February 2017 CDC Vaccine Schedules

cdc-opening-screenTitle: CDC Vaccine Schedules
What it is: A mobile app for all the CDC vaccine guidelines
What devices: Android and Apple devices
Cost: Free
Who should use it: Any healthcare provider or patient who wants to know more about CDC guidelines for vaccination
Why use it:  Vaccines are an effective and easy way to prevent disease and maintain healthy populations.  For many clinicians the source they use the most for vaccine schedules and information is the CDC website.  This CDC Vaccine Schedules app puts all the important information from the CDC website into a convenient mobile app.
    The information is broken down like most of the distributed vaccine information from the CDC.  The age categories include Birth to 5 years, Adolescents and Adults.  While looking at the graphics on a phone or tablet, turning your device horizontally allows for a broader appearance to the timetable.cdc-front-page
    There is also information on catch-up schedules for children, unique guidelines for pregnancy, immunocompromised patients and healthcare providers.  These are in separate listings on the front page of the app but there is also a lot of information available by tapping “note” from the vaccine schedule it self.
    Overall, this is a very easy to use reference from the CDC for all vaccination guidelines in the palm of your hand.

January 2017 LactMed app

Title: LactMed
What it is: A mobile database of information regarding the safety of medications and supplements during breast feeding
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What devices: Apple and Android Devices
Cost: Free
Who should use it: Physicians, nursing mothers
Why use it:  There are many things about bringing home a new baby that can cause a lot of anxiety.  There are new feeding and sleep schedules, baby proofing your house and maybe even other siblings who needs to get used to the new addition to your family.  Another source of anxiety can be trying to know whctzhat medications are safe for a nursing mother.  That is where the mobile app LactMed can come in handy.
       LactMed is a mobile searchable database that has thousands of medications created by National Library of Medicine, a part of the National Institutes of Health.  For each medicine, LactMed provides information on whether or not the medicine can be found in breast milk, whether it can have an effect on nursing babies and other options for that class of medication. It also provides information on whether or not the medication could effect lactation as well.
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       What’s is great about this app is that not only are there prescription medications but over-the-counter medications and supplements.  All this clinical information is updated monthly.
       This app is perfect for the primary care physician in clinic taking care of their patients who are nursing or for the doctor providing Urgent Care who has a nursing mother as a brand new and ill patient.  If you are not taking care of nursing mothers on a regular basis, it may be hard to stay familiar with medications that are safe for breastfeeding.  This mobile app will be a great, quick reference.
       For patients, specifically nursing mothers, this can be a great app to review the medications you are already taking or any new medications that are started while nursing.  It can be a good way to start a conversation with your physician about your medications.  Of course, always speak with your personal Obstetrician or Primary Doctor before making any changes to your medication regimen.

Review of 2016

good-year-1911507_1920     2016 was a very exciting year for me.  I completed my MBA, took on a new role at my institution as Associate Chief Medical Officer and in February I launched this website, Digital Health and You.  This website has been an important outlet for me and I hope  has helped improve the landscape of medicine and digital health.
     This year the website had 11 digital health app reviews published.  These included apps for understanding your lab results, cognitive behavioral therapy, concussion prevention, zika virus and even to help monitor your caffeine intake.
     I am really looking forward to 2017.  We will be discussing EMR’s, PHR’s, more Profiles in Digital Health and of course 12 new Health App of the Month posts.  My readership waxes and wanes, as does my ability to publish often but creating and maintaining this website has truly been a joy.

Evidence of Digital Health Adoption by Patients

       A really exciting thing has been happening in my clinic the last few weeks.  In addition to holiday decorations and the rush year end refill requests, I have noticed an increase in the amount of times patients have talked to me about health apps.doctor-563428_1920
       The March Health App of the Month was Sworkit and I recommend it often.  Those who travel a lot for work or whose busy work schedule limits going to the gym can find good success in an app like Sworkit.  I am receiving good feedback on the impact of Sworkit.  During follow up clinic appointments with several patients over the last couple weeks they had followed my prescription of Sworkit and were using it regularly.  They all travelled extensively for work and found it was easy to have an intensive exercise session from the privacy of their hotel room.  For one patient is was really helping maintain good blood pressure control.
       In my clinic I usually have my diabetic patients come in for appointments a regular basis, around every 3 months.  I recommended to many the use of the MySugr Diabetes App.  Many are finding it a really intuitive and easy way to track their sugar and their insulin regimen.  The visual nature of the blog sugar graphs and the ability to export the data are features that patients appreciate and really use.  Especially when trying to help someone with uncontrolled high blood sugars, the more data points the better.  Since almost everyone has their phone on them at all times, it is easy to log every blood sugar taken, every dose of medication, calories and any hypoglycemic symptoms – and it is easy to look at in the clinic to make clinical decisions.  I have worked with patients to change insulin regimens while we both look at the MySugr App on their phone.
       Any intervention where a patient can see and feel the results can be more impactful and lead more permanent healthy habits.  It is clear that the Sworkit app and MySugr can have that kind of impact.  Physicians need to be more mindful of talking about digital health apps with their patients.  It’s clear that patients will listen.

December 2016 WebMD Mobile App

Title: WebMD Mobile App

What it is: A mobile medical reference app

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Front Page of the WebMD Mobile App

What devices: Apple and Android products

Cost: free

Who should use it: Anyone who wants broad reliable medical information at their
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Why use it: There are numerous medical websites on the internet and if you are looking for medical information it can be hard to know where to start.  What is good information and what sources can be trusted?  The first place to start can be the WebMD mobile app.

The mobile app has many different features that make is a very useful first step to researching medical questions.

1 Symptom Checker – to guide you towards potential medical diagnosis based on symptoms you are experiencing

2 Reference of medical conditions – broad list of medical conditions with useful information for each condition, all presented in a format that is easy to understand and geared towards patient usewebmd-med

3 Drug reference for pharmaceutical information. – listing pertinent information about what it treats, what to look out for, what a specific medication interacts with other and what to do if you miss a dose

4 First Aid – Basic How-to for caring for injuries and medical conditions on your own and instructions for when to seek carewebmd-first-aid

5 Provider database – You can even search your area, or any area you might be traveling in, to look for physicians and hospitals.

The WebMD mobile app is a nice way to have reliable medical information at your fingertips.  The app is definitely geared for lay-person use.  This app not rigorous enough for physician use.  The Medscape mobile app may be better suited for that.

While the WebMD mobile app may not meet the needs of physicians in daily practice, it is a great useful reference for anyone looking to obtain quality medical information from a reputable source.

November 2016 ASCVD Risk Estimator

ASCVD Risk Estimator
What it is: A mobile app that uses an algorithm to determine risk of cardiac disease
What devices: IOS and Androidfront-page-app
Cost: Free
Who should use it: Physicians who want more guidance on cardiovascular risks and treatment guidelines for hyperlipidemia.  Also patients who want to be more proactive win their own healthcare, who want more information on their own heart risks and what they can do about it.
Why use it:  The goals physicians set for cholesterol levels change based on a specific set of risk factors.  Essentially this makes cholesterol levels a moving target at times.  Not every patient will have the same goal.
       The American College of Cardiology and the American Heart Association has developed a mobile app to help physicians and patients make the most informed decision about cholesterol treatment.  The app is called the ASCVD Risk Estimator.  ASCVD stands for Atherosclerotic Cardiovascular Disease.  The uses published medical guidelines to set a 10 year and lifetime risk of heart attack, stroke or death from a cardiac cause.
     To use the app, one needs information regarding age, gender, race, total cholesterol, HDL cholesterol, systolic blood pressure, diabetes status, smoking status and use of blood empty-front-pagepressure lowering medications.  By inputting this information, one can see the 10 year and lifetime risk of heart disease.
      The app also uses the current published guidelines on treatment.  Based on the risk that is calculated it will review current treatment options.  For instance if the risk for a patient is calculated to be 14%, then the app can easily show you that the next step is high intensity statin and lifestyle modifications.statin-therapy
       There are two educational sections of the app, one geared for physicians and one geared towards patients.  The Physician section is more technical and comes with a strength of recommendation rating that physicians will be familiar with.  The Patient section is much more approachable.  Conveniently there is a section that provides definitions to common medical terms that could be quite helpful for patients.

Are you prepared for a video recording device in your exam room?

       During residency, one of my patients brought a tape recorder to his appointment.  It was a bulky old tape recorder, which was already antique technology 10 years ago.  He was older and wanted to record his appointment so he could remember every detail.  His children often called him and wanted an in-depth report of all of his medical visits.  He decided he would audio-record his appointments and send the tape to them instead. 

     His intent was good, but I could only imagine terrible outcomes.  Somehow, my voice would be used against me.  Maybe my documentation would not match my words.  Maybe it would be obvious on the tape that I forgot to ask a crucial question.  When he told me he wanted to tape our encounter, my mind almost immediately jumped to it being Exhibit A in a lawsuit.  

     Before he could plug in his tape recorder, I told him he could not tape his appointment.  (Looking back, I am not sure what made me think I had the power to say no.)  We compromised, and I wrote a letter to his children summarizing our visit and any tests or medications ordered.  He was satisfied with that, and this system worked for us throughout my residency.  

     My memory of this was brought to the fore today as I learned about the new SnapChat snapchat-3Spectacles, wearable glasses that go on sale soon.  Created by SnapChat itself, these trendy sunglasses are equipped with a small video camera.  After pushing a button on the frame, the glasses will take up to 30 seconds of video of whatever the wearer happens to be looking at.  Of course, Spectacles connects wirelessly with the wearer’s phone and can instantly post videos to the social media site.  

     There are other products on the market right now that can do similar things.  The iOn Snapcam weighs less than an ounce and is a 1.5 inch-wide square camera with the ability to take pictures or video.  It can clip to clothes and, at just a tap, start recording.  It can even live-stream for up to an hour!

     What does this have to do with healthcare?  Recent advances in technology have propelled many new ways to access healthcare, but these two products have the potential to be detrimental.  

     How long will it be until someone’s Spectacles video becomes admissible in court?  A simple tap of someone’s glasses, and 30 seconds of a full patient encounter could be taken out of context.  Plus, it could be posted to multiple social media sites as well.  What about the privacy rights of other patients around someone with these video recording devices?  If someone posts a video to their social media profile from a physician’s office lobby, other patients will likely be in those videos.  How will we protect  privacy of the other patients in those situations?  snapchat-1

     If you are a physician, would you recognize any of these social media video tools?  What about your staff?  Would you feel comfortable telling your patients to make sure they were not collecting video or live-streaming their appointment?  Do you have a written policy to provide patients about limiting video capture in the office?

     There are many rules and regulations that require healthcare providers to obtain very specific consents before using any type of image or video recording of our patients.  Protecting the privacy of our patients is both the law and our responsibility.  Being aware of the new video technologies and preparing for their use by our patients are increasingly more important parts of that responsibility.