"What's App?" Utilizing Evidence Based Medicine Apps in the Clinical Setting

The medical community has utilized evidence-based medicine, or EBM, in practice for decades, and healthcare personnel are used to the idea of utilizing research and statistics to determine optimal treatment plans for patients. However, as technology advances, the use of electronics and EBM apps has increased in the clinical setting. While there are advantages to clinicians having resources at their fingertips, there are also obstacles that could harm or offend patients. As healthcare inevitably becomes more electronic, can providers strike the balance needed to effectively use EBM apps in practice to provide optimum patient care? O’Donovan KC. What’s app? Using evidence-based medicine smartphone applications in healthcare practice. BU Well. 2016;1:18-20. or the modern healthcare provider, evidence-based medicine is, “the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances. ” The term, often abbreviated as “EBM,” was established in 1992, but the concept of using research to determine treatment of patient symptoms has been prevalent since the mid19th century. With the overwhelming volume of research done every day, healthcare personnel rely on resources such as textbooks, professional journals, and websites to keep up with everchanging practice guidelines. Additionally, the healthcare system is shifting to the electronic world by storing records, patient files, and pharmaceutical information online. Now more than ever, practitioners turn to their smartphones and tablets to make educated choices for and with their patients. As the use of technology becomes more integrated into the healthcare world, mobile EBM applications will play a growing role in practitioner assessments. But what exactly are these apps, and how effective are they in assisting healthcare providers in clinical decision making? Evidence-based medicine is utilizing data from clinically relevant systematic research to influence patient care. EBM is currently used in a variety of ways, including but not limited to: development of universal guidelines for care, deciding the “gold standard” tests for disease screening, calculating individual patient risk of disease based on related factors, and establishing which treatment would be the most effective for individual patient cases. These apps, also called electronic knowledge resources (EKRs), bring research and evidence to the clinician’s fingertips through mobile technology devices. However, a clinician must answer specific questions before applying evidence to each patient. When looking at the evidence within research, one must ask, what is the relevant patient population, what intervention is being considered, what is the comparison intervention or patient population, and what outcomes are of interest? The questions can be abbreviated as “PICO. ” If the PICO information in the app aligns with the specific patient, the clinician may then use the app to aid in the care of the patient. First and foremost, these apps are designed to be efficient and user friendly, allowing anyone with a smartphone to learn to use this technology in practice. More interactive than a traditional textbook, these apps allow the patient or provider the ability to click through different links, definitions, and treatment options to improve understanding. This technology allows a clinician to double check their assessment of a patient almost immediately in order to ensure the best possible treatment. In addition, these apps can be used collaboratively with patients. Providers can open these apps and look at them with the patient, showing them the statistical likelihood of a diagnosis based on symptoms, the patient’s percent risk for a certain disease process, or the nationally-approved treatment guidelines. In utilizing this method of practice, patients possess more autonomy over their own care than in the past. The apps can become a means for dialogue between patient and provider, moving away from the paternalistic style of practicing medicine where the patient followed the doctor’s orders without question. Another benefit of EBM apps is that the apps make it easier to keep up with the constant stream of new information. The information provided on these apps can be updated faster than it takes to print the newest edition of a textbook or journal, which ensures that the most cutting-edge treatments and accurate resources are available to practitioners. For example, if a commonly used medication develops new adverse effects or contraindications that significantly alter the patient population who can safely take the drug, the information can be rapidly changed with an app update. The nature of smartphone apps lends itself well to the changing and growing data that is the foundation for evidence-based medicine. Despite the positives of using EBM apps, there are still obstacles to their widespread use. Complications are especially present when apps are used as an exclusive resource. A major concern with EBM apps is reliable contact with this technology, since all providers may not have secure access to a smartphone or tablet. Even with access to the technology, app glitches can temporarily leave a provider without additional resources. Additionally, some providers could potentially become too reliant over time on information from the app and miss physical exam findings, key symptoms from a patient histories, or abnormal F