Our goal with this survey: Find out what healthcare professionals want in a tablet and how well Apple’s iPad fulfills those wants.

Let’s see what we found out from our survey results:

Majority of Healthcare Professionals Are Likely to Buy a Tablet

This chart shows how likely respondents are to purchase a tablet for healthcare use in the next year.

When nearly a dozen new tablet devices were shown at the Consumer Electronics Show earlier this year, it looked like 2010 was going to be the year of the tablet’s emergence as a consumer gadget.

Judging by the survey data above, 2010 also may be the year of the tablet’s emergence in healthcare. Of the respondents to the survey, 54% said they were either very likely or somewhat likely to purchase a tablet for healthcare use over the next year. That’s good news for tablet makers.

Tablet Tasks

This chart shows what percentage of respondents want to use a tablet for a particular task.

Healthcare workers want to use tablets for a wide variety of tasks. A majority of our respondents said they wanted to use a tablet for all of the above tasks except for billing, coding and claims.

Ease of Use and Software Selection are Top Reasons for Tablet Selection

This chart shows what criteria is most important to survey respondents when purchasing a tablet.

According to survey results, ease of use is the major purchase reason for a majority of healthcare professionals. That may fare well for the iPad. Why? The iPad runs on the popular iPhone operating system. Thousands of doctors are already using iPhones in clinical settings.

In addition, the iPad has a finger touchscreen. Of our healthcare respondents, 63% said they preferred a finger touchscreen over styluses and voice dictation when asked about their data input preference. Many of those same people said that the speed of the data entry was the determining factor when noting a preference for the finger touchscreen.

How important is quick data entry in healthcare? Here’s what one respondent had to say:

As an MD in the ER, I am the most ‘expensive’ employee … doing data entry. The available software for data entry for my physicians is rudimentary at best. Speed is the key. I need to be able to see 30 patients in 8 hours and FULLY document the visit in a time-efficient fashion.

In the case of healthcare workers, ease of use could appears to at least partially equate to speed of use. The iPad’s operating system and touchscreen would appear to have both criteria.

In terms of medical software selection, the iPad lags far behind virtually every other tablet on the market. Despite having over 5,000 medical apps immediately available for download through Apple’s App Store, none of those apps are a functional EMR system or even remotely close to one. The vast majority of EMR software on the market today will not run on a Mac OSX operating system. Most require a Windows-based operating system to function.

The iPad may have an easy to use operating system helped by a finger touchscreen but those pros are nullified by that system’s inability to run the vast majority of medical software on the market today.

What Healthcare Wants, the iPad Doesn’t Have

After reviewing dozens of tablets on the market, both consumer focused and healthcare focused, we came up with the above list of “must-have” features for healthcare tablets. We asked our survey respondents to check all of the features they felt were “must-have” features in a healthcare tablet device.

This chart shows what percentage of respondents thought a feature was a “must-have” in a tablet.

Unfortunately for the iPad, as we found out last Wednesday when Steve Jobs unveiled the tablet’s features, it only has a few of the top “must-have” features for healthcare use.

The iPad has Wi-Fi access; lightweight hardware (1.5 pounds); and arguably an ergonomic design. That’s it from this list.

It lacks a large number of features that healthcare professionals deemed important, such as resistance to dust and hospital fluids and disinfectants (the iPad does not have sealed ports); fingerprint access to the system (HIPAA compliance); barcode scanning (patient safety); and an integrated camera (documenting diagnosis). In fact, you could argue that the iPad’s difficulty in being disinfected or kept clean of hospital fluids is a deal breaker for healthcare workers.

Peripherals, such as an RFID reader and barcode scanner, may be available in the future. But because they’re not native to the iPad, they’re just more cables and cords a busy healthcare worker has to lug around. That’s another negative mark for the iPad.

Also, as we mentioned before, the iPad does not have a wide selection of medical software because of interoperability issues with it’s operating system. A wide selection of medical software was voted as a must-have feature by 70% of our respondents. Most medical software on the market, EMR software especially, will only operate in a Windows-based environment. This presents a huge problem for the iPad in healthcare.

The Verdict

Healthcare wants a tablet. Healthcare likes the iPhone. That does not translate into healthcare liking the iPad.

Simply put, the iPad lacks many fundamental features necessary to function in the healthcare field. From the difficulty disinfecting the device to its lack of interoperability with the majority of Windows-based healthcare systems and software, the iPad in its current state suffers from many of the same problems that previous, failed healthcare tablet PCs have suffered from.

The iPad may be sleek and simple to use. But that doesn’t translate into widespread adoption by the healthcare industry. In fairness, it doesn’t appear that Apple was targeting the healthcare vertical; their bread and butter market remains the consumer.

Survey Comments

In our final survey question, we asked the respondents, “Why haven’t tablets become mainstream devices in healthcare?” Here are a few of the more interesting responses we received. They touch on a few topics we didn’t address here today. They are sure to spark more discussion.

• “Shoehorning a desktop OS into a tablet does NOT work. This has been the approach of Microsoft and hence no uptake. A modal interface like the iPhone is more suitable to touchscreen use and makes more sense in this setting.”
• “Why use a new product when old ones are properly doing their jobs?”
• “Lack of a streamlined, polished UI for task specific functions inclusive of each practitioner’s duties.”
• “I have worked in ERs that have them and they never seem to work.  Low battery life? Unstable software? Limited functionality, too (not integrated with imaging).”

Demographic breakdown:

• Health IT Professional: 29% (52)
• Physician: 28% (50)
• Nurse: 16% (29)
• Other: 14% (23)
• Student: 12% (22)
• Admin support: 1%  (2)

Here are 4 other ways we think Apple’s 3D head-tracking could be used in healthcare:

• MRI scans and X-rays – Gone are the days of the light box. Doctors will view MRI scans and x-rays in 3D from their tablet or smart phone. Fractures that were once difficult to find will now be easy to identify by looking behind the bone.
• Graphics & drawing – Some EHRs allow physicians to draw on anatomical diagrams or digital pictures and include them in the patient record. Using Apple’s technology, physicians could “draw with their hands,” like in this demonstration of Pranav Mistry’s “Sixth Sense.”
• Ultrasound – Soon-to-be mothers will appreciate this. Not only will you be able to view an ultrasound in 3D, Apple’s technology would allow you to view a fetus from all angles.
• Medical education – Some of the best selling iPhone apps are 3D human anatomy apps designed for med students. If head-tracking doesn’t become widely adopted by practicing physicians, at least it will be a cool way for students to memorize bones of the body.

These documents give us the clearest picture yet on what features physicians and hospitals need to look for in their EHR technology. They also tell us how that technology needs to be used to meet the definition of meaningful use during the Stage 1 (2011) EHR adoption period.

Among other things, these documents show us:

• How physicians and hospitals can achieve meaningful use in Stage 1;
• What software features your EHR technology needs to become certified; and,
• What the final rulings mean for CCHIT certification.

We’ll also look at a few points that the rulings didn’t address.

How to Achieve Meaningful Use in Stage 1

In the table below, we’ve combined the meaningful use objectives for both eligible professionals (physicians) and hospitals for the Stage 1 adoption year, the required EHR technology criteria to accomplish those objectives and what criteria the government will use to measure meaningful use.

CMS defines “meaningful use” as using an EHR for the objectives listed in the first column. The objectives fall under these general topics:

• Improving quality, safety, efficiency, care coordination, population and public health;
• Reducing health disparities;
• Engaging patients and their families; and,
• Ensuring adequate privacy and security protections for personal health information

For the first time, CMS has also outlined specific measurements for how the government will determine if an EHR is being used in a meaningful manner for the Stage 1 (2011) adoption year. Updated definitions of meaningful use for Stage 2 (2013) and Stage 3 (2015) EHR adoption periods will be released in the year before those periods begin.

This table outlines what Stage 1 objectives define meaningful use, what software features are necessary to accomplish those objectives and what criteria the government will use to measure meaningful use. EP refers to eligible professional.

How long does EHR software have to be used in a meaningful manner to qualify for incentive payments? In the first year of adoption, CMS states that a physician or hospital must be using an EHR in a meaningful manner for a minimum of 90 days in order to qualify for incentives. In subsequent years, the EHR must be used in a meaningful manner for the entire year.

The ONC’s interim final ruling details what software features EHR technology must have to become certified. Those criteria are listed in the second column. These criteria form the basis for the definition of “certified EHR technology,” which we discuss next.

To summarize, the government now has told physicians and hospitals what tasks they should be using their EHR for (meaningful use); what EHR software features are needed to accomplish those tasks (certified EHR technology); and how the government is going to measure those tasks to determine whether or not they are being performed to their satisfaction.

What EHR Technology Will be Certified?

Here is the ONC’s latest definition of certified EHR technology:

“A Complete EHR or a combination of EHR Modules, each of which (1) meets the requirements included in the definition of a Qualified EHR; and (2) has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the [ONC].”

In a nutshell, as long as the EHR software meets the software certification criteria laid out in the table above, an integrated EHR software suite or combination of best of breed EHR modules is going to fall under the ONC’s definition of “certified EHR technology.”

CCHIT Certification

Within the available EHR universe are a number of EHRs certified by the Certification Commission for Health Information Technology (CCHIT). The ONC feels that 90% of the EHRs that are CCHIT-certified (~80) will become certified under their proposed certification criteria. The ONC also feels that a significant number of the remaining EHRs will require only minor upgrades to comply.

As we’ve noted before on the Software Advice blog, CCHIT-certified systems are a good bet if you want to qualify for incentive payments. If you want to find out more about these systems, take a look at our list of CCHIT-certified EHRs.

What was left out of the final rulings?

What body will be doing the certifying? This wasn’t made clear and is already a point of contention between the ONC and many healthcare organizations.

Who will enforce the meaningful use measures? Again, this is not clear in the documents released. The measures are clearly defined. What body will enforce them is not.

By now you’ve heard about the $850 billion American Recovery and Reinvestment act of 2009 – the stimulus bill recently passed by Congress. The bill is aimed at spurring economic growth across multiple industries by way of government spending.

What’s in it for you?

Well if you are a healthcare provider, you can take advantage of the $51 billion that has been allocated to the health care industry, $19 billion of which will be used to incentivize medical practices to adopt and implement Electronic Health Records (EHRs), also known as Electronic Medical Records (EMRs).

How does the subsidy work?
Starting in 2011, providers deemed to be “meaningful users” of EHR systems will be eligible to receive $40,000 – $60,000 in incentive payments paid out over five years in the form of increased Medicare and Medicaid premiums.

For the first year a physician is deemed to be a meaningful user, he or she will be eligible for payments of 75% of that year’s Medicare and Medicaid charges, up to a maximum of $15,000. The maximum payment is increased to $18,000 if the first year is 2011 or 2012. The incentive payments decline for each subsequent year within the five year period; $12,000 will be paid in year two, $8,000 in year three, $4,000 in year four, and $2,000 in year five.

No incentive payments will be available after 2015, and no payments will be offered to physicians who first become eligible after 2014. This creates a decreasing incentive for late adopters.

What is a “meaningful user”?
To qualify as a “meaningful user,” eligible providers must demonstrate use of a “qualified EHR” in a “meaningful manner.” The bill defers to the secretary of Health and Human Services (HSS) to set specific guidelines for determining what constitutes a “qualified EHR”; however, it does specify that e-prescribing, electronic exchange of medical records, and interoperability of systems will be determining criteria.

HSS will be working throughout 2009 to set the necessary criteria for certifying systems, and is expected to have a final report by January of 2010. Many expect CCHIT certification to play a major role in setting standards of interoperability. (See “Should CCHIT Influence Your EHR Selection” for more information). After all, HHS funded the creation of CCHIT to start certifying EHRs a few years ago.

View a list of CCHIT Certified EMRs/EHRs

How do I qualify for the maximum payment?
In order to receive the maximum payment, physicians must qualify as a meaningful user in 2011. Eligible physicians will receive a first year bonus of $18,000 (up from $15,000) and will max out the payment schedule over the next five years.

The table below illustrates the amount of a subsidy paid each year (columns) based on the year the provider first becomes eligible (rows):

No payments will be offered to physicians who first become eligible after 2014.

Practices with multiple physicians will be eligible to receive incentive payments for each provider. Remember that payments will be based on 75% of the correlating year’s Medicare and Medicaid charges. Therefore, in order to qualify for the maximum payment of $18,000 in the first year, each provider must bill Medicare or Medicaid a minimum of $24,000.

Should I purchase an EHR now or wait until 2010?
An obvious concern is whether an EHR implemented in 2009 will meet the standards set by HHS in 2010. Although a legitimate concern, waiting until 2010 to implement a system may be a mistake. Researching and selecting the right EMR can be a lengthy process, and many providers who wait may find it difficult to have a system in place in time.

Practices would be well-served to begin the research process now, allowing ample time to create a short-list of systems, perform demos with several vendors, check references, meet with vendors in person, negotiate terms, and complete the implementation and training process. To alleviate buyers’ concerns, vendors may provide binding agreements, guaranteeing their system will comply with all emerging standards.

Furthermore, buyers’ should consider CCHIT an important Certification relative to the requirement for “qualified EHRs.” While we have discussed the many opinions for and against CCHIT, we expect it to play a critical role in the EHR subsidy qualification.

What if I choose not to purchase an EHR?
Unfortunately, for physicians who choose not to implement an EHR, the stimulus bill is a double-edged sword. Not only will they forego thousands in incentive payments, but starting in 2015, they will be penalized by way of decreased Medicare and Medicaid payments. Physicians who fail to qualify as meaningful users will face decreases of 1% in 2015, 2% in 2016, and 3% in 2017, with a maximum reduction of 5% by 2020.

Bottom Line
Although each physician’s individual situation will dictate whether or not they choose to implement an EHR, the unique opportunity offered within the stimulus bill should not be overlooked.

Practices understand that up to $45 billion is allocated to provide incentive for physicians to adopt EHRs. However, many questions remain about how and when providers will receive stimulus funds.

We teamed up with Justin Barnes, Chairman of the HIMSS Electronic Health Record Association and Vice President of Greenway Medical Technologies, to help answer these questions. The original presentation was delivered last week, however you can view the entire webinar above. In this hour webinar, you’ll learn:

• How the stimulus money will be paid out
• What it takes to qualify for funding
• Which specialties qualify for funding
• How “meaningful use” is defined
• What constitutes a “qualified EHR”

Our answer: No.

We believe the chances of not qualifying for stimulus funds are next to zero, so long as you make smart decisions based on existing working definitions of meaningful use and certified electronic health record software. We know enough today to make the right purchase and implementation decisions.

There is another philosophy behind our answer: the stimulus opportunity is making too many practices lose sight of the real benefits of an EHR transformation. Focusing solely on government subsidies distracts practices from setting the right goals for the EHR project (e.g. quality of care, efficiency in the office). Without well-aligned goals, implementations fail.

Certified EHR Technology and Meaningful Use are Nearly Finalized

Update 1/7/09: Final interim rulings on meaningful use and certified EHR technology have been released.

The Health Information Technology for Economic and Clinical Health Act (HITECH Act), signed into law as part of the American Recovery and Reinvestment Act of 2009 (ARRA), created compelling financial incentives for physicians and hospitals who adopt electronic health records over the next five years.

If you do the proper research and follow the recommendations that have been made public, it’s nearly certain that you will qualify for ARRA incentives. Delaying an EHR software purchase not only defers the cost savings of using the software but also puts you at a disadvantage as EHR vendors become busier and busier in the coming year. Those that wait may find that their software vendor of choice is overwhelmed with other customers.

EHR Benefits Greater Than Stimulus Incentives

ARRA incentives begin in 2011 (assuming 2011 is your first year of being a meaningful user) and decrease over the next four years. Below, we put these incentives in the context of other return on investment (ROI) that you could realize from a successful EHR implementation. The takeaway is that ARRA incentives are significant, but they are just one piece of the EHR value proposition.

ARRA incentives represent just 29% of the five-year ROI on a successful EHR implementation.	Over a five-year period, ARRA incentives represent a decreasing portion of total EHR ROI.
Source: Electronic Health Records: A Guide for Clinicians and Administrators, Jerome Carter, MD, FACP

The five-year savings of a full EHR implementation ($151,620) far outweigh the ARRA incentives ($44,000) over the same time period.

What does this mean for your practice?

You’re not buying an EHR to to receive the ARRA incentives. You’re buying an EHR to help you manage your practice more effectively, reduce costs and improve patient care. These are the goals that should drive your decision making.

The potential ARRA incentives for adopting an EHR are substantial. Over five years, the savings may be up to $44,000 for Medicare providers and up to $63,750 for Medicaid providers. But the benefits of choosing the right EHR for your practice are greater over a longer period of time. If you can choose an EHR that is right for you and is also eligible for ARRA incentives, then all the better.

Let’s move on to what eligible professional, certified EHR technology and meaningful use mean in the context of the HITECH Act so you can better understand how to select your EHR software.

Eligible Professional Defined

This is the most straightforward section of the HITECH Act – defining who an eligible professional is.

Under Medicare, an eligible professional is a:

• Doctor of Medicine and Osteopathy
• Doctor of Dental Surgery or Dental Medicine
• Doctor of Podiatric Medicine
• Doctor of Optometry
• Chiropractor

Under Medicaid, an eligible professional is a:

• Physician
• Dentist
• Certified Nurse Mid-Wife
• Nurse practitioner
• Physician Assistant (Rural Health Care Clinic/FQHC)

You cannot “double dip.” You can only qualify under one program – either Medicare or Medicaid. The ARRA incentives will be payed out as Medicare or Medicaid reimbursements.

CCHIT

In 2006, the Certification Commission for Healthcare Information Technology (CCHIT) became the first group designated a Recognized Certification Body by Health and Human Services. CCHIT is not a government entity, but a non-profit, third party that certifies EHR software based on a number of stringent standards.

Right now, CCHIT’s certification criteria for EHR software is the closest guide for what may be deemed the final certification standards criteria used by the United States government. Therefore, we believe that most any EHR with recent CCHIT Certification (i.e. 2007 or later) will qualify under the ARRA program.

However, in August 2009, the federal Health IT Policy Committee recommended that multiple entities be recognized as EHR certifying bodies in the interest of objectivity. In that August meeting, the committee discussed the possibility of up to a dozen certifying bodies in addition to CCHIT. It appears that CCHIT will eventually have some company as we move into 2010.

Defining Certified EHR Technology

On October 7, CCHIT announced two new levels of certification for EHR technology in 2011 and 2012: a) one designed to be comprehensive and exceed the federal standards; and, b) one designed to meet the federal standards for receiving ARRA incentives.

Here is CCHIT’s EHR software criteria for meeting the less stringent ARRA standards level (which are also covered by the comprehensive certification level):

If your EHR software has these features, you’re in good shape for getting reimbursed by the government for your software purchase. At the same time, keep in mind that not all specialties require all of these features. If the features do not apply to your specialty, they would not be a requirement.

Defining Meaningful Use

Becoming a “meaningful user” of EHR technology is another step in meeting the ARRA incentive standards.

This definition has caused big debates in the healthcare community over exactly what the government means. But as in the case of certification, enough information exists to effectively guide your purchase.

The Health IT Policy Committee, a federal advisory committee that provides recommendations to the National Coordinator for Health IT, released its final recommendation of the definition of “meaningful use” in August. These recommendations have been forwarded to the final decision makers – the Center for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT.

Here are the Health IT Policy Committee’s final recommendations for defining “meaningful use:”

• Provide access to comprehensive patient health data for patient’s health care team
• Use evidence-based order sets and CPOE
• Apply clinical decision support at the point of care
• Generate lists of patients who need care and use them to reach out to patients (e.g. reminders, care instructions, etc.)
• Report to patient registeries for quality improvement, public reporting, etc.
• Provide patients and families with timely access to data, knowledge, and tools to make information decisions and manage their health
• Exchange meaningful clinical information among professional health care team
• Communicate with public health agencies
• Ensure privacy and security protections for confidential information through operating policies, procedures, and technologies and compliance with applicable law
• Provide transparency of data sharing to patient

We recommend that you follow CCHIT’s ARRA certification criteria; use an EHR in a meaningful manner according to the recommendations above; and most importantly, choose the EHR software that is the best fit for your practice, regardless of ARRA incentives.

More than likely, the EHR you choose will qualify for incentives.

At Software Advice, we have noticed a big jump in the number of medical practices researching electronic health records (EHR). But are these practices ready to purchase, or has the Stimulus only reinvigorated research?

Are more doctors buying electronic medical records than before? Or, has the Stimulus bill only brought out the tire kickers?

Last week we posted a survey to find out what the industry consensus is. We sent a message to our favorite medical bloggers and posted a few tweets to help spread the word. Thanks to all who participated!

We tallied up the results this morning and a clear winner has emerged. Roughly half of our participants believe the Stimulus Bill has only reinvigorated research among doctors and health IT staff, creating a growing pool of “tire kickers.” 20% of voters think more doctors are buying EHRs, while 19% think the bill has had no affect on purchase decisions. Finally, another 12% of voters answered “other” and left us with a comment. Here are their remarks:

Medical practices have until 2014 to take advantage of the HITECH Act incentives. We’ll be keeping track of EHR buying trends until then, so be sure to check our blog for new reports. In the meantime, if you have a firsthand account of how the Stimulus has affected EHR adoption rates – or if you just want to speculate – feel free to leave us a comment below.

Choose your color scheme and number of posts to display below and simply cut and paste the code into your site. To see what the widget looks like, click Preview next to each one.

Here are the blogs in the widget:

We’re using Google’s RSS widget, which will automatically fit to the width of your blog’s sidebar. So don’t fret if the widget looks too big in the preview for your site.

Tip: If you’re HTML savvy, you can actually edit the widget to display as little or as many posts as you want. Look for the n= after TopMedicalBlogs? in the code and put in whatever number you’d like.

If you have any questions, feel free to contact me at (512) 364-0118 or by e-mail at chris@softwareadvice.com.

Widget #1 (Click here for preview)

Color: Blue

# Posts to display: 5

Code to cut and paste:

Widget #2 (Click here for preview)

Color: Blue

# Posts to display: 10

Code to cut and paste:

Widget #3 (Click here for preview)

Color: None/Basic

# Posts to display: 5

Code to cut and paste:

Widget #4 (Click here for preview)

Color: None/Basic

# Posts to display: 10

Code to cut and paste:

So, we decided to do the hard work. We hand picked a list of the top medical apps and separated them into 18  categories. Our approach was straightforward: remove the irrelevant results (e.g. “iPee”  and “Pimp My Ultrasound”), tag the rest with category names, sort by most popular and voilà. By the end, we went from 1,544 apps down to 55.

For reference, we discovered that only 733 apps could really be used in medical education or a professional health care setting. The rest were consumer-oriented applications (i.e. personal fitness, memory games, wellness, etc).

For all you app junkies (or those who simply have too much time on your hands), we’ve included the full list of 733 apps at the end of this post. You can view them in a Google Doc spreadsheet.

All-in-One

Medscape – Free – Features continually updated drug reference tools, specialty-specific medical news and mobile CME, physician & pharmacy directories and more. Save time when making decisions at the point-of-care with our fast and easy-to-use application.

Lexi-Comp Individual Application – Free – This application includes 30-days of access to all 32 databases (pharmacogenomics, medical abbreviations, protocols for medical emergencies, etc) Lexi-Comp offers for the iPhone and iPod touch. Hundreds of images, charts, and tables are available.

Skyscape’s Medical Bag – $1.99 – A highly useful collection of clinical tools including: over 30 Life Support information topics and guidelines; 50 Lab tests; over 185 Medical Calculators, and; continual feed of breaking medical news and information.

Anatomical Diagrams

Human Body 3D Anatomy – $3.99 – This application includes all the major systems of the human body, showing them with complete information using 2D graphics, extensive information and 3D animations too.

Muscle Head and Neck System – Free – This app is a high-end learning/reference application covering the muscles of the head and neck.

iAnatomy – $0.99 – Great for learning cross sectional anatomy as a student or for a quick refresher as a professional. Includes over 60 actual CT scans of the chest, abdomen, and pelvis. Separate tabs provide views of bone, muscle, organ, or blood vessel labels on each image.

Calculators

MedCalc (Medical Calculator) – Free – MedCalc is a free medical calculator, that gives you easy access to a wide array of medical formulas and scores. Includes Detailed information and bibliographic references for each formula.

Medical Calculator – $0.99 – Medical Calculator is an iPhone and iPod touch app that helps doctors and nurses compute useful formulas and equations. MedCalc supports US and SI units. Over 200,000 installs worldwide.

ABG – Free – A multipurpose medical calculator with functionality to: analyse arterial blood gasses; output a recommended FIO2, given a determined pO2, FIO2 and a desired pO2, and; perform hemodynamic calculations utilizing the Fick principle.

Cardiology

The ECG Guide – $4.99 – The most comprehensive ECG app in the app store, containing up-to-date guideline based content with over 200 illustrative high resolution examples of common and uncommon ECGs.

iMurmur – $0.99 – Teaches you how to recognize and diagnose heart murmurs. The heart sounds are presented in a rapid quiz format and are organized by clinical relevance emphasizing sounds you will encounter most frequently.

STAT Cardiac Clearance – Free – An educational tool that guides the user through specific elements of the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. Includes step-by-step cardiac evaluation and care algorithm for noncardiac surgery based on active clinical conditions, known cardiovascular disease, or cardiac risk factors for patients 50 years of age or greater.

Dentists

Orasphere – Free – Using Orasphere dental educational videos saves you time, reduces liability and increases patient case acceptance for your dental practice. Easily view Orasphere dental videos on your iPod or iPhone and start educating your patients today.

3Dteeth - $1.99 – This application includes: general information about teeth and mouth; 3D images of each tooth; dental caries, dental disease, causes, and; dental implants, kinds, benefits of dental implants.

DAT AudioLearn – $14.99 – DAT AudioLearn is a complete audio study guide and test prep for the high yield science portion of the Dental Admission Test (DAT)

Clinical Decision Support

Diagnosauras DDX – $0.99 – This reference tool helps healthcare professionals perform differential diagnosis with speed and confidence at the point of care. With Diagnosaurus you can quickly search over 1,000 diagnoses by organ system, symptom, disease or view all entries.

ACC Pocket Guidelines – Free – This clinical practice support tool set from the American College of Cardiology Foundation includes the Transthoracic and Transesophageal Echocardiography (TTE/TEE) Appropriateness Criteria Tool which provides a list of common uses of echocardiography and a decision support application that helps guide physicians in the ordering of SPECT MPI for the detection and risk assessment of coronary artery disease.

Merck Manual of Diagnosis and Therapy – $49.99 – The Merck Manual of Diagnosis and Therapy is packed with essential information on diagnosing and treating medical disorders to help health care professionals and medical students deliver the best care.

Dictionary

Taber’s Medical Dictionary – $49.95 – Contains over 60,000 terms, 1,000 photos and more than 600 Patient Care Statements. Also included are medical abbreviations, symbols and units of measurement, immunization schedules, nursing diagnoses, and more.

Eponyms (for students) – Free – Brings a short description of more than 1,600 common and obscure medical eponyms (e.g., Rovsing’s sign, Virchow’s node) to your iPhone or iPod touch. A perfect tool to quickly look up the meaning of any eponym.

Medical Terminology and Abbreviations Quick Reference – $1.99 – Terminology is broken down into prefixes, stem words and suffixes, and then alphabetically. Abbreviations are stored in alphabetical order as well, and both have a quick scroll on the right side to instantly skip to the letter you’re looking for.

Drug Reference

Epocrates Rx – Free – A drug reference guide providing monographs for 3,300 brand name and generic drugs. This app includes information on dosing, adverse reactions, interactions, pharmacology, pricing and images of the medication. This is the #1 ranked free medical app in the App store.

Skyscape RxDrugs: Dosing Companion – Free – Provides dosing guidelines on thousands of commonly used brand and generic drugs and now includes nearly 400 integrated weight-based drug dosing calculators.

Davis’s Drug Guide – $49.95 – Delivers up-to-date, comprehensive, and practical information on over 5,000 trade name and generic drugs. This powerful app contains everything you need to provide premium care to your patients including information on dosing and administration, safety, interactions, patient teaching, and much more.

Eyecare

EyeChart – Free – A Snellen Eye Chart is an eye chart used by eye care professionals to measure visual acuity. While the classic Snellen chart is typically placed at 20′ or 6m, pocket-sized versions such as this one can provide useful screens for rough visual acuity.

Eye Test – $0.99 – A portable testing tool for near visual acuity, color test and visual illusion. It’s very useful for people who need to do visual acuity testing routinely.

EyeChart RandomEyes – $0.99 – A unique application that produces an infinite number of randomized eye charts to offer a rough but useful screen of visual acuity. Simply tap the image of the die to randomize the entire eye chart, or touch an individual line on the chart to randomize that series of letters.

Flashcards/Games

Diagnose the Disease Game – Free – Race against the clock to diagnose the disease and test your knowledge! This game challenges you to identify diseases as the images are revealed. Physicians, nurses, medical students or others interested in medicine will find this game interactive, educational and fun.

Speed Bones Lite – Free – A must have game if you are tackling anatomy for high school, university or medical school. It is more captivating than flashcards and practice mode allows you to learn specific regions without doing all the previous levels. Review mode lets you replay all the mistakes you’ made in the last game to facilitate learning.

Med Mnemonics – $1.99 – Medical Mnemonics puts over 1400 clever acronyms, rhymes, and memory tricks on your iPhone or iPod Touch, covering topics ranging from Anatomy and Biochemistry to Pharmacology and Surgery.

General Reference

Medical Encyclopedia – Free – This comprehensive and free medical reference is from the University of Maryland Medical Center, one of the nation’s oldest academic medical centers. It contains more than 50,000 pages of in-depth and consumer friendly medical information in both English and Spanish.

Skyscape Medical Resources – Free – A collection of free Medical Information and Decision Support resources for Healthcare Professionals, including Physicians, Nurses, Physician Assistants, Nurse Practitioners, Medical Students, Nursing Students, and more.

BLACKBAG Medical Resources – Free – BLACKBAG™ offers medical news, tools, and resources for healthcare professionals across 35+ specialties and therapeutic areas.

ICD-9 Look-up

STAT ICD-9 LITE – Free – All 13,677 ICD-9-CM diagnosis codes are now available in your pocket for quick retrieval by disease classification in a drilldown format with no typing. Code to the highest level of specificity every time. It works fast because it gives you only the information that you need – the diagnosis name and the ICD-9 code.

ICD-9 pcp – Free – ICD-9 pcp was designed by a practicing internist to meet the needs of primary care providers. Includes over 2000 hand selected ICD-9-CM codes commonly used by primary care physicians.

ICDMeister – $0.99 – The 2010 update taking effect 10/1/2009 is here. ICDMeister includes all of the 2010 ICD-9 diagnosis codes, not just a subset of codes. Includes a powerful search function that lets you search for abbreviations & acronyms (e.g. Afib, DM, CHF, SK, etc).

Lab Tests

Normal Lab Values – $1.99 – Displays normal laboratory values to help medical professionals interpret test results. Reference values are shown in US and SI units. Includes search field to find values quickly.

Pocket Lab Values – $2.99 – The perfect companion for medical students, residents, nurses, and other medical staff while working in a hospital. It provides quick access to common lab values, quick info about a particular lab value, as well has links to sites such as Wikipedia, Google, and MedlinePlus.

Medical Lab Tests – $5.99 – Offers short and concise information including normal lab values of the most common clinical laboratory tests. Designed primarily for physicians, nurses and medical students. The application covers more than one hundred blood tests.

Mental health

Mental Illness – Free – Mental Illness is a useful application that discusses the most important topics in mental health. This application is ideal for all medical professionals, medical residents and interns, nurses and medical students.

Psych Drugs – Free – Learn important and useful information about various psychotropic medications such as antidepressants, antipsychotics, mood stabilizers, and anti-anxiety medications. You can use the search box to type a psychotropic medication you are looking for, or you can scroll alphabetically through the list and quickly jump to a letter with an A-Z side panel.

PsychTerms – Free – Contains a rich selection of 1000+ frequently used psychiatric and mental health terms, phrases and definitions — concisely written for quick and easy review. Ideal for all medical and mental health professionals, psychiatric residents, medical students, psychology students, therapists and counselors.

Nursing

Informed RN Pocket Guide – $9.99 – Gives access to the critical information nurses need, in an easy to use app with rich content, detailed illustrations, and pioneering features. Includes vital assessment information, with updated and expanded sections devoted to cardiovascular, respiratory, neurological, pediatric, OB, GI/GU, and mental health topics.

Nursing Central – $159.95 – Helps nurses and students find detailed information on diseases, tests, drugs, and procedures. The moment a question arises you can consult the up-to-date database of 5,000 drugs, find a definition in the dictionary with more than 60,000 terms, interpret hundreds of lab and diagnostic tests, and discover the latest information on a disease.

Nursing Pharmacology – $0.99 – Nursing Pharmacology is a fully-featured flash card app that helps you learn about nursing pharmacology. Individual cards can be added to or removed from a built-in “Faves Deck” at any time. Use the “Faves Deck” to study only the cards that really give you trouble!

Pediatrics

Pedi STAT – $2.99 – A rapid reference for RNs, paramedics, physicians and other healthcare professionals caring for pediatric patients in the emergency or critical care environment.

STAT GrowthCharts Lite – Free – Calculate accurate growth percentiles and Z scores using the latest CDC Growth Charts including the Body Mass Index-for-age charts. Also calculates blood pressure ranges from the The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.

Pediatric Care Online (PCO) – Free – Published by the American Academy of Pediatrics (AAP) and powered by Unbound Medicine, Pediatric Care Online delivers fast, to-the-point guidance on the clinical problems pediatricians face in everyday practice.

Point-of-Care Patient Education

Blausen Human Atlas – $19.99 – The Blausen Human Atlas 2.0 combines 3D medical animations with a cross searchable medical term glossary and detailed still images. For doctors, nurses, students and consumer caregivers, this is the ideal resource for communicating core concepts, right in the palm of your hand and right at point of care.

Pronunciations/Translations

Anatomy Pronunciations Lite -  Free – Plays back audio of the correct pronunciations of many of the anatomy terms you have trouble with. Lite version has 100+ pronunciations. Full version has 700+ pronunciations!

Medical Spanish (with audio) – $6.99 – Written by physicians to help you obtain a history, physical, and manage a Spanish speaking patient in nearly any setting. Developed by a Mac and iPhone software engineer to provide you unsurpassed functionality with professional yet eloquent design. Triple reviewed by bilingual South American natives for accuracy and up to date terminology.

Drug Pronunciations Lite – Free – Simple application that will play back audio of the correct pronunciations of over 200 drugs used in medicine today. Be confident when pronouncing drugs by knowing how to pronounce them properly beforehand.

Study Guides

MedRef – $0.99 – This easy-to-use medical reference application is ideal for medical students and residents. It includes normal lab values, how to write service notes, and additional reference material that is useful while on the wards and in clinic.

BoardReview – Free – Busy students can prep for their board exams by reviewing electronic drug information on their iPhone or iPod Touch. nursing students can study electronic nursing review cards to prep for the NCLEX-RN, on their iPhone or iPod Touch so they can test their nursing knowledge anytime, anyplace.

MCAT Prep Chemistry – $4.99 – The most comprehensive Chemistry review tool for MCAT preparation. Covers General Chemistry and Organic Chemistry and includes over 500 pages worth of material.

To see list of all 733 medical apps, check out this Google doc.

At Software Advice, we just finished implementing a new phone system. It’s great! It got us thinking of how medical practices can take advantage of Internet Protocol – Private Branch Exchange (IP-PBX) phone systems to be more efficient and provide better patient care.

First, let’s get some definitions out of the way. A PBX is the system that routes phone calls to appropriate extensions within an organization. Actually, it can do a whole lot more (e.g. voicemail, auto attendants, etc.). To keep it simple, we’ll just say that it’s the system that manages the phone system within your four walls, rather than the big network of switches and routers that the phone companies use to move voice and data traffic around the country, or across the World.

PBXs have been around for decades. However, IP-PBXs are the newest breed of PBX based on Internet Protocol (IP) – the technology that makes the Internet work. So, they make it really easy to combine voice (i.e. phone calls) with data (e.g. patient information). IP-PBXs can exist as hardware or software; both have advantages and drawbacks. For example, software-based IP-PBX systems (e.g. 3CX Phone System) don’t require hardware, so it’s less expensive to implement and easier to manage using web-based interfaces.

Many other IP-PBXs are Asterisk-based. Asterisk is a collaborative project to build and maintain an open-source IP-PBX. It was started in 1999 and by now, it is pretty rock solid technology. And it’s free.

For the medical practice, we think there is a great opportunity to combine voice and data by integrating IP-PBXs with electronic health records (EHRs) and practice management systems. To our surprise, little has been developed in the way of medical-specific applications. We think that the leading EHR and practice management software vendors should integrate this open source technology into their systems. The combination could be intriguing.

So we decided to put together a list of ways IP PBX and EHR technology can be combined. A preliminary word of caution: Asterisk developers, make sure you understand HIPAA guidelines before developing any of these applications.

• Patient screen-pops – When a patient calls, caller ID recognizes their number and opens their patient demographic data in the practice management system. A dashboard view shows general demographics, appointments and recent encounter summaries. Of course, the system would require user-level permissions that limit available patient information by the user’s role in the practice.