SAN DIEGO – With approximately 100,000 mHealth (or mobile health) apps and 13,000 medical apps available to mobile device users, how should a hospitalist physician choose among those that claim to offer decision support at the point of care?
Hospitalists Dr. Bradley J. Benson, professor of internal medicine and pediatric care at the University of Minnesota, Minneapolis, and Dr. J. Richard Pittman Jr. of the department of medicine at Emory University, Atlanta, addressed that question at the 2016 annual conference of the Society of Hospital Medicine by first laying out their two essential criteria: a combination of “the wow factor” and “the quadruple aim.”
Dr. Bradley Benson
Dr. Benson explained that by “wow factor,” he wasn’t talking about “the glitzy, latest, coolest thing with bells and buzzers.” Rather, he said, the term means whether an app was used during “an authentic week on the wards. Did we actually take this thing out and use it to care for patients?”
And the second criteria, the “quadruple aim,” indicates how well the app “improves our ultimate goal. Better outcomes for our patients, better experiences for our patients, better value, and a better experience for us in providing care,” he said.
Here are the Top 10 medical decision support apps for hospitalists, as assessed by Dr. Benson and Dr. Pittman:
1. MDCalc – Free online. $10 app
Helps doctors calculate adverse event risks, such as stroke, bleeding, or clots. For example, Dr. Benson said, you could ask the app what is likely to happen to a 72-year-old observation patient with new atrial fibrillation if she is prescribed warfarin versus aspirin?
This clinical calculator computes the CHA2DS2-VASc score and shows the published medical research on which it is based, he said. “These calculators never have all the ones you’ll need, however. You’re going to need three or four.”
2. Calculate QxMD – Free
Helps determine emergency department patients’ suitability for discharge versus admission, such as for a 74-year-old ED patient with community-acquired pneumonia who was discharged with cellulitis 24 days prior, 6 days shorter than 30 days.
The app concluded “this patient may be appropriate for outpatient therapy,” said Dr. Pittman. “You still use your clinical judgment, but you do have some support if you want to send this patient home and avoid the readmission.” The app, he said, has “most of the calculators I need on a regular basis.”
3. NSQIP’s Surgical Risk Calculator – Free Web-based
Hospitalists are often an important voice on surgical appropriateness, and the American College of Surgeon’s National Surgical Quality Improvement Program’s app helps score that risk.
“What I love about this is that I can tailor it with the actual DRG [diagnosis-related group] for this procedure,” Dr. Benson said. “And it’s based on 1.4 million surgeries and their outcomes.” The risk calculator provides weights for other comorbidities, such as hypertension, “so I can say this patient is at higher risk [of complications] because of x, y, z … and email it to the surgeon. Bottom line is that I can cut and paste this into my note, and that’s what I will go over with the patient.”
4. Seattle Heart Failure Model – Free as Web app
Here’s a 65-year-old man with advanced heart failure and an ejection fraction of 25%, said Dr. Pittman. “He and his family want to talk about whether aggressive interventions prolong life and are worth it. It feels like, in our practice, we spend a lot of time bringing peoples’ expectations down, realistically, from where they are.”
The SHFM is a Web app that can be customized to use on a phone browser. “It’s a validated tool to give guidance about what’s the prognosis for patients living with heart failure,” Dr. Pittman said. “What’s cool is that you can plug in many of their baseline characteristics and demonstrate what happens with different interventions.”
A physician can ask the app what would happen to life expectancy if the patient received a beta-blocker? “We’re going to go from 4.2 to 5.7 years. And what about adding an ICD [implantable cardioverter defibrillator]? You go from 4.2 to 8.4 years.”
5. Lace Index Tool – Free
This app predicts the likelihood a patient will be back to the hospital within the next 30 days based on LACE: length of prior stay, acuity, comorbidities, and number of ED visits within the last 6 months. It helps clinicians “really focus limited resources to prevent readmissions on the right people,” Dr. Benson said.
Take a patient with advanced liver disease admitted with hepatic encephalopathy who is about to be discharged after a 6-day stay and has had three previous ED visits within the last 6 months, he said.