Medical apps for smartphones
Authors: Sean Ninan
Publication date: 17 Apr 2012
Sean Ninan reviews some of the most popular apps for doctors
At one time armies of junior doctors would march up and down hospital corridors with their pockets bulging with bleeps and books. Now, most of us don’t wear white coats and our silhouettes are streamlined. We don’t want our skinny trousers or pencil skirts encumbered by superfluous appendages such as books. Most of us will, however, have a smartphone through which we can gain access to a wealth of information via medical apps. Here are a few of my favourites.
1 UpToDate for iPhone, iPad, and Android
Subscription $499(£314; €380)/year. $199/year for trainees
You know those doctors who seem to know the answer to everything? They probably subscribe to UpToDate. The website is authoritative and comprehensive. One of its advantages compared with other sources is the practical nature of its articles. Scouring “Stupor and Coma in Adults” is useful before a trip to the resuscitation department, and also to digest later at home. As a first year registrar, I’ve found this source invaluable when giving telephone advice to GPs and colleagues in other specialties, as well as in the middle of the night when I’ve wondered: “Which patients with vertigo warrant magnetic resonance imaging?” and “Who do the neurosurgeons want to operate on?” UpToDate now comes as an app. Although it requires an internet connection, offline access is available in the US and Canada for a further $49/year, a feature that will be rolled out elsewhere this year. The interface is slick; favourite articles can be bookmarked and recently viewed articles are kept in your history. Topics are long and detailed, but you can quickly skip to the relevant section. Time spent on the app and online is logged for you to print out for continuing professional development points. The high price for a subscription and the US focus might deter some, but for me, having such a powerful resource to hand has been great. It’s easy to access information quickly and build your knowledge base. If you’re not impressed, you can ask for your money back in the first 60 days.
2 BMJ Best Practice for iPhone, iPod touch, and iPad
£59.99(€73; $95)/year for full access
The BMJ Best Practice app is a good option if your budget doesn’t stretch to the cost of UpToDate. Material is downloaded onto your device so you don’t need an internet connection to use it, which is useful in hospitals that have poor mobile internet access. The app is pleasant to use with a clean interface that is easy to navigate. Content is listed by disease and presentation; like UpToDate this is a helpful app to use at the point of care, but it is not as comprehensive. You won’t find answers to questions such as “What is the sensitivity and specificity of Helicobacter pylori stool antigen?” or “What is the risk of subdural haemorrhage with anticoagulation?” whereas you can with UpToDate. I found that the app often crashed—something which other users have also commented on. In addition, I find it frustrating that a British app does not always draw on recommendations from NICE. For example, the heart failure guidelines are based on latest NICE guidance, whereas the COPD guidelines are not. Nevertheless, if the app stops crashing, it is a good, cheaper alternative to UpToDate. You can preview the app with a free download that provides access to 20 sample topics.
3 Medscape for iPhone, iPad, Android, and Blackberry
If you don’t want to pay for one, then Medscape has to be the best app going. It has a clinical reference section containing more than 4000 conditions. Essentially, it is a comprehensive textbook in an app, which can be downloaded for use offline. It also has a section containing more than 600 procedures, some with videos (although watching video requires an internet connection). In addition, it has a drug reference, a drug interaction checker, and sections on medical news and education. The layout for reading a long article could be improved. You have to go back to the subsection menu to move on to “examination” after you’ve read “history,” for example. It would have been better to have been able to scroll down or swipe through the article. Another minor gripe is that the articles are focused on diseases. The sections detailing how to approach patients with particular presentations are a distinct strength of UpToDate and BMJ Best Practice. This app is an excellent resource, however, and it’s free.
4 NICE guidance for iPhone and Android
Released in March 2012, this NICE guidance app provides offline access to 760 items of NICE guidance. The app is fast and simple to use, and is automatically updated as soon as new guidance is published. Highly recommended.
5 Oxford Handbook Series for iPhone, Android, and Blackberry
Many of the titles from the popular Oxford Handbook are available as apps. Although the cost is similar to the price for the books, the apps are around £10-£15 more than the equivalent paperback edition. For many of us, the “cheese and onion” edition will have been indispensible as a medical student and foundation doctor with succinct details on many clinical conditions and scenarios to get you through an on-call shift. The apps are replicas of the books and it is easy to find the section you need with the search facility. You can bookmark sections and all content is available offline. If you’re using these as a handbook to dip into for specific advice rather than as a general reader, it’s worth the extra cost to buy the app so you don’t have to carry a book.
6 Medcalc for iPhone
This is one of my favourite apps. It contains more than 200 formulas, scores, and calculations, and it allows you to store the ones you use often in your favourites. It is useful when dealing with medical admissions during an “on take” session when you can impress your consultant with your ABCD2 scores, Wells scores, and Maddrey’s scores. The pro version allows you to save patients’ details and to email or print results to a colleague—a feature I have not found it necessary to pay for.
7 Journal Watch Hospital Medicine for iPhone, Android, and Blackberry
£59.99 in app purchase from Skyscape app, free
Journal Watch is produced by the publishers of the New England Journal of Medicine, and is an excellent way to keep abreast of research. The editors summarise the latest publications and provide a brief critical appraisal and commentary that places the findings into the context of what has already been published. The service allows you to stay up to date without sifting through a stack of journals. Each week the app provides you with a list of new articles related to your specialty. At £59.99 it is expensive, and it does not include access to the website or print edition. It is difficult to recommend because of the high price, especially when, if you subscribe to the print version, you also get access to all other specialty areas on the website. If they included the app with print and online subscription, I would heartily endorse it.
8 Procedures Consult for iPhone, iPod touch, iPad
Free to try for 30 days. £27.99
The days of see one, do one, teach one are long gone. As a core medical trainee, I found that, for more complex procedures such as central line insertion, it was often see one, do one, not sure when I’ll get to do one again. I wanted a complete understanding of the anatomy and technique as well as practical experience. This is where the Procedures Consult app is useful. It has 46 procedures available to view in the internal medicine edition, from joint aspiration to transvenous pacing. The app takes you through the procedure in detail including indications and preparation to post-procedural complications. Each procedure has a video that is available offline with full commentary.
Other apps have some information on procedures, but I haven’t found one as comprehensive as Procedures Consult, or with offline video content. I recommend this app to medical students and junior doctors, with the caveat that I have found it crashes occasionally. You can sign up for a free trial period, and you can use the app if your institution has access to the website.
9 BNF for iPhone, Android, and Blackberry
The UK’s drug reference book costs £29.99 to download onto your phone. It is made by the people behind the Oxford Handbooks and it is similarly easy to use. It provides access to the current edition of the British National Formulary, and you have to pay again if you want to upgrade to the new edition. If you want an alternative formulary, but don’t want to pay it might be worth checking out one of the free US drug formulary apps.
10 Micromedex, Epocrates
Several free US drug reference apps are worth considering as alternatives to the BNF. Medscape includes one such reference tool—Micromedex, Epocrates. Bear in mind that there are differences in names, licences, and doses of drugs between the UK and US.
Micromedex for iPhone, Android, and Blackberry (free)—This is my favourite of the free US drug reference apps. It has an unfussy interface with useful sections on pharmacokinetics and clinical teaching for each drug that make it a good adjunct to the BNF.
Epocrates for iPhone, Android, Blackberry, and Windows phone (free)—This is a popular app that has a drug interaction checker and a pill identification checker, which is supposed to help identify patients’ pills if they don’t have their packets. It is rare in being available on the Windows Phone platform.
11 iResus for iPhone
Produced by the Resuscitation Council, this app provides a clear and concise summary of the latest guidelines, and it is continually updated. The algorithms are reproduced in full; you have to tap the appropriate branch—for example, shockable rhythm—to bring up the next part of the pathway. It is a good revision aid, but I have yet to see anyone pull out their iPhone at an arrest.
These products were reviewed on an iPhone 4S. The iPhone is the most popular platform for medical apps, although Android and Blackberry users are still well catered for. Although the use of apps is growing, it is not yet commonplace to use your iPhone rather than a British National Formulary. I have had disapproving looks when digging out my iPhone on a ward round. It can look like you’re texting rather than searching for the side effects of gabapentin.
The quality and quantity of apps has improved to such an extent that you are missing out if you’re still relying on a trip to the library. I haven’t mentioned a host of other apps. In my specialty, geriatric medicine, the Frax app and Snellen chart have been useful when seeing patients with falls, and I am sure each specialty will have their favourites. Some of these apps are free, others have a trial period where you don’t have to pay or can claim a refund. Try them out, and if you have any other apps that you’d like to recommend, please let us know.
Sean Ninan specialty registrar
Castle Hill Hospital, Cottingham, UK