Speaker Notes: ipad in Otolaryngology April 2013

Transcription

1 TITLE: IPAD IN OTOLARYNGOLOGY Steven Smith, MD Mentor: Harold Pine, MD The University of Texas Medical Branch (UTMB Health) Department of Otolaryngology Head & Neck Surgery Grand Rounds Presentation Speaker Notes April 26, 2013 Disclaimer I have no stock or agreements with apple, application developers or devices developers mentioned in this presentation. I have no financial gain for recommending the use of apple products or its applications. The applications being presented are from personal research and preference. There are many applications available that may be beneficial to otolaryngologist that will not be discussed in this presentation. Introduction This talk will focus on the ipad and its use in Otolaryngology. This presentation will primarily focus on applications available for the ipad and how applications can be utilized in the field of otolaryngology. Some of the applications being presented are available on other handheld devices as well. History The ipad was first released in April Apple began development of a tablet like device in the early 2000s. The ipad was marketed as a new device labeled larger than an iphone, smaller than an imac with many of the capabilities of both. It was originally intended to compete with tablet computers and ereaders that were currently on the market. The ipad There are currently 3 types of ipad available, 4 different memory sizes depending on version, and each type with the option of wifi or wifi/cellular. The ipad mini is available in 16 gigabyte, 32 gigabyte, and 64 gigabyte with a 7.9 inch display. The ipad 2 is available only in 16 gigabyte with a 9.7 inch display. The ipad with retina display is available in 16 gigabyte, 32 gigabyte, 64 gigabyte, and 128 gigabyte with a 9.7 inch retina display which has 4 times the pixels of the other versions. The new ipad also boasts a faster processor, which allows quicker navigations through applications. ipad in The Hospital Where is the ipad being utilized in the hospital environment? The most common place the ipad is being utilized in the hospital is on the wards. It has become an integral part of team rounds. It gives access to new labs, vitals, and allows the review of patient notes. The use of the ipad is now expanding and is being utilized at the bedside to explain medical conditions, in the clinics for patient education, and now even in the operating room for case review. ipad in Otolaryngology The ipad has multiple uses but I will be speaking primarily about application based usage. I have broken the applications down into four types based on use: medical education, patient education, 1

2 productivity, and collaboration. Many applications can fall into multiple categories depending on their usage. Medical Education Applications The American Academy of Otolaryngology has developed two applications for the ipad. AcademyQ is a self-assessment tool developed by the academy, which has approximately 400 questions. The questions cost and have answer explanations with links to the articles from which the questions were made. There is a plan to release new questions each year that will probably require an additional charge, but the purchase amount has yet to be established. The OTO-HNS app is a free application, which gives full direct access to the Academies recent and archived journals. Journal articles can be downloaded or ed from the application. It does require a personal or departmental subscription to access the articles. Read by QxMD is a new application which is currently free. It is a journal search engine designed to run through the institutional library. It searches a database of journals based off of user input and specialty. There are only a few applications with capability of journal database searches and Read is one of the highest rated applications in this class. Advantages of this application include: integration with the institutional library which allows access to full journal articles and reviews, the ability to download and share articles, and it allows article searches to be specialty directed. The user interface is simple and easy to use once the program is setup with the institutional library. There are only a few disadvantages: recently released articles may not have PDF versions available in the library which causes redirection to pubmed, the ability to access full articles is dependent on the institutional libraries resources, and there is no way to download articles directly from the application without first ing it. E-Pimp Otolaryngology app is another question bank which was developed to run on the iphone natively from the creators of the E-pimp website but it does work well on the ipad. It has consolidated questions with answers from the E-PIMP site. The questions are organized into sections based on question type. Cancer management handbook is a free application, which has a general review of several types of cancer. The application has a head/neck tumor and thyroid/parathyroid cancers overview. Each section is broken down into several subsections like risk factors, pathology, staging, and treatment approaches. There is a separate palliative and supportive care section, which discusses pain management, management of nausea/vomiting, fatigue, and cachexia. The application is easy to navigate and has many useful tables available throughout the application. Otolaryngology call guide is an application created by an Otolaryngology resident. The application was created primarily for junior level residents who may be encountering an issue in the ER for the first time. It has an extensive list of otolaryngology problems with each problem being broken down into subsections which include background, diagnosis, what to do when your called, signs/symptoms, setup, and finish. There are images and more importantly initial ER workup included within each topic. Overall, it is a good application and easy to use. One issue with the application is the requirement of an Internet connection to work properly, which is not a huge negative due to the widespread availability of Internet in the hospital. The next application that is similar in some ways to ENT call guide is ENT surgery handbook. This application was created to give quick reference for common ENT issues. The application is setup nicely and does have good information, but it is not as complete as the ENT call guide. The application is more polished than ENT call guide but is lacking in content when comparing the two. 2

3 AO surgery is an orthopedic application with a high-quality and thorough overview of facial fractures, surgical approaches, and plating options. Within the application there is a maxillofacial section with subsections of mandible, dentoalveolar, midface, and skull base. The application is interactive progressing through diagnosis, decision, surgical approaches, treatment, and aftercare based on user input. Each section contains illustrations to help guide the treatment plan. Statref is an application giving access to certain books available in the medical library. The program has a search function which allows users to search within the entire library of statref books available. This application does have its limits which include requirement of Internet connection and limited otolaryngology resources available. The setup is difficult and requires users to reregister approximately every 3 months. Patient Education Many of the applications presented in the medical education section could be used in the patient education section to help explain conditions, but some developers have created applications directly to help improve doctor-patient communication. DrawMD applications are a group of applications made to help explain specialty specific common conditions to patients. DrawMD ENT was developed primarily to help explain common Otolaryngology conditions and help better promote understanding from patients. The application makes the process of patient education interactive. The program helps users create illustrations to explain procedures and medical conditions. The user interface is simplistic making the application easy to learn and use. When it comes to disadvantages, the worst issue with this application is the inability to communicate with EMR; and the application can be time consuming if the user is not familiar with the application. There is a similar application available called Luma ENT simulator but it requires a license agreement with eyemaginations. Due to licensing requirements, I have not been able to review the app personally but there are several videos demonstrating the applications capabilities. The user interface is slightly different from DrawMD and the application has more capabilities like disease progression and screen sharing which would be useful in some clinics. Productivity The next few applications I will be discussing are applications that help increase productivity including: word processors, note takers, and PDF readers. There are many PDF readers available in the application store. Goodreader is a PDF reader which has become very popular due to its capabilities, reliability, and PDF organization. There are many advantages to using this application including: the ability to store and organize not only PDF files but video, audio, and text files; its capacity to handle large PDF files efficiently and reliably; and the capability to annotate directly onto saved PDF files. There are only a few disadvantages. The user interface is intimidating to new users and has a rather steep learning curve. The application is complicated with enormous capabilities for handling files, which can be a negative because of its complexity. There is a useful and thorough help section available within the application. There have been many applications created to help work with Microsoft office files on the ipad. Two applications available are Cloudon and Smart Office. Neither application was created by Microsoft but both applications allow users to create and edit office files. I will be only discussing Smart office because of the similarities between the two applications (Cloudon is a free application). 3

4 Smart office is essentially Microsoft Office for the ipad and is a really nice application that has been tweaked several times based off of user input. This app was created partially to free users from needing a laptop for basic Microsoft office needs. It is a very polished application with only a small learning curve. Within the app users can create and edit office documents for the 2003 and 2007 versions of office. The application directly syncs with cloud applications giving access to the files from anywhere with an Internet connection. This application like all others does have its flaws but until Microsoft releases office for IOS devices, this will remain one of the best options available for editing office documents. Apple has created programs for word processing, presentations, and spreadsheets that run well on all of the apple devices. The apple programs will sync across devices making files readily available. The applications are relatively expensive but may be worth the investment for those who own multiple apple devices. Note taking applications are one of the most developed types of productivity applications and there are literally hundreds of them available. Notability is one of the highest rated applications for note taking. One of the reasons this app is so highly rated is because you not only can write notes but you can type notes and take voice recordings. The voice recordings will sync up with your writing at the time of recording. This application like goodreader allows you to import PDF files and annotate them. It would be difficult to use it as a dedicated PDF reader because it was not developed to handle large files like goodreader. Collaboration Cloud drives have become extremely popular over the last few years. Google drive, Dropbox, Box, icloud, Skydrive, and many others are available. They all have advantages and disadvantages. Two of the most used cloud storages are Google drive and Dropbox. Dropbox is the most polished and popular application available. It works across several devices. It allows you to store files and pictures in the cloud/internet storage which can be synchronized with several devices and shared with others. It can be compared to a USB flash drive except that it can be accessed at anytime with an Internet capable device. The application has become very popular and many people now use it as a primary storage for files. There are many advantages to using Dropbox. Many applications integrate with Dropbox allowing users to send files within applications directly to Dropbox. Dropbox Internet based software is widely used and most people already have Dropbox accounts; but probably the most important advantage is the ability to share files among large groups of people. There are not many disadvantages except that there must be an internet connection to access files stored within the cloud which is not a huge issue due to the wide availability of internet, and with the free account you only get 2GB of storage which can be filled quickly depending on your usage. The availability of data on the internet is an advantage and disadvantage of Dropbox because if someone really wants data you have stored, there is no way the developers of Dropbox can guarantee its safety even with encryption. Google drive is a good option for those who utilize Google services like calendar, Gmail, and Google docs because it integrates into these services well. Google drive is similar to Dropbox in appearance and functionality. It will synchronize with Google docs which is Google's version of basic office applications. As for which is the best cloud application available, it heavily depends on the needs of the individual users. Epocrates has been a leader in drug reference for many years but Micromedex has recently improved its interface. Overall, Epocrates is easier to use and still the most widely used and updated 4

5 drug reference application. Medscape is a general medical reference application based off the Medscape Internet website. Medscape has many tools available within the application including a drug reference, medical calculator, and general medical search. These applications have been available for many years and are helpful for quick reference. Accessories There are only three must have accessories for the ipad: a keyboard or keyboard case for those who plan to do a lot of typing because it is incredibly difficult to use the onscreen keyboard with any efficiency, a screen cover, and a good stylus for those who plan to take notes or do any type of annotation. There are many other accessories available that may be useful depending on usage like adapters, card readers, and even apple TV. Extras Print utility allows you to wirelessly print documents from your ipad to airprint enabled printers. Splashtop 2 is a remote desktop allowing users to run personal computers from the ipad utilizing the Internet. AppsGoneFree lists applications that are free for the day. Advancements This presentation was on the ipad but some of the new advancements have been with the iphone and telemedicine. IPhone otoscope adapter and phone scope adapter allow users to save videos and pictures from the otoscope and flexible laryngoscope. This allows for better explanation of disease processes to the patient. There are always new medical applications and accessories being developed. Imedicalapps.com is one of the best sources for this information and most of the information for this presentation came from this site. Conclusion The ipad and similar devices have become important tools in the medical profession. These devices give users access to unlimited resources and allow users to carry large amounts of data in small devices. With hospitals becoming more reliant on the Internet and technology, these devices will be more utilized in all aspects healthcare. (The pictures available in the power point presentation are screenshots or borrowed material. Do not copy or redistribute the pictures without permission.) 5