It’s pretty impressive how tablet computers, particularly the iPad, have quickly become the must-have gizmo among physicians. I think it’s the portability, usability, and battery life that have made it so useful. As electronic health records (EHRs) are increasingly designed to run on the iPad platform, this partnership will become the doctor’s new black bag.
This is the first portable computing device that truly will run all day without worrying about it dying in the afternoon. The thinness and light weight make it something you don’t even have to think about when it comes time to leave the house or office to go to a meeting or appointment. With a 4-pound laptop, I’ll give it some thought if the utility outweighs the inconvenience of carrying it around. With an iPad, I sometimes have to check that I have it with me because it is so light and slim. This is what makes it easy to take on rounds or have with you when seeing patients.
So these characteristics enable its usefulness, while its usability and numerous apps are what make it sprint past the others. I’ve seen a 3-year old pick it up and quickly start interacting with it, making it easy to use for even the most computer-phobic physician. It’s ready communication abilities – texting, e-mail, phone (via VoiP, like Skype or Google Voice), and web tools like Twitter and Facebook -- make it a handy communication tool, though often a smartphone will take over for these functions.
The numerous medical apps are particularly useful. Epocrates and Medscape help you look up medications and drug interactions. I also keep Stat ICD-9 and Stat E&M to look up codes (a necessity for hospital-based psychiatry). I have Dragon Recorder to dictate when I’m away from my MacBook, where I have Dragon MacDictate installed (works great). Keynote is great for viewing and creating presentations. GoTasks syncs with my Google account for to-do lists. And I also have Citrix, allowing me to log in to my hospital’s EHR to access patient charts, and enter orders and even notes.
There are many other great apps out there for the psychiatrist, though I’ve only used a couple. There is a free PHQ-9 tool, STAT Depression Screener, which is basic and has some limitations, such as providing a “provisional diagnosis” of, say, “Major depression, moderately severe”) and insufficient response to the self-harm question. It also has the MDQ, as well. It appears to be written more for a clinician than for a patient.
One of the most well-used apps, with over 400 reviews on iTunes, is the free My Mood Monitor app, aka M3. The current version of the app is called “depressioncheck.” This one is exceptionally well-done and is designed for the patient. It uses a published, validated, 3-minute, 27-item tool to assess risk for depression, bipolar, and anxiety, including PTSD. Patients are using it weekly to monitor symptoms and report to their provider. Another version of it can be bought by a physician, with codes given out to patients for them to monitor their symptoms, which are reported back to a secure web portal that the physician has access to. The patient tracking screen is very intuitive, with a graphic display for symptoms. Unfortunately, there has not been an update for iOS5 and the app crashes now if you have the latest Apple operating mobile system. The web version is mymoodmonitor.com. (Disclosure: I’ve known the author for the past year and have provided suggestions to improve the function.)
The other big area for iPad apps is for EHRs. There are a number of EHR apps that are mobile extensions of a more robust EHR that you might have installed in your office or hospital. Examples are Epic Canto, Epocrates EHR, and Allscripts Remote. The killer app in this area may be a self-contained EHR that is entirely iPad based but also accessible through a secure web connection. The APA will soon have a way for members to rate their experience with different EHRs, including iPad EHRs. This will help those of us who are just starting to think about moving off paper. For others, the risks of going electronic may still appear to be greater than the benefits.
I’d like to hear about other apps that psychiatrists have found to be useful for their “electronic black bag.” Please feel to add your experiences in the Comments section. (Next week, Dinah will talk about her love affair with Siri.)
<[QM—Steven Roy Daviss, M.D., DFAPA