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Melanie Cole (Host):  Welcome. This is Radio Rounds with St. Louis Children’s Hospital. I’m Melanie Cole. And today we are discussing helpful apps for busy physicians. Joining me is Dr. Tosin Adeyanju. She’s a Washington University Pediatric Hospitalist at St. Louis Children’s Hospital. Dr. Adeyanju, thank you so much for being with us today. Explain a little bit about why a physician may want to incorporate app usage in their daily practice. What do these apps help with?

Tosin Adeyanju, MD (Guest):  Hi Melanie and thank you so much for having me today. I would say honestly, it’s the same reasons that we use apps for everything else in our lives. The same way you use an app to figure out where to have lunch or how to make a reservation is how you want to use apps in your daily practice clinically to get things happening faster and to have up to date information. A lot of the apps have connections to things like the CDC, and the AAP and also calculators for formula that you know you learned in medical school, but you can’t remember off the top of your head because you don’t use them that much. You have easy access to those as well.

Host:  So, tell us how you are using them and what are the most popular physician apps that you like to recommend?

Dr. Adeyanju:  So, physician apps really come in multiple categories and I like to recommend a few different categories of applications that I think are particularly helpful for physicians on the go whether in clinic, in the emergency department, on the inpatient floors. The first types is what I call point of care resources. So, these are the apps when you see for instance a rash and you can’t remember exactly if that rash looks like what you remember any other kind of rash. Does it look like nummular eczema. You’re not really sure. Instead of trying to figure out from a computer or whatever else; you can pull up your phone and go for example to Up To Date which is one of the apps. Most physicians are familiar with Up to Date as a website and as a service, but they actually have an application that you can use and you pull it up on your phone or your tablet, you can type in whatever it is you’re looking for and bam, you’ve got it right in front of you within seconds. I’ve actually pulled up the Up To Date app in front of parents when I’m trying to convince them say that this rash, I’m seeing is actually a morbilliform rash and their kid has mono and doesn’t need the amoxicillin that they were prescribed for potential sore throat.

You can also use these apps to look up say treatment guidelines. So, for instance, the CDC has an STD treatment guideline application that they update as the guidelines come out. The most recent ones I believe were in 2015 and if you download that app and say you are seeing a child with or an adult with an STI and you are trying to decide what antibiotic is the recommended and more importantly, how many days am I supposed to give this for because I know it’s different from what I use azithromycin for other things. You can pull it up right on your phone. It give you not only the treatment guidelines; it can give you testing guidelines and it can give you things like let’s say your patient is allergic to the first line treatment, here are some other options that you can use.

Another type of point of care application that I like to recommend are more of the point of care calculator apps. So MD CALC and Calculate by QXMD are two types of apps that have a lot of just guidelines that have been operationalized so you can use them to calculate. So, for instance, if you are an adult emergency medicine doctor and you’re trying to remember how to do a wells score or you’re trying to have a medical student or a trainee do a wells score; they can pull up the app and look at it and not only does it have input the data that helps you calculate their score but it also has the resources to figure out how they calculated it and what the scores mean.

Or say for instance, you’re a small town urgent care and you’re seeing a kid who kind of sort of matches appendicitis but you’re not completely sure if you should test them or not. You can pull up the Pediatric Appendicitis score, plug in their symptoms and see okay well, if I do bloodwork and it’s positive then this may actually guide me towards doing imaging or not doing imaging. My other favorite thing about both MD CALC and Calculate is it has things like eating disorder scales, depression scales, the type of things that you use maybe infrequently in certain practices but they’re helpful because they are actually validated scoring scales that you can use to determine look I’m concerned about this child, they might be depressed, I made them fill out this depression scale or this Vanderbilt for ADHD or this eating disorder scale and it really just validates that concern and it’s something – a communication tool you can use when you are talking to the psychiatrist or whoever else about the patient.

Another type of app that I like to recommend that is also at the point of care sort of medication apps. So, most of us have probably heard of either Epocrates or Lexicomp. Both of which have medications with the indications, the doses. It talks about dosage forms which is really helpful as a pediatrician as I’m trying to figure out is there a tablet small enough for this child who really doesn’t want to take a liquid. It gives you the dosing for different things so the dosing for amoxicillin for strep throat for instance, is different from the dosing for pneumonia and I know for instance for myself, I have a hard time remembering what’s the max dose for pneumonia. Because most of the kids I see with pneumonia are small but when you are diagnosing a 17 year old and you are trying to remember what’s the adult dose for amoxicillin for pneumonia, I can’t always remember that, I pull up Epocrates or Lexicomp and bam, I’ve got that covered.

There’s also applications that are particularly useful if you have patients who are trying to figure out which med is covered by their insurance or which med is cheapest at what pharmacy. Formulary Search and Good Rx are two applications that are really useful for that particular thing. So, as you can see, and I can go on and on about this. There are sort of apps at the point of care, at the bedside that can immediately help you take care of your patients and can help you give your patients information moving forward.

Host:  Wow, what a comprehensive list. You certainly do know your apps so Dr. Adeyanju, are there any HIPAA concerns with any of these apps? I mean they are pretty well generic and anonymous but are there any that are not?

Dr. Adeyanju:  Not the one I’m mentioning. There are some applications that have some more patient information storing. I don’t talk about those apps very much because I personally haven’t done a lot of digging into their HIPAA compliance and I want to make sure that I’m recommending things that you don’t have to worry about that for. So, all the apps I mentioned don’t ask you for anything specific to your patient. At most you might be asked for the age of the patient for helping you figure out or their weight for helping you figure out dosing of medications. But I will say, there are some applications that maybe for instance I remember as a medical student, there was an application that was supposed to help you keep your patient list intact so you can get patient information at your fingertips. And those applications do have pages to talk about how they manage HIPAA and stuff like that, but I really don’t use them.

One of the applications that can have HIPAA concerns is if you use an EMR such as Epic, I believe both Epic and Cerner have IOS and maybe Android applications on your phone or on your tablet so you can look at patient lists remotely and both of those have multiple layers of protection including having to log in with the same user name and password that you would have to use with your institution. I know most institutions that use Epic or Cerner also have sort of extra steps on the backend to make sure, I know our institution specifically has two factor authentication to make sure that not only are you logging in with your user name and password but also that you can only use the application on a device that has already been checked out and has already passed the two factor authentication. But for the most part, honestly, I would say if you are a small hospital, if you are an independent clinic for instance, using those applications can be a little bit more challenging just because most of the time, those are applications that you may or may not know to trust but if you work at a big institution, as long as you follow the instructions and the guidance of your IT department; you can make sure that the HIPAA concerns are not a problem.

But the apps that I mostly mentioned are apps that you don’t put any patient information in in the first place.

Host:  Well thank you for that answer. And what apps are physicians recommending for their patients as far as wellness, and nutrition? There probably are so many. What do you like for physicians to recommend to their patients?

Dr. Adeyanju:  So, I find in general, that again, comes down to who are your patients and what do they need. So, one group that I recommend an application to a lot is teenage girls. Every physician who has ever seen a teenage girl has had this problem. You ask them when was your last period and they look at you and then they look at their mom. And then they say, last month? And it’s April 15^th and you don’t know if last month is March or last month is actually end of February. So, I recommend all of them to download a period tracker to their phones both IOS and the Android OS have multiple types of period trackers that you can use. A lot of them are attached to fitness trackers such as the Fitbit app. I know the Garmin Connect App also has a period tracker. There’s an app called very astutely Period Tracker. Even the Apple Health application has a period tracker. So, most of the time, I give the children a few options and then I say, just pick one, it really doesn’t matter which one. Every month, plug in the day you have your period just so the next time someone asks you and it helps them too because then they can look and make sure their periods are regular and they can notice if there are patterns.

Another type of application that a lot of physicians can recommend to their patients is the CDC has a few different applications for this. There’s a Milestone Tracker the CDC has that can be really helpful for parents in between well checks to see what should my nine month old be doing? There’s an application by the CDC called Heads Up. It’s about signs and symptoms of concussions which I know is something that’s of concern to patients’ parents a lot of the time. When you have a kid in a football game who gets beaned and loses consciousness for a few moments; that’s not confusing. What’s confusing is when your four year old like is running, slips and falls and hits the ground and you’re trying to figure out am I worried about a concussion or not. Do I really need to go to the ER or not. The Heads Up app is something that can help parents make that decision.

There’s also an app called TravWell which helps families who are planning to travel internationally figure out what things do they need to do. Do they need to get a health screening? Do they need to get extra shots? Do they need malaria prophylaxis for example? I know the St. Louis Children’s specifically has an application called Kid Care which gives a lot of information about both well and sort of routine illnesses for parents as far as things they can do at home, when to be concerned and then another application that I know we have specifically called Surgery Connect but other big institutions also have similar applications that are specific to for instance a child who has an outpatient surgery planned for next month, their parents can log into Surgery Connect and they can see all the pre stuff that they are supposed to do to make sure they are on time for their surgery, they know what the NPO time is, they know what lab work maybe needs to be done prior to. They have information for connecting to their doctors.

There’s also an application, this is a particularly useful one for families, for moms who are breastfeeding called Lactmed, Lact like lactation and then med, one word. It’s by the NIH and it really goes through as much information as we have for what meds are safe for moms who are breastfeeding to take and what meds may or may not cross into the breastmilk.

Host:  Wow, what a comprehensive list for physicians to recommend to their patients. As we wrap up, Dr. Adeyanju, what would you like other physicians to know about the benefits of using these helpful apps that you’ve discussed in detail and it’s such an interesting topic and can make their practice just a little bit easier. As you wrap up, please also mention, we’ve seen a lot of physician burnout lately, if there are any apps that you feel might help physicians with that as well.

Dr. Adeyanju:  To the first question, I would say honestly, I think it’s the same as everyone has the one family member who resisted getting a Smart phone because they just didn’t want to deal with it. And then they got it and it made certain things easier, right? It made remembering phone numbers easier. It made finding where the nearest grocery store or flower shop is easier. It’s the exact same thing here. If you are a physician who is busy, who is running around and who is occasionally seeing things that you don’t see very often, so for instance a general pediatrician doesn’t usually need a resource to remember how to dose amoxicillin for an ear infection. They do that a hundred times, two hundred times a month easily. What they might need though is when they see an odd rash, the first place to start to figure out where do I go from here and I will tell you right now, that my job as someone who works in the hospitals and in the emergency departments is made so much easier when I see a rash and it kind of sort of looks like the description I remember of something but then I pull up the picture right on my phone or right on my iPad and I look at it and I look at the child and I show it to the mom and we are all like yup, that’s what we’re looking at. Nobody is worried anymore. We know where we are going from here.

I would say it makes things faster and easier once you know how to use them and I will also say knowing how to use them is not hard. Most of these applications know we don’t have time to mess around. Most of these applications are not about spending lots of time trying to figure out really complicated user interfaces.

I will also say burnout is obviously a multifaceted thing that lots of lectures can be given on, but I will say that one of the things that’s helpful about applications is that whole making things easier and faster and streamlined. So, for instance, task management is something that’s really important for physicians. Figuring out both household tasks and work tasks van be really complicated and very quickly get messy. So, if you are someone who likes to do lists but always loses the piece of paper you wrote them on; look into the vast world of to do lists that you can have on your phone. Lake to do lists, Microsoft To Do. There’s one called Remember the Milk. There’s one called Any Do. This is just a small listing of to do lists and then if you want something more complicated; there are some that are more project management based Slack, Asana, Tello are some examples that you can look up and the best thing about these is as I mention them if you remember and you Google one of them, you will get not only a big list but also pros, cons, which ones you can use and why.

I will also say that there’s a lot of wellness type applications. One that I always – that always comes to mind for me is one called Head Space which is a meditation/wellness app. There’s another one called I believe Ten Percent. These are all applications that can help you just spend some more time being mindful during your day. I know the day gets really crazy sometimes and you realize you haven’t sat down or had a quiet moment and for instance, I have a Fitbit that sometimes will tell me to sit down and take two minutes to breathe because I have been running around for too long. So, these are applications that can very easily be added to your life. If you want things that are more complicated, there are apps that have for instance yoga, or more sort of in depth mindfulness things that you can also look at as well. If you are a Fitbit user, I recommend very strongly downloading their app and spending some time on it because a lot of the things I have just mentioned specifically relating to wellness are integrated on that kind of application which at the end of the day, having six apps that do one thing or that do six different things but having one app that can do five or six of those things is even better.

Host:  Thank you so much Dr. Adeyanju for coming on. What a fascinating topic and a great segment. You have so much great usable information for physicians that can really help them not only in their practice but in their daily lives. That concludes this episode of Radio Rounds with St. Louis Children’s Hospital. To consult with a specialist or learn more about services and resources available at St. Louis Children’s Hospital, please call the Children’s Direct Physician Access Line at 1-800-678-HELP. Or you can visit www.stlouischildrens.org to learn more about this and other healthcare topics. Please remember to subscribe, rate and review this podcast and all the other St. Louis Children’s Hospital podcasts. I’m Melanie Cole.