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In the age of smartphones and tablets, it has become commonplace to find apps that help you do or find almost anything. The quality and breadth of medical apps has improved greatly in recent years. You can now find medical apps that recreate textbooks, search for current articles, calculate likelihood ratios and find point-of-care answers to clinical questions. This article describes and reviews apps aimed at helping clinicians search for evidence to support the practice of EBM.
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Introduction
Having the ability to search for clinically relevant evidence at your fingertips is now a reality. The frequent use of smartphones and tablets opens up the possibility that clinicians can find the answers to clinical questions in real time at the bedside, provided the right tools are available. This article reviews smartphone and tablet applications (apps) that can help a clinician search for evidence to support the practice of EBM. While many of the apps discussed are free, some apps have free access as part of a professsional society membership benefit, and some apps have an initial cost or in-app costs. Table 1 provides a summary view of these apps including the platform that supports the app. Of note, there are many apps available and this review provides examples of the breadth of available apps; it is not meant to be comprehensive and does not provide app ratings.
Summary of medical apps based on the area or level of EBM it addresses*
Apps to help search for the best evidence
DiCenso et al1 published a hierarchy of preappraised evidence called the 6S model. This model denotes the six levels of clinical evidence available to help in medical decision-making. It starts with the largest resource available, original published studies. It then moves upwards through synopses of studies, syntheses of studies, synopses of syntheses, summaries and ends with the most specific form of evidence at the apex, with the ‘systems’ layer. This section will review apps using the first five levels of evidence. For more information about clinical websites and the 6S model see Windish.2
Apps to identify original published studies
These apps allow you to review the primary literature using PubMed or Medscape searches. Some allow you to search using the Patient, Intervention, Comparison, Outcome (PICO) format. Many allow you to save and/or email your search results. Sample apps in this category include PubMed for Handhelds, Medscape and EBSCOhost.
Apps to identify synopses of studies
These apps allow you to review resources that summarise the results of single published studies. Many have customised alerts that deliver the latest evidence from recently published articles and provide expert classified summaries of the evidence. Sample apps include ACP JournalWise, Journal Watch and InfoPOEMS. Most of these apps have a cost associated with them; others however, are included (free access) as part of professional society membership benefits (eg, members of the American College of Physicians have free access to the ACP JournalWise app).
Apps to identify syntheses of studies
Syntheses provide resources that integrate clinical information of multiple single studies through systematic reviews and/or meta-analyses. The apps that provide these syntheses often are the same apps that provide access to single studies. As with other apps aforementioned, the content of medical journals and databases are often monitored for the latest evidence. Some apps provide summary recommendations and/or practice guidelines from organisations such as the US Preventive Services Task Force (USPSTF).
Apps to identify synopses of syntheses
These apps provide an overview of the results of systematic reviews and meta-analyses with expert summaries of them. The apps in this category are the same apps that provide syntheses and synopses of studies.
Apps to identify summaries
These apps provide clinical practice guidelines. Many provide guidelines by organisation, profession, specialty and categories from worldwide medical associations.
Apps to identify EBM tools and clinical calculators
There are many EBM tools and clinical calculator apps. Some apps focus only on EBM tools, like calculating likelihood ratios and post-test probabilities or prediction rules. Two dedicated EBM apps are called EBM tools and MedCalc 3000 EBM. Other apps have clinical calculators that can provide medical formulas and other calculations such as determining clinical risks.
Cautions about medical apps
Recent studies have demonstrated that 65–86% of medical apps had no medical expert involvement during their development.3 ,4 In addition, questions have arisen regarding the reliability and accuracy of the medical content in apps and the potential consequences for patient safety.3 ,5 ,6 Given the high stakes nature of medical apps, the US Food and Drug Administration intends to regulate apps including those that: (1) control a medical device or display, store, analyse or transmit patient-specific medical device data (eg, ECG), (2) provide patient-specific results with help from formulae or algorithms and (3) transform the mobile platform into a regulated medical device by using attachments or sensors.
Another issue to consider with using medical applications is their use of consensus abstracts that were developed by the National Library of Medicine. Consensus abstracts allow a search of MEDLINE/PubMed using PICO or free text formatting. These searches provide links to individual citations and a statement indicating the final summary. These summaries, or bottom lines, can be the conclusion of the article abstract, if one is provided, or derived from an algorithm and the last two sentences of the abstract.7 A potential problem with this approach is that no evaluation has been conducted to determine if consensus abstracts reach the same conclusions as systematic reviews or meta-analyses or how clinicians interpret consensus abstract results.7 Thus, those who use apps with consensus abstracts should be aware of this potential limitation.
Choosing medical apps
Trying to choose apps for your medical practice may be difficult given the lack of regulation. While individual apps themselves may have ratings based on current/past users, there is no standard by which to choose an app and no way to guarantee their validity or utility. Given this, one approach to finding apps can include using apps from medical organisations which are more likely to have medical professionals involved with their creation. Table 1 includes several such applications. Another approach can include trying apps with little or no cost to see if they meet your needs.
Footnotes
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Competing interests None.