Traditionally, physicians have relied on textbooks, conferences, and, more recently, the Internet to keep abreast of the latest clinical data and support clinical decision-making
Traditionally, physicians have relied on textbooks, conferences, and, more recently, the Internet to keep abreast of the latest clinical data and support clinical decision-making. Now, in addition to these resources, physicians are turning to their smartphones. Currently, more than 60% of US physicians use a mobile device, and the number using smartphones is increasing as technology advances and platforms like the Apple iPhone, BlackBerry Storm, and Palm Pre continue to gain popularity.
Smartphones are especially advantageous to physicians because they allow numerous tasks to be performed on one portable device, including calling, paging, scheduling, and accessing clinical resources, eliminating the need to wear a cumbersome utility belt that has numerous devices attached to it, such as a cell phone, personal digital assistant (PDA), and pager. The availability of reliable medical references on mobile technology platforms, such as PDAs and smartphones, has led to the emergence of tech-savvy practitioners who can stay informed and up-to-date without leaving their patients’ bedsides. This has revolutionized how medicine is practiced, as physicians are no longer tied to their offi ces to carry out functions that are essential to their practices and patients’ well-being.
The availability of clinical reference products has proven to be paramount to physicians adopting new devices, such as smartphones. Mobile tools provide a solution to the information overload and administrative burden that many practitioners face, as clinical guidelines are constantly changing, many new drugs and indications are approved every year, and demands on time are becoming more pronounced. It is impossible to keep up with all the latest clinical developments and available literature, and, in general, oncologists face an even greater information burden because our patients tend to be older, have numerous medical comorbidities, and are often receiving multiple highly toxic drugs, all of which require special considerations. We are also often tasked with addressing the primary care needs of our patients, making access to the latest guidelines for treating a wide range of diseases and conditions a necessity. Oncologists must wear many hats in a field that is rapidly changing, and smartphones are proving invaluable in keeping us organized and up-to-date both personally and professionally.
I am currently using a Palm Treo, but I am looking to move to the Apple iPhone or Palm Pre. These devices have all the functions of a traditional cell phone, including contact lists, calendars, and cameras. They also, of course, serve as a communication tool through calling and texting. The large memory of my device allows me to have all the tools and resources I want and need in one place. I can access pictures of my family, watch movies on the plane as I am heading to a conference, or read the news at leisure. I can also access the Internet and e-mail through my data plan. The multitude of features that smartphones provide can help you balance your personal life, while still allowing you to stay connected to your practice.
Smartphones can be used in the office daily and are especially valuable when loaded with clinical references and tools designed to assist with drug lookups, symptom diagnoses, and prognoses. The resource I turn to most often is Epocrates Essentials, a clinical software solution that allows me to obtain concise and critical information while in the exam room. Epocrates and the other software
on my Palm have saved me time, increased communication with my patients, and helped me to become more efficient.
Saving Time While Improving Patient Safety
Physicians can save a significant amount of time by using software solutions like Epocrates Essentials, which provide instant access to information on diseases and allow drug—drug interactions to be quickly checked and drug doses calculated without needing to leave the patient’s side. Many of the calculations that physicians frequently need to make can be performed expeditiously using mobile medical calculators and tools, such as MedMath.
Oncologists often treat patients who are on several highly toxic medications, and interactions between these medications can cause serious complications. Oncology patients are also increasingly taking herbal supplements and over-the-counter medications in addition to their prescription drugs, further increasing the risk of adverse events. Whenever I see a patient for the first time, I use the Epocrates Interaction Checker to find out whether a patient’s symptoms are related to their medication or their illness. I can look up drugs with high toxicity levels and find those with fewer side effects before prescribing a new drug or recommending nonprescription medications and supplements, which lowers the chances of an adverse reaction.
Mobile access to a patient’s health plan formulary is important when patients are on multiple medications and are facing high medication bills. With electronic formulary information on hand, I can select generic versions and provide drug costs to my patient as I write the prescription. In this downturned economy, it is a great relief for patients to have additional control over the cost of their treatments. Prescribing medications that are covered by my patient’s health plan also reduces the number of callbacks I receive from pharmacists. The time I save by not having to be on hold with pharmacists or looking for information can be spent more meaningfully with my patients.
Some physicians have the misconception that patients will think they are uninformed if they reach for their smartphone to access clinical references and tools. I have found the opposite to be true. Seeing me use technology to confirm clinical decisions has provided reassurance to my patients and fostered more open communication with them by instilling confidence that they are receiving top-notch care. Patients find it most useful when I show them the information presented on my smartphone about a specific drug, such as a picture, possible interactions, or the dosage schedule.
Smartphone users not only have access to downloaded software tools and programs, but also to the Internet, which infinitely expands the resources available to them. I can access the National Comprehensive Cancer Network (NCCN) guidelines from the NCCN Website to help determine a treatment for a comprehensive chemotherapy regimen. Other tools I use often, such as a cancer staging table or the Gail Breast Cancer Risk Calculator, are important to have at the point of care. For instance, the Gail Calculator on my smartphone allows me to calculate a woman’s risk of breast cancer instantaneously, which opens stronger lines of communication with my patient.
A growing number of prognosis applications can be downloaded from the Websites of reputable institutions, such as the Memorial Sloan-Kettering Cancer Center 5-year Survival app, or can be increasingly found in apps stores, such as Apple’s App Store. When encountering a rare hematology disease, having access to a symptom checker and differential diagnosis at the point of care is essential. Although I do not use these tools daily, they are readily available on my Palm for when I need them.
Set to Play
Mobile technology is easy to use and inexpensive, which has contributed to it becoming more commonplace in the medical community. Smartphones with clinical reference solutions are set to play a critical role within the health care system in reducing medical errors, saving clinicians time, and enhancing overall patient care. These are all critical for oncologists, who often treat patients with multiple highly toxic agents, are practicing in a field that is rapidly changing, and are set to face an ever-increasing cancer burden.
William Thomas Muuse, MD, FACP, is a medical oncologist at Falck Cancer Center, Elmira, NY.