SAN DIEGO — To talk to Nancy Allen, MD, a locum tenens physician who works in Portland, Me., is to get a sense of that head-spinning sensation you can have in the digital age. For hospitalists, it’s an endless stream of patients, diagnoses, documentation, and performance metrics. Following an HM16 session here, it’s also an endless litany of ways to try to make all of it more manageable.
Looking for on-the-job shortcuts, Dr. Allen attended the session “There Is an App for That, 2016: Update in Hospital Medicine Mobile Applications.”
“You always feel like there’s too much information,” she said. “I do 14-hour days. To add anything that takes time is crippling.”
The session was helpful, she said, with eye-opening presentations on apps Dr. Allen never knew existed. Most important, the recommendations came with the seal of approval of practicing hospitalists. But even the information presented in the session felt perhaps too much, she said.
“They seemed really doable,” Dr. Allen said. “But I felt like by the end, I’m overwhelmed.”
Health information technology (IT) had its own educational track for the first time at the annual meeting, with offerings on using technology for better documentation, social media, and clinical informatics.
In the apps session, presenters Bradley Benson, MD, professor of internal medicine and pediatrics at the University of Minnesota, and J. Richard Pittman Jr., MD, assistant professor of medicine at Emory University, cautioned that FDA regulation of mobile apps will be getting more stringent. They encouraged physicians to stay ahead of the game, using apps that are based on sound research so that they don’t begin to rely on apps that will eventually no longer be options.
Their recommendations were based on personal experience, some admittedly biased published reviews, objective criterion-referenced reviews, and peer-reviewed study data.
Dr. Allen said she was especially interested in MedCalX, an app designed for physicians and featuring medical formulas, scores, and classifications. She also liked that the presenters gave a lesson, short but complete, on how to get a Web-based app that you find on a browser to appear as an icon on your phone, just like any other app.
Presenter recommendations ranged from the nifty (GoodRx allows you to type in a medication and map both local pharmacies and what they charge for the drug) to those that help with basic life and job logistics (Evernote makes it easy to file away emails, attachments, and images). Evernote is the app Dr. Pittman said he’d keep if he could only use one.
As dizzying as it was, the session seemed to lift Dr. Allen’s hopes that she’d be able to incorporate apps more into her work.
“You have to make a decision on the fly a lot of the time,” she said. “You have to do it in real time. … In theory, apps should be able to do that.”
Teri Dyess, MD, director of hospital medicine at St. Dominic Hospital in Jackson, Miss., said that the “Optimizing IT for Documentation and Handoffs” session underscored a problem she has noticed in her department: doctors cutting and pasting too much information in their progress notes. That includes CT reports, labs, pretty much everything, she said.
“It’s just one long note,” she said, adding some notes “get out of hand.” Now, she has information—and reinforcement of her own concerns—that she can take back to her center.
Presenters said that physicians should remember that notes primarily serve the needs of patients and providers and should focus on quality and clarity rather than excessive detail. They recommended the “APSO” format, with the assessment and plan at the beginning, then the subjective history next, then the objective info such as vital signs and physical exam details. Studies have found this tends to work better than the “SOAP” method, with subjective history first.
Katherine Chretien, MD, chief of the hospitalist section at the Washington, D.C., VA Medical Center, described the growing use of crowd-sourcing and social media in medicine, by both physicians and patients. More than half of patients, a survey found, said that they are comfortable or very comfortable with their doctor seeking advice online. And about half of hospitals have a presence on Facebook, Twitter, Yelp, and Foursquare.
With the growing use of social media, though, comes the importance of knowing etiquette and being aware of the legal pitfalls, Dr. Chretien said. Posting specifics, even without names, about a case might violate patient privacy laws simply because the date of the post might give away too much information, she warned. Mixing the personal and the professional is not advised.
Peter Balingit, MD, a hospitalist at Olive View-UCLA Medical Center who said he doesn’t use social media for his work, said the session raised his confidence, and he might start a Facebook page or begin interacting through a patient portal.
“After hearing this, I think I’m more comfortable trying to develop more of an online presence,” he said. “My biggest fear is trying to keep my personal life and my professional life separate.” TH