The iPod Touch Medical PDA: Foot in the Door

Several months ago, I wrote about my plan to use my new iPod Touch as a medical PDA in lieu of purchasing a PDA phone and using the outdated Palm OS or the volatile Windows Mobile OS. So far, I have been quite pleased with the results and can report, at the very least, marginal success in my use of the device. My fiancée and a classmate/friend have both followed the same path to the use of an iPod Touch as a medical PDA. Here are the details:

Advantages

1. Flexibility – Both the iPod Touch and the iPhone have a considerable amount of flexibility with respect to the content that can be placed on the device. With the arrival of Apple’s App Store, it is now possible to install a variety of programs onto either device that can expand their range of uses and the range of storable content. Several programs offer the ability to store, organize, and view PDFs, Microsoft Office documents (Word, Excel, Powerpoint), videos, images, and sound files. The devices themselves already have built-in capabilities provided with Apple efficiency through iTunes for viewing images (Photos – which I use for medical images from Gray’s Anatomy, Netter’s Anatomy, and Access Medicine, including Chest X-Ray reading guides), videos (Videos – which I use for NEJM Procedure Training videos, and also downloaded movies and TV shows for long plane flights), and sound (Music – which I use for music and more recently podcasts from NEJM audio interviews, Johns Hopkins Medical School discussing new studies, from Discover Magazine’s Vital Signs discussing mysterious medical cases, and from Coffeebreak Spanish to begin learning Spanish). When I discussed potential options with my fiancée for her desired new device, she spoke of how an Apple device in particular would do wonders for adding new functionality to her lifestyle: providing video/audio entertainment during gym workouts, allowing her to store cooking/baking recipes in a single location that can be readily consulted in the grocery store, etc.

2. Financial Savings – This advantage may be more tenuous, depending on how one uses the device. The iPod Touch cost me $300 to purchase, and I have since spent another $40 on iTunes App Store applications (Netter’s Neuroscience Flash Cards) to expand its uses as a medical PDA. Several programs I use as medical references are free, however: Epocrates Rx (the program I consult 20-30 times each day to look up generic names and pharmacologic classes of medications, drug prices, adverse reactions, and interactions between two or more drugs), Eponyms (a neat little program providing concise descriptions of a vast number of diseases and clinical signs with eponyms), and Unit Convertor (for changing Celsius to Fahrenheit and vice verca, since temperatures are often recorded on the same day in either modality depending on the thermometer used). Similarly, I have been able to store PDFs from Access Medicine on the device including reference materials from Harrison’s Internal Medicine, Current Diagnosis and Treatment, and Current Consult, as well as assorted files including the Walmart $4 prescription list. This has thus far allowed me to avoid having to purchase an expensive new data plan, a yearly subscription to Epocrates Essentials, new copies of pocket pharmacopeias and medical references, etc.

Disadvantages

1. New Device with Limited Medical Software Repertoire – Since the iPhone/iPod Touch is new to the market, medical software companies are still taking their time to convert their packages to these devices. Epocrates did an excellent job of making Epocrates Rx available at the opening of the App Store in July, but it has not yet provided versions of its Essentials software which would be desirable for medical professionals with less time to customize and seek out free content.

Nonetheless, Epocrates Rx, as one of the most readily updatable pharmacopeias, has given me an edge in providing my medical teams with up-to-date knowledge on medications, their prices, and interactions they might have with other drugs (the program has a handy Interaction Checker in which you can input several drugs, and it will determine any possible interactions), something the pocket pharmacopeias do not provide as well (despite being a few seconds quicker to access).

I have also found the use of Epocrates Essentials by my colleagues to be of limited use so far: the information is usually accessed on a mobile device in the context of pimping, but I don’t think it necessary looks particularly good to be asked a knowledge question and immediately pull out one’s PDA. I feel much more comfortable saying “I don’t know,” learning from the attending physician or resident, and then reading up more about the disease, clinical sign, or treatment method at home. Using medical software for guiding treatment can usually be done at the computers provided at the Nursing desks or elsewhere in the hospital, all of which should usually have access to UpToDate and similar high-quality, online medical resources. By the nature of most medical PDAs running Palm or Windows Mobile OS, the information provided by mobile medical software packages has to be more concise and abbreviated, which might not always be useful in the context of guiding subtle treatment decisions.

Unbound Medicine has opened access to its “medical software” (Harrison’s, 5-Minute Consult, etc.) to the iPhone/iPod Touch, but these packages require the Safari browser and an internet connection. For me with my WiFi-only iPod Touch in WiFi-scarce hospital areas, it makes more sense to rely on downloadable information.

2. Single Carrier – One of the reasons I chose the iPod Touch over the iPhone is to avoid having to switch cell phone carriers. While I am not pleased by the business model, expensiveness, and general lack of user friendliness of Verizon Wireless (my current carrier), the service has the best signal in the hospitals in which I work. Personally, I find that it is very frustrating (and seemingly unprofessional) when I call someone and consistently receive their voice mail because they lack cell phone signal. Frankly, I don’t want to be that person. However, AT&T is the only carrier for the iPhone right now, and their cell phone reception is very poor in virtually all of the areas in which I work. This limits the utility of the cell phone and Internet-based capabilities of the device.

Summary

Overall, my experience has been quite good, and I have found that between my iPod Touch and Pocket Medicine, I can cover most of my information needs (occasionally supplemented with a small field-specific reference, such as for Psychiatry, my current rotation). I look forward to what the future has to offer for these devices! (Already, there are several EMR/EHR and radiological imaging viewing packages.)

My iPod touch allows me to:

Medical
• Access the most up-to-date, user-friendly, and free drug database I am aware of – Epocrates Rx
• Reference anatomy and neuroanatomy resources – Netter’s Neuroanatomy, images from Gray’s and Netter’s Anatomy
• Quickly convert units – Unit Convertor
• Manage work tasks – iProcrastinate Mobile
• Locate inpatient and outpatient work sites – Apple’s Maps
• Learn medical procedures such as inserting femoral venous catheters and performing lumbar punctures – Videos – NEJM Procedure videos (downloaded)
• Stay up to date with recent studies and medical news – NEJM audio interviews, Johns Hopkins PodMed medical news discussion podcast, Discover magazine’s Vital Signs medical mysteries podcast

Life Management
• Keep a tight Calendar that syncs with iCal on my laptop – Apple’s Calendar
• Check, manage, and reply to e-mails within WiFi range – Apple’s Mail
• Surf the web and check my RSS Feeds – Apple’s Safari browser
• Check the weather and storm alerts – WeatherBug
• Write and post blog posts away from home – WordPress app
• Set recurrent alarms, use a stop watch – Apple’s Clock
• Maintain a contact database that syncs with Address Book on my laptop – Apple’s Contacts
• Write notes – Apple’s Notes
• Stay in contact with friends using Twitter and the Facebook – Twitterific, Facebook app
• Learn Spanish – Coffeebreak Spanish podcast
• Read Associated Press news offline – Mobile News app
• Use a tip calculator – Tip

For Fun
• Use language references for learning – LastMinute Spanish/French/German/Italian, Lonely Planet Mandarin
• Play weekly crossword puzzles – 2 Across (I blame my fiancée for getting me into this)
• Play random games – Sol Free (solitaire), Jawbreaker, Cube Runner
• Watch YouTube – YouTube built-in app
• Watch movies and TV shows – Videos (downloaded content)

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21 comments
  1. John Roger Bell said:

    Are you still using mail to store documents? I’ve been watching two programs: File Magnet and Datacase. Datacase should be released any day now and will be $7, File Magnet is $5.

    Let me know if you have any thoughts on that.

  2. Apollo said:

    Yeah, I am still using Mail. I have been watching File Magnet and Files, but have not purchased either of them yet. I’m trying to determine which downloadable medical resources I will find most useful to carry: Current Consult might be redundant since I now carry Pocket Medicine, and I do not intend to replace Pocket Medicine since it serves as an excellent expandable medical resource (with new insertable sheets for my own notes), flat writing surface, and storage unit for patient data cards. I suspect either Harrison’s or Current Dx/Tx will be useful (which I currently have in e-mail accounts), but I do not know how the PDF view capabilities are in the Apps yet.

  3. ClosetNerd said:

    Thanks for the review on the IPOD touch! It is exactly what I was thinking of doing. Thank you for being brave enough to try it out. I’m considering buying the ipod touch (2nd gen) instead of a PDA for rotations.

    Does the calender function alert you to events? And can you set reminders?

    Also, if you listen to podcasts ect is there a third party app or a built in feature that lets you speed it up (ie, play and listen it at 1.5 speed?)

  4. Apollo said:

    Yep, you can set alerts/reminders in iCal on the iPod (or on your computer and have it sync to your iPod).

    I’m not currently aware of a third party app for speed-playback. That sort of program might violate Apple’s stringent App development policy since it might too closely mimic iTunes. But who knows! Maybe something will come out sooner or later.

  5. ClosetNerd said:

    I’m excited, I think I’ll take the plunge later this semester…..ahhhh and now I should go study cardio…. booo

  6. Andrew said:

    As a developer for an EMR that’s getting ready to make an iPhone application (not stand-alone atm, it will talk to our app’s database) I’m curious to know what features people would want. Atm we’re thinking of dictation, schedule (not using built-in iCal incase the phone is stolen), patient medication list/vital signs (for the current appointment). The idea is so they have another option than an expensive tablet PC if all they do is dictate. Also Apple at least gives developers a way to record sound files through their API.

  7. Apollo said:

    Hey Andrew – I think you’ve already picked up on several of the more attractive features iPhones and iPods can have as medical PDAs.
    – Being able to dictate into an iPhone would be incredible if the software had good speech-to-text technology.
    – Great security is a must, of course, for privacy protection.
    – I think an EMR might be more attractive if it offers flexibility in the way items are labeled, sorted, and formatted. Nothing is more frustrating than not being able to find a particular item because it is only labeled in one non-intuitive manner or more frustrating than being presented with fixed input fields that cannot be adjusted for a particular patient’s needs or a doctor’s organizational style. I wonder if a standardized “tag” infrastructure with good search engine capability could make a new EMR more user-friendly and attractive to doctors.
    – iPhone/iPod Touch screens are still relatively small and many people don’t like reading lots of text on the small screen when computers are available. On the other hand, a minimal EMR with just vital signs and a medication list might not be worth the cost when the information could be conveyed just as easily on paper (with known risks and inconveniences). As such, I think an EMR for iPhone/iPods work best when wirelessly synchronized completely with a desktop based EMR system such that the iPhones are mostly used for quick (but full) access to information (e.g. Is the patient’s most recent CBC in? What were the vital signs 24 hours ago? What did the Social Work note say? Did Physical Therapy/Occupational Therapy visit the patient yesterday?). At my hospital, there never seem to be enough computers at the nurses’s desk or in the dictation rooms during certain hours of the day when notes need to be written and labs and studies need to be checked.

  8. pk said:

    what kind of memory do you think one needs on an ipod touch if one is a med student. i wasn’t clear on how much memory i should buy. (230 dollars vs 400 dollars.

  9. PG said:

    I am looking into this for my fiance so I dont understand the medical terminology. If she uses the touch, will she be able to access the schools secure websites and email? She cannot when she uses Mozilla on her notebook.

  10. Apollo said:

    Hi PG – I have been able to authenticate into the secure websites for my university using the iPod Touch without any difficulty. Please note that the Safari browser on the iPhone and iPod Touch cannot use either Flash or Java, though (as far as I can tell, currently).

  11. mr said:

    Hi, I will be starting medical school this fall and I seem to be facing the same dilemma you faced…

    I have verizon, but don’t want to cancel the plan (good service, would cost a lot) and they don’t seem to have any good medical PDAs/smartphones. Something like the iPod Touch sounds perfect. However, I have a PC- will the calendar/document editing software on the phone still be compatible and able to sync with the software on my PC?

    Sorry, I’m not the most tech-savvy future doc.

    Thanks!

  12. Apollo said:

    I also have Verizon and am hesitant to give up the good reception around my hospitals!

    Synchronization will depend on the programs you use – generally, synchronization only works if you have the program available both on your PC and the iPhone. You might want to check your software package developer’s website to see if they have that.

  13. grimgrizly said:

    Thanks for the heads up
    Just bought an ipod touch for my wife, peds resident to be : ) Do i need to “jailbreak” it to be able to use iphone apps or not?
    Thanks
    grim

  14. The iPhone is still extremely limited compared to some of the higher-end Windows Mobile phones/PDAs (such as the HTC Touch Proi2). For starters, the iPhone’s screen is less than half the resolution of a higher-end phone, so your display simply isn’t that good. And the color resolution is lower, and the gray scales, so your CXRs etc look really poor and you can’t find theshadows as easily. You don’t have anything that can pass HIPAA or CPRA 21 part 11 certification so not only are they not cleared to interface with electronic hospital record systems, but placing identifiable patient data on an iPhone as records or as monitoring is strictly against Federal regulations. Finally, the big kahunas like Skyscape and Med Wizards have around 20x as many apps for Windows (and Palm) over Apple.

  15. Christine said:

    I’m a nursing student, and planning on buying a PDA for my clinical rotations, and use in nursing practice once I graduate. I’m considering buying an iPod touch, but I’m worried about people seeing me as unprofessional because of the stereotype around iPods. Any thoughts? Have you had any comments about your use of an iPod in the hospital?

    • Apollo said:

      They’re quite prevalent, at least in my hospital. Maybe half to three-quarters of the nurses I know use iPhones, and my entire Neurology service is populated by iPhones and iPods with the exception of my attending who uses a Blackberry. At least in my neck of the woods, it doesn’t seem to carry an unprofessional appearance!

  16. Melissa said:

    I am an NP in a rural health clinic and a little bit techno ignorant. I have used a palm for a long time with several apps, but mine is in need of replacement and want to go to a itouch. Do the apps work without internet/wifi just as they would on a palm? In other words do you have to be in a wifi area to use the apps? I do not always have wifi around here. Let me know what you think/know. Thanks.

  17. Apollo said:

    Hey Melissa,

    The apps for the iPhone and iPod Touch vary with respect to WiFi/Internet requirements: some are merely portals for websites, while others function completely offline. For example, Epocrates Rx/Medscape/Skyscape, Diagnosaurus, the various medical calculator apps, and others work offline (but require Internet connections for updates, which you can easily perform at home). Until recently, the hospitals I work in didn’t have guest wireless or consistent wireless either, so I had to function completely offline. The descriptions in the user reviews of the apps on the iTunes App Store usually give some indication as to whether or not they are Internet-based or not.

    ~ Lester

  18. David said:

    Great Information!! I have a PDA, but the excitement from a 3rd year resident has me wanting an IPOD touch. He was very excited showing me all the things he had acquired for reference and games!!
    I may need to re-think my personal goals here!!

  19. Mary said:

    hi, thanks for ure information round ipod medical tools.The most offensive problem with ipod which makes me hesitate to buy it as a PDA is that it does NOT! cover UP-TO-Date software as a converted program! every body says that the only solution is to use online version.but I don’t know if wireless network covers all the wards in our hospital. tnx

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