The Notebook of Medicine App is a great idea but may be too early to be truly helpful
Every day, science expands what we know about medicine. New disease processes are discovered, new medicines are developed, old medicines are repurposed, and old diagnoses are adjusted and changed. The art and science of medicine are in constant flux, requiring the need for a continual study to remain viable. Whether you use textbooks (outdated the day they are printed), journal articles or summary websites like UpToDate or DynaMed Plus, diagnosing patients remains a relatively personal/individual process. Years of study and countless hours of education go into each encounter. Summarizing personal/family/surgical histories, reviewing symptoms, looking for signs, examining the patient and evaluating any imaging/lab studies, we can create a differential diagnosis of what ails the patient.
One of the best aspects of residency was the camaraderie and the ability to bounce ideas off of fellow residents. The collective brains of multiple providers enhanced the diagnostic throughput and likely decreased diagnostic errors. According to Dr. Ken Wallace, the developer of Notebook of Medicine App on the iOS App Store and Google Play Store, millions of patients are misdiagnosed each year throughout the world. By creating a worldwide resident like atmosphere, information, notes, and opinions can be shared among doctors from around the world. The Notebook of Medicine iOS App is created by physicians for physicians and creates a searchable database of clinical diagnoses, images and treatment records. The app states that there are roughly 4.5 million diagnoses currently present in the App. Providers can search and find clinical, diagnostic and treatment options for a variety of diseases. Other providers from around the world can upload notes, images, learning materials to assist the educational process further. You can keep your own notes, add images and video to the app and keep them for private viewing or pass the knowledge forward.
DR. Wallace notes that the app is designed to be HiPPA complaint, protecting specific patient information. As a user, you can follow other doctors and receive notifications when they post onto the app. The strength of the application is in the users. Upload your own information, review notes from others, watch surgical videos, created educational presentations, read new notes, etc. You can also specifically follow a disease or individual organ system. If someone posts new information about your interest, an alert will post to your device. In this case, you can see anyone posting about that process. We can ask questions about symptoms, add pictures and get second opinions from experts in the area. Notes can get rated and shared and earn more followers. The overarching objective is to “make the world a healthier place by doctors sharing with other doctors,” unencumbered by borders.
The promise of the app is much grander than the current utility. As stated above, when more people use and add to the app, the real power/benefit will be realized. There are a few glaring issues, however. When you sign in, you will be required to add the first/last name, enter email information and password information twice, select your profession, name of the healthcare facility and a zip code. There was nothing in this step that authenticated any of this information, which is a huge problem. I entered “Jon Walt, Doctor, University to test this and it took the information. If we are to use this as a medical repository, we need to know that the data that is being updated/added to the site is medically correct and the credentials of the person are accurate as well. I would be concerned that non-medical individuals may place incorrect information on the site. It may be possible that downvoting the information may allow incorrect information to be less evident. For now, this may be problematic enough to question the validity of the data. I wish that there was a way to see how many people are logged into the app. Additionally, with separate iOS and Android apps, it would be interesting to see which OS generates more users.
To test the search feature, I tapped the magnifying glass on the top right and typed “Mumps.” It opened a large tree of headings: Genus: rubulavirus, Clinical, SSP, Mumps Virus, Clinical, Presentations, Mumps. Tapping mumps, it opened a section on Mumps. This section detailed some of the signs/symptoms to include Eponyms (Findings named after people) like Hatchcock sign, Mirchamps sign (painful secretion of saliva with strong tasting substance to the tongue). Scrolling down below clinical, you can tap pathology, Dx/diagnosis, Rx/treatment, alternative treatments and alternative medicine. These were all empty. I was actually impressed that Mumps was present, but saddened that much of the information was missing. For a second test, I entered a second diagnosis. I was watching the television show “The Curse of Oak Island” and one of the brothers was sick. I suspect Lyme based on the symptoms and rash displayed on the television. This app provided a decent clinical picture discussing/reviewing tick types, bullseye/target rash description, Erythema Migrans, etc. It did not provide any treatment options, unfortunately.
If you select the three horizontal lines, the app will take you to a side panel detailing your name, home, follow, send feedback to Dr. Ken, How does it work? rate and review, like us, settings, sign out and version. If you touch the little pencil, you can alter your personal information. Selecting follow will allow you to monitor postings by a variety of providers. You can see their name, email and the typed profession. You cannot really see anything more about the people. You can also add diseases that you wish to follow. I did not find much utility in the main organ system tree. The best way to get to your diagnosis is to search for it along the top right. The app appears to be early in its development and may be an amazing asset to our everyday life. I love the idea of having this repository to share knowledge. The overarching feel is a medical Wikipedia that is monitored/adjusted and maintained by physician input. This app will only be as strong as the number of users/posters and the quality of the uploads. I do not know how the app/team will handle incorrect information and if this will be deleted immediately or if it will go through some vetting/voting or other professional evaluation. What happens if incorrect information is disseminated? I would also caution using any patient images/data due to concern for HIPPA. There are 18 identifiers that if violated can lead to HIPPA fines/violations.
Today as I tried to search for the above dx again, as well as influenza, malaria, rabies, lateral epicondylitis, the app would take me back to the main tree. There may be too many diagnoses to search through as there are multiple symptoms. There are currently three reviews on the iOS app store, and all have given the app five stars. I agree that the utopian idea is amazing, but at present my paid subscription is a better more “Up-to-date” system. A few of the reviews commented about utility for non-medical individuals. If we post to this site and someone uses this information, does this pose any risk to the poster? How does the app/developer generate income from the app?At this time the app is not as helpful to me as DynaMed Plus or UpToDate, but the added benefit of following specialists and collaborating between physicians provides a sense of Utopia. I have downloaded the app and will continue to check it out. Personally, it is too early to rate the app fairly as it needs more users.
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