Nursing Informatics

The Use of Clinical Mobile Apps by Nurse Practitioners: A Guideline for Selecting the Appropriate App

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Introduction

Nurses as knowledge-workers are increasingly dependent on information technology (IT) to provide safe and effective care.   As the health information technology (HIT) industry and information science continues to grow it is important for nurses to be at the table with other health care professionals to participate in the collection of appropriate data and the generation, processing and dissemination of knowledge (Mastrian&McGonigle, 2017).   An area of HIT that nurses can become involved in is the mobile technology industry.  Timely and relevant information at the point of patient care is very important in the primary care setting.  Mobile health applications (apps), software used on a mobile device, provide quick access tomedical information including up to dateevidence-based guidelines, diagnosis and treatment for a specific disease, pharmacology information, medical calculations and continuing medical education (CME)to support the nurse practitioner (NP)in providing high-quality, safe and effective care.  There are over 100,000 apps available for download (Cook, Ellis, Hildebrand, 2016).  With all the different products available, how does a NP decide which appwill work best for him or herin their clinical practice?

 Background

Since the 1990’s technology has exploded and many clinical mobile apps have been developed for use by all health care professionals.  The mobile apps provide a quick reference for a provider who may have a question about a preventive care guideline, drug-to-drug interactions or the appropriate antibiotic for a specific bacterial infection.Little discussed that for every three patients seen in the office, two important clinical questions are generated.  “Physicians who want to keep up with relevant journals in their field would need to review 19 articles per day, 365 days per year.”   Doctor Little used a personal digital assistant (PDA) which offered a fast, easy to read format to gather information on clinical practice guidelines (https://www.healthplexus.net/article/evidence-palm-your-hand-using-pdas-implement-clinical-practice-guidelines-primary-care).The PDA was initially introduced in 1993 by Apple and was called the Newton (Zeldes, 2005).  In 1996 U. S. Robotics introduced the PalmPilot which had 128k of memory and a touch screen display.  In 2007 the first iPhone was launched by Apple which became a new device for the mobile apps (Niccolai&Gohring, 2010).  In 2008, Apple opened its iTunes Appstore which allowed its customers to shop for and download apps            (Ventola, 2014).

Many health mobile apps are available to download from either the Apple Store or Google Play (Cook et al, 2016).  Many are free but have limited access to information.  Other apps such as Dentsio for dentists and EP Cookbook for cardiac electrophysiologists can cost up to $1,000 for an annual subscription (Husain, 2015).  Two of the top ten free iPhone medical apps identified by the iMedicalApps Team include Medscape and Epocrateswhich are commonly used apps by NPs (Husain, Alkadhi&Misra, 2010)

The NP may suggest specific health apps to his/her patients to encourage self-care for monitoring blood sugars, blood pressure, weights for heart failure patients, weight lossefforts and that information can be sent directly to the NP in a timely manner.  Medical apps can also direct a patient to adhere to medication regimens and remind them to get their labs done ie: protime for anticoagulation management.  The World Health Organization refers to the mobile medical devices supporting medical and public health practices as “mHealth”(Cook et al, 2016).

Solution

When deciding on which app to use the NP will need to evaluate the many different options available and determine the primary use and information he/she would like to have readily available.   If an NP does not feel confident with his/her pharmacology knowledge then an app with detailed and complete drug information would be more beneficial than an app for reading imaging studies.  The primary criteria for selecting a certain app is often cost (Ventola, 2014).  Boudreaux, Waring, Hayes, Sadasivam, Mullen and Pagoto (2014) identify seven strategies for evaluating and selecting mobile health apps prior to recommending to patients.  The strategies include: 1) reviewing the scientific literature available on mobile health apps; 2) searching the app clearinghouse websites; 3) searching the app stores for products available; 4) reviewing the description of the product and ratings information; 5) ask your professional colleagues about their experiences and preferences with mobile apps; 6) test the free version of the app if available; 7) obtain feedback.  This process can be utilized for all the apps an NP may be interested in using for clinical practice.

Conclusion

There are thousands of mobile health apps available to health care professionals.  These apps provide many benefits to the NP in promoting better clinical decision-making and improved patient outcomes.  The NP will need to utilize the Data-Information-Knowledge-Wisdom paradigm (Mastrian&McGonigle, p. 6, 2017) when researching the available apps to help him/her determine which app(s) will provide the most accurate information and are the most user-friendly.  It is also important to compare the available information in the free apps versus the paid yearly subscription.

As HIT continues to grow exponentially there will be opportunities for NPs to participate in the development of more user-friendly point-of-care information technologies for mobile devices that will enhance theirknowledge and improve the quality of health care.

https://www.healthplexus.net/article/evidence-palm-your-hand-using-pdas-implement-clinical-practice-guidelines-primary-care

http://www.nursetogether.com/theres-app-you-nurse-practitioners

http://www.clinicaladvisor.com/top-8-mobile-apps-for-nurse-practitioner-students/slideshow/2589/

Evaluating and selecting mobile health apps       https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286553/

Top 10 Free iPhone https://iims.uthscsa.edu/sites/iims/files/Top%2010%20iPhone%20Medical%20Apps%20for%20Health%20Care%20Professionals.pdf

3 alternatives to Epocrateshttp://www.imedicalapps.com/2015/06/alternative-epocrates/