New Media,Part One: Tool Apps for Palliative Care Providers

We live in a mobile world in which the use of mobile apps in the workplace is becoming mainstream. In one survey, over 84% of physicians in the United States used their smartphones for professional purposes. Mobile apps related to health care exceed over 100,000 in some estimates and are expected to increase by 25% every year. Only a small percentage of these apps will be adopted into a busy clinician's workflow or will be used by the general public.

In June 2015, Dr. Christian Sinclair posted an article on popular blog Pallimed entitled, “Steal This Idea: Hospice and Palliative Care App Reviews,” urging the palliative care community to “try out different apps and give all of us palliative advocates a better understanding of how it might work for us.” The authors of this article agree with this sentiment and hope that this review will be one of the first steps in starting a dialogue about the role of technology in hospice and palliative care.

The following review represents only a sampling of mobile apps available and is not meant to be comprehensive. The authors are both palliative care consultants, one who is an early adopter of technology and the other a late adopter. Each app was accessed in its updated form between the months of October and November 2015. In this first installment we review two tool apps that help palliative care providers to work more effectively.

Doximity. Website: www.doximity.com. Platforms: iOS, Android, web. Price: free. Function and relevance to palliative care: Doximity claims that it is the largest online physician community, with over 60% of physicians in the United States as verified users. You can connect with colleagues and read news articles for your specialty. You can even earn CME credits from some of the articles at Doximity. All physicians can undergo a verification process that opens up additional features to the verified user—in particular DocFax, a free HIPAA-compliant faxing service that is compatible with smartphone applications. How I use it in my practice:

Haipeng (Mark) Zhang, DO: As a social network for doctors it is not particularly useful. I am connected with scores of medical school and residency colleagues; but unlike Facebook or LinkedIn, Doximity does not offer many ways to interact with your connected colleagues other than viewing their profile and direct messaging them. There are no updates or posts to follow, making the social aspect of the application weak in my opinion.

The real jewel of Doximity is DocFax. You get a free fax number that is HIPAA-secure. Other web-based faxing solutions do not offer HIPAA compliance as a feature. DocFax in combination with a document scanning application on my smartphone allows me to fax scripts to pharmacies from anywhere. It makes being on call much easier, because I no longer have to be tied to home.

So far, the service has been very reliable with both sending and receiving faxes. I have run into a few issues with the Android application, particularly with the inability of the application to send PDFs created on my phone. To get around this I save my documents as pictures and send. For me, DocFax is the reason to sign up for Doximity.

Irene M. Yeh, MD, MPH: Not limited to Doximity—many of these apps will send you e-mail notifications when you create an account with a username and password. I have found it helpful to create a separate e-mail account to manage these notifications, particularly if using multiple phone apps.

Scannable & CamScanner. Websites: www.evernote.com/products/scannable/ and www.camscanner.com/ Platforms: iOS (Scannable); iOS, Android, Windows Phone (CamScanner). Price: free (Scannable); free (CamScanner basic version). Function and relevance to palliative care: Auto-captures images/documents via camera lens on your phone. You can rotate and crop the image, give it a title, and e-mail the images. It is helpful to have the Evernote app (a documentation organizer app) if you want to save the image. How I use it in my practice:

Irene: The Scannable app has been vital in facilitating communication. After a meeting or a brainstorm session I use it to capture various images: a PowerPoint slide, whiteboard ideas, back-of-the-napkin drawings, or handouts. I simply store these images in the Evernote app, and just as quickly and easily, e-mail the images to the group. Scannable app also automatically reads information on business cards, not only capturing the image of the business card but also auto-creating contacts. Scannable has become one of the most used apps on my phone.

Mark: The key to the application is how it can consistently detect and create a high-quality scan while adjusting the image from practically any camera angle with minimal input from the user. It makes digitizing documents very easy.

For Android users, CamScanner is a good alternative, although scanning a document with CamScanner, requiring manual adjustments, is not as easy as with Scannable. CamScanner comes in both free and paid versions. The premium version of CamScanner offers additional tools including auto-syncing documents to cloud storage services such as Google Drive.

Of note, Scannable and CamScanner feature the ability to upload scanned documents into cloud storage. Most cloud storage platforms are not HIPAA-compliant, and we would recommend not uploading documents with protected health information to these services. In particular, creating a CamScanner username and login will trigger the application to automatically backup any scanned photos to CamScanner cloud storage, which makes no claim to be HIPAA-compliant. We recommend using CamScanner without creating a CamScanner account to avoid uploading sensitive data to potentially unsecure cloud storage.

Discussion

Mobile apps have the potential to help a busy clinician with his or her workday, either by helping with productivity or as a tool to improve patient care. Patients are beginning to use mobile apps more frequently and may seek clinician engagement with these technologies. The challenge remains in determining the usefulness, quality, and safety of these mobile apps. An understanding of the ever-changing landscape of digital applications will better inform our specialty in identifying areas and problem points that can benefit from further innovation.