential.

The NIH plans to launch a similar app for men’s health in the near future.

Previously: Diagnosing ear infections using your iPhone? Not so far-fetched, Stanford medical residents launch iPhone app to help physicians keep current on research and School of Medicine alumni association partners with Doximity to test first-of-its-kind smartphone app
Photo by Jeffrey Pott

As a parent, the iPhone has been a godsend - helping me with everything from taking cute photos and videos to keeping up with doctor’s appointments and playdates to providing much-needed entertainment on long car rides. Well, it looks like I can add “checking for ear infections” to that list. A simple attachment would transform my phone into an otoscope, as explained by an article on Forbes.com:

The peripheral attaches to the top of an iPhone and provides a 10x magnification. Using CellScope’s web platform, users can upload captured images and pediatricians can remotely assess the severity of the infection. Doctors can then provide a diagnosis, prescribe antibiotics, or recommend the child be brought into the office for a more thorough examination. Additionally, the images enter into the patient’s electronic medical records, so any susceptibilities to infection can be tracked through image comparison throughout the childhood years.

Ear infections are the most common reason children are brought to the doctor. Having this technology available could reduce health-care costs attributed to those visits and give parents a more hands-on role in their child’s health. “It seems pretty obvious that this sort of thing is going to happen… 5 years from now, 10 years from now, people will be able to do diagnosis from home. Patients will have more control over taking data and being a participant in their healthcare delivery,” Erik Douglas, co-founder and CEO of Cellscope, tells Forbes.

The story mentions that pediatricians in the Bay Area and Atlanta are already testing the device and that clinical trials are underway to test its accuracy. Considering both of my girls recently had a bad case of the sniffles (ear infections often follow colds), I could definitely see myself giving this a try. And the idea that I could do a medical diagnosis on my phone? My inner Trekkie is doing cartwheels right about now.

Previously: Stanford medical residents launch iPhone apps to help physicians keep current on research, School of Medicine alumni association partners with Doximity to test first-of-its-kind smartphone app, Using an iPhone as an imaging device in developing countries and Mobile phone app helps manage diabetes
Photo by Steve Johnson

There’s a nice Q&A with designer John Ferrara on O’Reilly Radar today about how games can be a “force of cultural transformation.” As part of that conversation, Ferrara discusses how games can be used to improve health and make healthy behavior more fun (or, if you’re a believer in the coming zombie apocalypse, utterly terrifying):

You know, there’s so much really inventive work being done right now. Recently, I’ve been playing a lot of “Zombies, Run!,” and I think it’s great. This is a game for smartphones that overlays a narrative about survivors in a zombie apocalypse onto your daily run. As you’re out getting your exercise, you’re listening to the game events as they unfold, and you can hear the zombies closing in. It’s a great use of fantasy, and it plays as a true game with meaningful choices and conflict.

The video above, originally produced for its developers’ Kickstarter campaign, offers a little more detail about how the “Zombies, Run!” app works. He also touches on how games might play a role in research, citing FoldIt as an example:

This is what’s been called “human computation,” where a group of people work together to solve some complex problem as a by-product of some other action, like playing a game. Luis Von Ahn at Carnegie Mellon describes games as algorithms that are executed by people rather than machines, and I think that’s a really fascinating idea. Foldit is a great example. This is a puzzle game where players try to figure out how to fold chains of proteins. This is a problem that’s very well suited to human computation because it requires a type of intuitive reasoning that’s very difficult for actual computers. Foldit made a big news last fall when the people playing it decoded the structure of a protein related to a virus that causes AIDS in monkeys, which had eluded researchers for years.

In all, it’s an interesting Q&A and well worth reading. And, if you’d like to read more about how games can be used in scientific research, I recommend a 2011 story by my colleague Bruce Goldman about a Stanford/Carnegie Mellon project called EteRNA, which draws on gamers’ skills to accelerate biochemists’ understanding of RNA. I think this is an absolutely fascinating field.

Previously: Mob science: Video game, EteRNA, lets amateurs advance RNA research

As evidence-based medicine takes a greater foothold, medical residents and physicians are tasked with the seemingly constant challenge of staying up to date on the latest treatments and drugs. To help their colleagues keep current on medical advancements, Stanford medical residents Dave Iberri, MD, and Manuel Lam, MD, introduced a new medical app that features physician-written summaries of landmark clinical trials.

Lam, a third-year resident with an undergraduate degree in computer science, and Iberri, a second-year resident and an experienced web developer, carved out time from their busy clinical schedules to develop the recently released Journal Club for iPhone (link to iTunes store).

Below Iberri, a second-year medical resident, discusses the motivation for creating the app and how the Stanford medical center community helped shape the final product.

What spurred the creation of this product?

As medical trainees, we furiously jotted down medical acronyms in our notebooks hoping to read these articles on post-call days. But early on we realize that wading through the sea of medicine journals can be overwhelming, if not downright impossible. In the midst of our resident schedules, how can we digest all this content? Which articles should be at the top of our reading list? Passionate about medical education, Manny and I wanted to solve this problem. We sought to put answers at the clinician’s fingertips, immediately accessible at the point of care. Since smartphones, and the iPhone in particular, are revolutionizing the way medicine in practiced, deciding to design an iPhone app was a no-brainer. Thus the Journal Club. Written by physicians, these article summaries are distilled into bite-size morsels that clinicians can digest quickly. Think of it as CliffsNotes for medical research.

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