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Medical Apps For The iPhone: Diagnosaurus, ICD9 Consult, and WellAdult

As of this writing, there are over 400 medical applications in the iTunes App Store. Whether you’re a health care provider or patient, and whether you have an iPhone or iPod Touch or not, it’s worth exploring the impressive range of applications available for this new mobile platform. (Later this year, when iPhone 3.0 is introduced, these applications will be able to interact directly with compatible medical devices, like glucometers and blood pressure monitors.) Here’s a brief introduction to three medical apps in the iTunes App Store.

Diagnosaurus. Many medical specialties—and Internal Medicine in particular—require working through a “differential” of possible causes of  a patient’s clinical presentation. Diagnosaurus ($.99) provides a polished interface for searching differential diagnoses for over 1000 conditions, divided by organ systems, symptoms, and diseases. As a bonus, at the end of each list is provided a list of links to related differentials. For example, “acute hepatiis” and “cholestatis” are listed at the end of “AST/ALT increased.” Much like Wikipedia, you can spent half an hour browsing and clicking through links. For $.99, it’s a steal.

ICD9 Consult. Health care providers must frequently scramble to come up with ICD9 codes for unusual or complex diagnoses in order to bill appropriately. ICD9 Consult ($29.99) is an excellent solution for those moments when you don’t have time to consult a thick book or spend time seaching online for the right code. It allows you to easily search through the different codes or browse by type of disorder (infections, circulatory, respiratory, etc.) or procedure. At $29.99, it’s not cheap, but if it saves you enough time, it’s worth it.

WellAdult. The guidelines for optional clinical preventive services for adults—when to perform cholesterol tests or colonoscopies, for example—are scattered among many different expert organizations and are sometimes contradictory. WellAdult ($2.99) provides an easily navigatable database of recommendations from all major organizations for adults of different ages. Click on “Women Ages 50 – 64,” for example, and you can easily compare the reommendations of different organizations for testing lipids, blood pressure, vaccinations, and cancer screening. For $2.99, this app is well worth it.

*This post, Medical Apps For The iPhone: Diagnosaurus, ICD9 Consult, and WellAdult, was originally published on Healthline.com by Joshua Schwimmer, MD.*


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2 Responses to “Medical Apps For The iPhone: Diagnosaurus, ICD9 Consult, and WellAdult”

  1. Phil Dodier says:

    Nice article!
    I invite you and your readers to stop by my blog, http://www.medmacs.com to check out our regular medical app reviews;
    in my opinion, the iphone is on its way to become THE medical handheld (for physicians and patients) and your article is endosring this development; Thank you for that!

  2. Phil Dodier says:

    Nice article!
    I invite you and your readers to stop by my blog, http://www.medmacs.com to check out our regular medical app reviews;
    in my opinion, the iphone is on its way to become THE medical handheld (for physicians and patients) and your article is endosring this development; Thank you for that!

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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