As a resourceful physician working full-time in the urgent care and emergency department, I have found that the iPhone provides incrediblely simple resources to prevent medication errors, maintain accurate records, and connect to patients in a more timely manner. The tips below are easy to implement and allow physicians and patients to interact through telemedicine, an innovate method of transforming health care delivery across America.
1.) Use your phone to list your medications. As a doctor, it always amazes me when patients arrive to the clinic and have no idea what medications they are taking. Your doctor can’t help you with any new medicines until she knows what you already take. Often times, these people are diabetics, have high blood pressure, or were recently on multiple medications. Wallet cards and the actual bottles are very helpful, but those get smudged or misplaced over time. I recommend using the Contacts section of your cell phone or creating a simple document on your iPhone that includes the full name of the medicine, what it’s for, the milligram strength, and how often you take it. That way the doctor can update her information and type in the new medicine right in the exam room.
2.) Itemize your allergies. Patients will describe medication allergies in different ways. To a doctor, an allergic reaction means a rash developed, the person had difficulty breathing, their kidneys shut down, or the patient ended up in the hospital. Generally, if your symptpms weren’t this severe, you probably had a medication sensitivity. These can include nausea, diarrhea, stomach aches, or dizziness. Include a section on the iPhone for these side effects too. For example, if Amoxicillin caused your lips to swell for 2 days, but Cipro gave you diarrhea for a week, make a note of that. This way your doctor will never prescribe Amoxicillin, but may be able to use Cipro as a last resort to save your life. Keep your list current on your iPhone and show it to your doctor before he writes the prescription to prevent you from getting an inappropriate medication.
3.) Save your vaccination history on your phone. Because Tetanus bacteria is very aggressive and people can die in a few days from simple cuts while gardening, doctors always advocate receiving the vaccine during the initial visit. However patients usually can’t remember if they had a Tetanus shot in the last 10 years. If you have a wallet card with the vaccination history, take a picture of it today on your cell phone and the nurse can add it to your profile during your next routine or urgent care visit. She can also verify if you are due for your flu shot, whooping cough booster, or pneumonia shot. This way if the clinic doesn’t have your records, at least your cell phone has the most recent information. You can also download the CDC App that will tell you the correct adult and pediatric vaccinations as well as itemized information for the elderly, pregnant, or immuno-compromised patients.
4.) Take a picture of your insurance card and store it on your iPhone. Many illnesses and injuries seem to happen on weekends or when you are out of town. Having the relevant information and telephone numbers saved to your phone will make the clinic registration smoother and your claims process much easier. You can also send it quickly to your daughter in college or your husband at the emergency department. You should password protect your phone to minimize theft of sensitive information.
5.) Prepare an Advance Directive through an app. These are health care documents also known as living wills, but they have no relationship to your financial details. A person has the ultimate right to accept or refuse a treatment recommended by their doctor. Generally, the patient and doctor will agree on medications, testing, and follow-up. Unfortunately, if a trauma occurs, the patient may not be able to make those decisions. For example, a healthy 29-year-old male who suffers a head injury on his motorcycle could be in the hospital for weeks or months. It is possible that this patient would refuse blood donations for religious reasons, refuse to be put on a ventilator for artificial breathing, or refuse to have CPR done if there were no benefit to revive him. The spouse or family members would have to decide what to do next and this can be source of confusion, tensions, or misunderstandings. In this situation, it would have been best for an Advance Directive to be typed, signed, and kept at home or the doctor’s office to guide the family and doctors about what to do. Putting a sticker on the back of the driver’s license, telling family members exactly what he would prefer, and keeping a copy saved on the iPhone would allow for his final wishes to be respected. Now, you can download the free UTHSC Advance Directive app and follow the easy instructions to create the valid document.
6.) Take pictures of rashes. Rashes are always confusing to patients and doctors, especially if there is no obvious cause. Taking a picture of the rash on your iPhone and using descriptive words and timelines is vital to the correct diagnosis and treatment. The rash is always much worse several days later by the time the clinic visit arrives and the doctor would benefit from seeing how the rash looked like on the first day. Using a ballpoint pen, draw a line marking the edge of the redness to compare different days and identify if it is growing or shrinking. Also note any fever or take pictures of other ill contacts in the household with similar rashes.
7.) Use ePocrates and the pharmacist to screen for drug interactions. You and your doctor can download the free ePocrates app and look up $4 generics or verify any Black Box Warnings from the FDA. If you use several pharmacies to fill your prescriptions or a mail-order service, your profile may be incomplete. Take your bottles and medication pamphlets to your local pharmacist and have the generic and brand names entered into the database. The system will automatically trigger alerts for serious interactions that your doctor may not know yet. For example, people that take Warfarin as a blood thinner know they have a long list of medications that interact poorly and cause hemorrhage or strokes. However, certain antibiotics can decrease the effectiveness of birth control pills and increase the chances of unintentional pregnancies. Also, taking over the counter pain medicines and prescription painkillers has been linked to side effects on the liver, kidney, and stomach. ePocrates is very easy to use and lists generic names, brand names, relative cost, and safety issues. It is designed for reference only, so always respect the final recommendation and instructions from your doctor.
8.) Type your list of questions into your iPhone. Patients will have several questions that they must ask at the visit, but can’t remember when the doctor is actually in the room. Type up any questions you had in mind before the visit, including lab results that you did not get back (cholesterol values), any testing you are due for (mammograms), or a mole on your back that has been growing for months. Give the list of questions to the nurse when she gets your vital signs so the doctor can he review the information before coming into the room. If a child’s father brought the patient to the emergency department, I actually tell them to text or call the child’s mother while I am in the room finishing my notes to make sure both parents are in agreement on the symptoms, history, and my recommendations. The parent who could not come to the visit is always impressed by this small attention to detail and I know this will minimize confusion, reduce parental stress, and improve the overall outcome for the ill patient.
9.) Translation software. Doctors will frequently encounter patients who do not speak English as a primary language. Several medical Spanish iPhone apps have been developed that allow written and audio files to be used for basic questions such as “Does your right ear hurt?”, “How long have you been ill?”, and “What medications do you take?” The apps allows the English speaking physician to tap on the icon and the Spanish speaking patient to listen and respond with yes or no questions. Encourage your English speaking physicians and their staff to download these apps and become familiar with them. It is a great way for the clinic to learn a new language on the job.
10.) Telemedicine. With the Health Care Reform Act, telemedicine is receiving special attention in positive ways to provide health care through alternative resources. Telemedicine is a way to provide virtual housecalls through email, telephone, and video-conferencing. Patients can call a licensed physician from their own home and ask the same questions that would be discussed in a face to face visit. This is beneficial for rural towns across America and underserved neighborhoods in large cities where access to clinics is already limited. It is also a time-saving method of providing care to busy professionals, college students, and the general public. If appropriate, the doctor may be able to prescribe medications or recommend testing. Consumer health care organizations such as AmeriDoc and HealthNation are creating hybrids of telemedicine and electronic health records to connect patients with doctors in real-time. Patients will soon be able to download apps to their iPhones and click a button to speak directly with a physician. Physicians can use their iPhones to review records securely even if they are making rounds at the hospital or attending a conference. This allows health care encounters to take place 24 hours a day.
In summary, the iPhone itself and the apps available are a a low-cost and easily-accessible method of recording health information that can be shared with the patient, pharmacist, and doctors across the country.