Have your patients closely monitor their pain levels—with a series of taps. Keep a list of articles from medical journals you want to read—and have them laid out instantly in a digital magazine format. Calculate disease scores—on the fly with the touch of a screen.
It’s good, old-fashioned medicine done the new-fashioned way.
With apps, of course.
The available sea of apps for rheumatologists—those specific to the specialty and others that just make it easier for all doctors to do their jobs—is widening inexorably. So we asked some tech-savvy doctors for their thoughts on a few notable apps and to point us to others that are highlight worthy. It’s an update to a rundown of apps we previously published (“Apps Put More Rheumatology Information at Fingertips,” June 2012).
Apps are becoming so infused into the practice of medicine that, in September 2013, the FDA announced that it will begin regulating mobile medical apps, treating them as medical devices. The FDA describes these apps as those intended to be used as accessories to a regulated medical device, or those that transform a smartphone itself into a medical device, with the use of such things as light, vibrations or a camera.
The FDA also announced that it is beginning to exercise “enforcement discretion” over apps that do such things as help patients self-manage disease, communicate their condition, provide easy access to information on medical conditions and provide an easy way to access medical health records.
Apps named by rheumatologists tend to be skewed toward the iPhone and iPad, which is in keeping with apps for those devices outnumbering Android apps by about a 3-to-1 margin, although technology observers say that gap is closing.
Here are some apps to keep on your radar screen (and, if you prefer, your smartphone screen):
DAS Calculator (free; upgrade for more formulas, $1.99; iPhone, iPad, iPod touch): This app allows for quick calculation of disease activity scores, with a clean look and simple, odometer-style wheels to input variables.
The free version comes with DAS 28. The upgrade comes with formulas for Clinical Disease Activity Index (CDAI), Simple Disease Activity Index (SDAI) and Routine Assessment of Patient Index Data (RAPID 3).
Paul Sufka, MD, a rheumatologist with HealthPartners in St. Paul, Minn., and who produces a rheumatology podcast with Suleman Bhana, MD, a rheumatologist with the Atlantic Health System in New Jersey, says this is his choice when calculating these scores.
“This is my favorite of the disease activity calculators for iOS (iPhone),” Dr. Sufka says. “The in-app upgrade for a number of other useful calculators is $2 and is highly worth it.”
HealthTap (free; iPhone, iPad, Android): This app creates a digital village of doctors who field questions from patients, with the disclaimer that they’re not providing medical advice and that patients should seek their own health professional.
The app—and website—has generated coverage by the mainstream national media. So far, almost 2 million questions have been answered, according to HealthTap.
To answer questions, users must be verified physicians.
Still, the app should be approached with caution, Dr. Sufka says.
“I’m a bit wary of a place where I might be providing medical advice to a patient I haven’t met in person and might not have all of their information,” he says.
Tracy Lovell, MD, a rheumatologist with the Northeast Georgia Diagnostic Clinic, Gainesville, Ga., who has posted answers on HealthTap, says she participates carefully.
“You always recommend that they see a health-care provider,” she says.
But she says, “it’s just nice to be able to help and educate patients.” Plus, for a doctor who might be new to an area, particularly a tech-savvy area, posting on the app might help get his or her name out.
“You’re trying to get your presence out and about, so it is a good marketing (tool),” she says.
MyRA (free; iPhone, iPad, iPod touch): Because information about pain and disease activity is crucial for rheumatologists to treat their patients optimally, it makes sense for patients to have a tool that makes it easy for them to keep tabs on their disease activity and report it to their rheumatologist.
MyRA sets out to do this. If patients have severe pain in the knee, they can tap a dot for that, until the dot turns red, denoting a high pain level. If the pain is mild, then fewer taps will do, and the dot can be, say, green.
Patients, in this way, can also record fatigue, functionality, stiffness and other important parameters. Then, at a glance, they can see how they’ve done over a period of time, with an array of colors populating a calendar. The doctor can see how they’ve done, too.
A two-page summary can be printed and brought to appointments.
Dr. Bhana says the app “does a decent job in keeping the patients mindful of their condition and enables a better dialogue between patient and physician.”
But since it was developed by lab company Crescendo Bioscience, “There may be some bias issues in recommending it to patients,” he says. “Many organizations have a zero-tolerance policy toward industry-sponsored products.”
3D4 medical apps (mostly $9.99; for iPhone and iPad, with some options available on Android): This slate of anatomy apps offers high-resolution views of the human body, with animated videos on disease states. The app allows users to slide their finger across, say, an image of a hand, then see a corresponding, cross-section view. Users can label the images and test their anatomy knowledge, as well.
Options include Hand and Wrist Pro III, Shoulder Pro II, Knee Pro III, Spine Pro III and many others.
“Anything by 3D4 Medical is essential for point-of-care patient education,” Dr. Bhana says. “The prices are reasonable for such a high-quality product.”
Docphin and Docwise (free; Docphin available on iPhone, iPad and Android; Docwise only on iPad): These apps help doctors keep up with their medical-journal reading—without the medical journals.
They can all be accessed in one place, and users can choose topics and authors to follow.
The app also gives quick access to medical news articles, with Docwise laying out users’ chosen articles in a magazine format.
Dr. Bhana says this is his preferred way to keep up with his medical reading.
“You can get the abstracts of any journal you want,” he says. “If you have journal access you can view the PDFs via the app.”
(Also see Mobile Health Devices May Have Limited Use in Rheumatology.)
Thomas Collins is a freelance medical writer based in Florida.