Integrating Patient Apps into Clinical Conversation

How I Practice Video Series 
Nathaniel DeNicola, MD, MSHP, FACOG
Washington, DC

Integrating Patient Apps into Clinical Conversation from ACOG on Vimeo.

Now I ask all patients about app use during every visit – whether it’s the new OB visit, the return OB visit, or the annual GYN visit. There are 1800 ob-gyn apps alone and its use is nearly ubiquitous when it comes to patients. So the answer is often yes. And if they are using an app, I make sure to ask them how they use it, what information they’re getting from it and what they want from the app. That way it opens the conversation into something patients and doctors can discuss together. The apps can often be a nice adjunct to clinical care but it’s still important that the doctor is still the trusted choice for medical information and clinical counseling. Often the apps are something that is providing purely informational content, such that a patient can already get from the internet, so all that is needed from the provider is a little bit of clarification. Other apps make the patients very engaged in their health care. The pregnancy apps, for example, will often track a patients gestational age and perhaps provide some educational material relevant to their point in pregnancy.  These can and should be discussed during the clinical visits to make sure we’re integrating with the patient and there is not misinformation being provided.  Additionally, some apps are used to monitor contraction timers.  This is a very similar function to what is done by a stop watch, simply contained in a digital tracking in the phone.  These generally, in my opinion, would pose limited risk and again it is a way to engage patients and perhaps provide actually accurate information.  More and more patients are tracking their period with some kind of app. And this can be to applicable to both the OB and the GYN visits.  Usually now when I ask the patients when their last menstrual period was, the first thing they do is pullout their cell phone and scroll right back to the date that they had recorded on their calendar in their phone.  So this can be a helpful adjunct to the clinical history. Additionally, during GYN visits, patients can often point to an exact number of days for their menstrual cycle – it’s been 26 days, it’s been 32 days.  They can scroll back through their phone and tell me exactly what the pattern has been. And it’s helpful to have this as part of the clinical integration. 

Sometimes when I ask patients about apps, there are some that are concerning.  There are two are in particular where I take extra time to counsel patients about the apps that they are using. The first is for fetal heart rate monitoring. There are number of these apps available that claim to build a monitor of the fetal heart rate using a built-in microphone or a connect device to the smart phone or tablet. Obviously, this is obtaining critical clinical information that often requires the supervision or input of a health care provider. And most of the apps do not have that kind of clinical integration.  So I make sure to counsel patients about the importance of an accurate fetal heart rate monitor and the limitations of the apps capacity. We can offer alternatives; we have things like the fetal kick counts; we have things like triage numbers that the patients can call and actually talk to a health care provider if they are concerned about fetal movement. We have more evidence-based and more clinically sound counseling than the medical apps, that I recommend.  The other area of concern for apps are patients that use apps for contraception. These might be helpful adjunct to fertility awareness methods; however, it is important that patients know the real risks for pregnancy which are not necessarily what the app developer has advertised. So all kinds of questions and counseling can emerge when you ask your patients if they have an app, what they’re using it for, and if they have any questions.

There are some apps that are particularly helpful for providers as well. For example, ACOG has released an estimated due date function in their ACOG app.  The ACOG due date calculator is the only app right now that builds in the ACOG guidelines into its logic. So it can help instantly reconcile any difference in establishing a due date, whether it’s based on an ultrasound or last menstrual period. So physicians may find apps that are helpful for them as well but whether it’s the patient using it or the doctor using it’s important that we’re discussing it together so that the patient-doctor relationship remains the trusted source for medical information and counseling. And this is how I practice. 

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