Time was, lab coat pockets were stuffed with folded papers, laminated drug cards, obstetric wheels and other tools of the medical trade. Today’s residents and medical students are more likely to carry mobile phones loaded with apps that assist them on their rounds.
They may not realize an Upstate connection.
Joshua Steinberg MD, a clinical professor and alumnus, collaborated with computer science students from SUNY Binghamton to create eight medical apps available for download in the iTunes store, and he’s got four more in development.
The apps, designed for clinicians and students, provide “decision support,” putting information at the point of care. No need for a computer.
“Doctors want quick information. They don’t want to have to sit down and open up a textbook and go read an entire chapter. Doctors want answers within 10 seconds,” Steinberg says. “Actually, this has been studied. They’ve had medical students follow doctors around in various settings just to see in the course of a busy day, how often does a doctor have a question that comes up that they don’t have an answer for? It comes up an average of 10 times per day, and 80 percent of the time, they don’t seek the answer.”
Instead, a doctor will decide he or she can get by without the answer by taking an educated guess and making adjustments later, or by referring the patient to a specialist, or by ordering additional tests. “We compensate in all kinds of ways,” he says.
Which is why he decided to delve into mobile information.
Steinberg says in the early 2000s, he was a “big-time user” of Palm-Pilots, hand-held personal digital assistants. By the late 2000s, he was wishing for some tools that weren’t available, and about the time he got comfortable with Palm Pilot software construction, the Palm Pilot went the way of the dinosaurs. So Steinberg looked into creating apps for the iPhone and discovered that “you actually have to know what you’re doing as a programmer.”
So he called Madhu Govindaraju PhD in the computer science department at SUNY Binghamton.
Govindaraju chooses a graduate student or senior undergraduate who has an interest in learning Apple programming and who needs an independent project. The student works together with Steinberg and Govindaraju to produce the app. “They get to be involved in a real world project,” Govindaraju says.
Steinberg says, “I liken it to building a small house. I don’t know how to build a house, but they do. They know how to do the foundation and the plumbing and the wiring. They frame the structure. I come in and put up the drywall and decorate.
“I have a vision for what I want the software to look like and how doctors will use it. So we have to go back and forth on design interface.”
Learning how to make Apple software may take the student four or five months. “Once they build me a basic structure for an app, then I’ve been able to adapt it and change it into a few other apps within days or weeks,” Steinberg says.
He has not produced apps for Android phones because it’s difficult enough to build for a single platform.
The apps Steinberg creates are free.
“I’m an educator. I train students and residents, and I want to make tools that help them. I want to make tools that help my colleagues. So I want to share them,” Steinberg says. Also, he cannot monetize someone else’s property. He takes existing information, such as guidelines from various medical societies, and makes it available at the fingertip as an app.
Jeremy Joslin MD, fellowship program director of emergency medicine at Upstate, has created three of his own Apple apps, including the running log, iRun, for $3.99, and the popular Joslin Chest Atlas, for $14.99.
“I sort of got into the business when I was a resident, when I was poor and starving and I needed an extra $10 any way I could get it,” Joslin says. As an undergraduate human biology major, he worked in the information technology department for an insurance company and had an interest in computers.
He soon realized that Apple did not make it easy for programmers to create apps. The coding is complicated, but so are the efforts to get a completed app offered in the iTunes store. As he mastered both, Joslin formed a company that creates apps for hire and recently finished a project for the New England Journal of Medicine.
Joslin now plans to turn the Joslin Chest Atlas app, an interactive collection of radiographic chest images, into an Apple textbook. Using tools Apple makes available for free, authors can include video, audio and interactive quizzes on the pages, something Joslin believes will further revolutionize education.
Meanwhile, Steinberg has heard from faculty from other institutions, who use his apps to teach certain subjects. He has tallied 90,000 downloads of his apps, worldwide, and he says many of the reviews posted on iTunes are in languages he cannot read.
His “ABG Acid-Base Eval” app has more downloads than all of his other apps combined. It helps providers analyze blood gas results, something a few other apps claim to do.
“My app is different. Mine is educational,” Steinberg says. “You type in the blood gas results, and then the app walks users through a thinking process. Look at this number. Is it normal, elevated or depressed? Second, look at whether this is a breathing problem or a metabolism problem. Each screen tells you about metabolism or the lecture you long since forgot from medical school. Then it summarizes what you, yourself, have discovered, and says to go look at these options.
“Each time you use it, you learn the material a little bit more. It shows the thinking process, and you decide whether you agree with it, whether it makes sense, whether your patient is a special case.”
Steinberg’s newest app, being developed a senior resident, will help evaluate pulmonary function tests. Other residents are working with him on a “Pap app,” which will use the latest guidelines on Pap smears and cervical cancer screening to answer every question a doctor might have about what to do for various results. He is also collaborating with the Broome County Health Department on an app for screening for lead poisoning, and he is two-thirds of the way done on an app for concussion management.
In decades past, the “best” doctor was the one who could remember the most. That’s not as true today. Steinberg tells residents and students to “study hard. Learn as much as you can, but recognize that you can’t know everything. You can still provide good care if you know how to look everything up.”