Twice as many physicians are using iPhones this year, compared to the number of physician-users from only one year ago, according to an April 14th news release by Manhattan Research, LLC—a pharmaceutical and healthcare market research firm. As we take a look at applications (“apps”) for fetal, heart, and general patient care, you may begin to see what they have to offer ‘twice as many’ of you.
Real-time updates for OB/GYNs
The AirStrip OB app, from AirStrip Technologies, offers a priceless service, even before a child is born. Using the iPhone, physicians receive real-time fetal heart tracings via the OB application. “If I can cut 5-, 10- or 15-minutes [off the time it takes to receive that data], that will make a dramatic difference in outcomes,” says end-user Bryan K. Iriye, MD, OB/GYN of Las Vegas, NV.
OBs log-in to the AirStrip server via their iPhones from anywhere they receive service. The application presents real-time waveform and other data including fetal heart tracings, contractions, patterns, nursing notes, vital signs, and exam notes. “The application displays the fetal strip, multiple pages of nursing notes, cervical exam status, patient name, room number, and other useful data,” says William Cameron Powell, MD, the president and chief medical officer of AirStrip Technologies.
When a hospital calls, Iriye logs-into AirStrip OB to interpretcurrent data. “If a patient is having contractions, I am able to give a therapy [medication], and then—before the nurse calls back—I can look at what the response is and determine whether I need to give more,” says Iriye.
Before AirStrip, if a patient had an abnormal fetal heart tracing, Iriye would have to wait for the fax. This could take 20- to 30-minutes. Now, he logs-in on the iPhone, views the tracing and instructs the nurse for immediate action.
Before AirStrip OB, doctors retrieved patient data by calling the nurses and asking them to describe the waveform or fax it over, Powell explains. Some doctors used PC-based solutions from perinatal vendors, Powell adds, though these are not widely adopted (doctors are not chained to PCs). “AirStrip OB was designed so that, when the demands of the doctor’s day periodically took him away from the hospital, he would have access to this critical data any place, at any hour,” says Powell.
Put into practice
Iriye once used the technology to monitor a patient having pre-term contractions. Physicians may give the indicated medication three times, but it carries the risk of increased heart rate. Iriye gave the medication after the patient’s tracing showed contractions.
“I logged-in after 30 minutes and the tracing still showed some contractions, but they had decreased. I knew the patient’s pulse was elevated because I could see the vital signs. I knew I could not give the patient any more medication and that she was probably dehydrated. I called the nurse and said, ‘I see her pulse is high, so lets give her some hydration IV.’ The nurse asked, ‘How do you know this?’ I was just logging-in,” Iriye says.
Iriye has seen abnormal tracings where he has had to advise doctors to deliver the baby immediately. According to Iriye, it only takes 10- to 15-minutes for a bad heart tracing to cause damage—or 30 minutes for an abnormal tracing to potentially cause harm. “AirStrip OB provides me with immediate, accurate, real-time information. It enables me to provide care I could not have provided in the past because I would have to have been in every single hospital at the same time,” says Iriye. It also decreases liability and lawsuits because the doctor can recognize problems more quickly, and avoid them.
Good for the heart
Subha V. Raman, MD, of the Ohio State Medical Center at Ohio State University in Columbus was searching for “ready access” to cardiovascular imaging studies in a format useful to physicians performing cardiovascular procedures and to referring cardiologists, cardiothoracic surgeons, internists, and house staff. What she found was the Enterprise Picture Archiving and Communications System (PACS) solution offered by Heart Imaging Technologies (known as HeartIT)
“The Enterprise PACS system has multiple rack-mounted servers capable of supporting heart hospitals like the one at Ohio State University (OSU), for example. We manage all the cardiac modalities for OSU. We receive as many as 500 cases a day from them,” says Brent Reed, marketing specialist of HeartIT. Overall, the Enterprise PACS system stores more than 180 million heart and procedure images across all installations including those at Wake Forrest, Johns Hopkins, and Ohio State. HeartIT has installed the Enterprise PACS system at major academic medical centers in the United States, Europe, and South America.
The solution facilitates quick comparisons between a patient’s present exam and prior studies including cath images, CMRs, and echos, according to Raman. It also enables point-of-care imaging information availability.
With appropriate PACS systems for three different levels of healthcare, HeartIT has made heart images available across the healthcare industry. “Doctors are able to arrange images such as stress perfusion, rest perfusion, and delayed enhancement at a given section through the heart,” says Raman. Doctors can e-mail the arranged images to the referring physicians using HeartIT systems. “HeartIT makes it easier to review a broad spectrum of information in a single platform,” Raman says.
A parallel system to HeartIT, the Private Practice PACS system, is not quite as scalable as the Enterprise version, but is suitable for practices that store a terabyte in images over a two- to three-year period, according to Reed.
Doctors in private practice use Private Practice PACS for long-term medical image storage and global secure access. Physicians view and interpret patient medical images anytime, anywhere from their iPhones (or any device that uses a standard Web browser such as Internet Explorer, Firefox, or Safari). The technology is available for any size medical practice. Both the Enterprise and Private Practice systems include hardware installations at the customer site.
HeartIT also designed a third parallel system, the Software as a Service based product called SaaS PACS, for smaller healthcare providers or practices that do not have large imaging needs or enough hardware to support them. “The SaaS product doesn’t require the user to have anything in the way of hardware. Doctors send scans directly to our SaaS hardware, then access those scans by logging-in [via a Web browser],” says Reed. With these three multi-level offerings, HeartIT intends to reduce costs for any size medical practice.
Finally, doctors use a HeartIT Clinical,Trials system to upload medical images to share with their colleagues. Physician students view images via the Physician Training Center and take online tests to increase their knowledge. Anyone can use this software for free at www.webpax.com.
iChart options, too
Chiropractor Alan J. Arnone, DC, of Santa Clara, CA, was looking for a replacement for daily Subjective, Objective, Assessment, and Plan (SOAP) notes and paper exam forms, when he came across the iChart app with iNotes. Additional modules for the application are even more likely to be used by doctors, especially the iPrescribing capability. “My favorite feature is the iNotes,” says Arnone. The iNotes module completes, exchanges, and accesses electronic notations.
“I see about 20 patients a day. There are two other doctors in this practice here using the same application,” Arnone says. “My shorthand notes are meaningful to me—quicker—but they are not necessarily meaningful or legible for anyone else. That is where the application saves the time. I don’t have to go back and rewrite, copy, or translate what I did,” says Arnone. The iChart app is fast and glitch-free, he adds.
The iChart digital medical assistant was the first electronic medical records (EMR) application available for Apple hardware, according to Tom Giannulli, the president and chief executive officer of Caretools, maker of the iChart and iChart Sync for iPhones. Before iChart, doctors had to use handwritten notes or larger EMR systems via PCs. “EMR systems are not really well adopted,” notes Giannulli.
The iChart app (www.caretools.com) keeps patient data organized using iPrescribing, iBilling, and iNotes. The product’s iPrescribing feature—a form of e-Prescribing—helps doctors to prescribe and administer medications while cross-referencing patient meds with pharmaceutical databases. “It eliminates legibility issues and call backs and ensures that patients receive their medication the first time they walk into their pharmacy,” says Giannulli.
iBilling records and submits accurate billing information employing all of the ICD-9 codes. The iBilling module simplifies the selection and assignment of billing codes associated with procedures and diagnoses for insurance company claims submission, according to Giannulli. “The application provides an easy hierarchical menu for finding and selecting the right codes,” says Giannulli.
The iChart Sync (www.caretools. com/about_ichartsync.html) securely syncs and exchanges data between iChart for iPhone and the practitioner’s desktop computer. The software is free for one year.
Interested in syncing with some of these medical apps? Visit the iPhone Apps Store or the respective product sites to learn more.
March 1, 2017
Iltifat Husain, M.D.
