Medical Knowledge and Skills – 2.3: Utilize state of the art information technology and tools to retrieve, manage and use biomedical information in the care of individuals and populations.
One of the frustrating things about medicine for me is that although there is a lot of cutting-edge technology being used and developed to treat patients, much of the medical system still lags behind. There are many reasons for this, including the high need for security and the cost and difficulty of updating large and complicated systems; however, that does not make it less frustrating when trying to return a page with one of the numbers missing in the call back number. Despite the fact that some of these technological dinosaurs are seemingly here to stay, there are a huge number of apps available that improve medical care from both the patient and physician ends.
One well known app is MyChart, which allows patients to do things such as view test results, message their doctors, and schedule appointments. MyChart gives patients the opportunity to be more engaged in their medical care, and during medical school, I worked with a program called Moms2B to assess whether it could be used as a teaching tool to help participants improve health literacy. Moms2B is a multidisciplinary program that strives to address clinical and social determinants of high infant mortality rates in Columbus through a community-based nutrition and social support group model. Pregnant women and moms with children up to 1 year old are invited to a weekly session with education, social support, connection with resources, and a free healthy meal. My project at Moms2B was a pilot program to see if MyChart could be used to help pregnant women “know their numbers”, with lessons on anemia, blood pressure, STI status, and blood sugar. Each education session included a short lesson with a portion dedicated to looking up the mom’s numbers on MyChart and talking about what they meant for her health. An example of the lesson on anemia can be seen below.
Although we did not end up being able to study enough patients to publish our results, we did find that individual moms were able to learn and retain information using MyChart. For example, in the study pre-survey, one mom said she had never heard of hemoglobin readings, despite me knowing that she had been to a group lesson on anemia a few weeks earlier. However, on the post-survey weeks after a lesson where she looked up her own hemoglobin value, she was still able to remember that if her hemoglobin was low that was called anemia and there are certain foods you can eat to help with it.
While the MyChart app is useful for patients to have better access to their doctors and medical information, there are other apps that I have used that helped me quickly access best practice treatment guidelines. For example, during my adolescent medicine rotation, there were many apps that I used on a near daily basis to help me make decisions. One such app was the CDC STD Treatment Guide. This app lists sexually transmitted and other urogenital infections and provides information on best practice treatments and alternatives, along with more information such as diagnostic criteria and links to publications about the treatments. I used this app to help guide treatment for issues I saw in clinic every day such as yeast infections and bacterial vaginosis, as well as to look up less common issues such as how to escalate suppressive therapy for recurrent herpes and publications on nonalbicans vulvovaginal candidiasis. A screenshot from the app detailing treatment of chlamydia in adolescents and adults is shown.
Another app that I used was the CDC contraception guide, which helped me guide contraceptive choices for patients with other medical conditions. When a patient let me know she was interested in birth control, I would use the app to look up other conditions she had to see if any contraceptives were relatively contraindicated. I used this to guide our discussion on which birth control would be best suited to her needs. For example, the screenshots below show guidelines for patients on anticonvulsant therapies and the reasoning behind contraindications or recommendations.
Technology has made it so there are many ways for both patients and physicians to access medical information and communicate with each other. I am excited to use these as a future physician to be able to directly answer patient questions, as well as make sure that I am treating my patients with the most up to date, evidence-based treatments. The apps that I learned to use during my adolescent medicine rotation will be useful during intern year and beyond, and may prove especially helpful if I become a primary care pediatrician, as I will not see the issues as frequently and will benefit from being able to easily look up the most updated treatment guidelines. Other programs, such as Lexicomp and Micromedex incorporated directly into the EPIC for prescribing medications, the CDC vaccine schedule app, or best practice alerts will also be helpful in making sure I am giving the best care. Intern year will have a steep learning curve, but the wealth of information easily available through technology will make it a little bit easier. There is a huge and growing amount of medical information available, and technology can be used to make that information more accessible and easier to integrate into clinical care.