Apps

Quality and Safety Concerns for Medical Apps

I just read a brief perspective article in the journal Evidence Based Medicine, “Medical apps for smartphones: lack evidence undermines quality and safety.”  It is a quick little read and it brings up some very real and interesting points which I will try to summarize.

  1. There is no official vetting system for medical apps – Some apps are blatantly wrong and dangerous, some are out of date therefore also dangerous.
  2. Lack of information and clinical involvement in the creation of the apps – There is a paucity of information regarding the creator of the app. Some apps have no physician involvement.
  3. Companies (authors specifically mention Pharma) creating apps could create conflicts of interest and ethical issues – Pharma apps could produce drug guides or clinical decision tools that subtlety push their own products.

The FDA will regulate some apps but not all.  The FDA will regulate apps that control a medical device or displays, stores, analyzes patient data (example: electrocardiogram).  They will also regulate apps that use formulas or algorithms to give patient specific results such as diagnosis, treatment, recommendation or differential diagnosis.  Finally they will regulate apps that transform a mobile device into a medical device (example: apps that use attachments or sensors to allow the smartphone to measure blood glucose).

That still leaves a ton of medical apps hanging out there in the app stores which are largely unregulated.  The article states, “Until now, there has been no reported harm to a patient caused by a recalled app. However, without app safety standards, it is only a matter of time before medical errors will be made and unintended harm to patient will occur.”  Basically it is the Wild West in the medical app arena.

There are two groups that are trying to evaluate medical apps.  iMedicalApps.com and the Medical App Journal review various apps directed toward medical professionals.  I take issue with the article authors who state these sites are a “good starting point for peer-reviewing apps, the current assessment criteria do not address the scientific evidence for their content, but rather matters of usability, design, and content control.”  While I don’t use the Medical App Journal as often,  I use iMedicalApps.com quite often and they do more than just assess the usability and design. I have read reviews where they question the medical correctness of apps, intended audience, and have even pushed for more information regarding authorship/responsibility.  Several of their reviews questioned an app’s update schedule and updated content.  They have also investigated, questioned, and reported instances of fraud and plagiarism with medical apps.  I think iMedicalApps does a very good job in a very flooded market, but there are areas for improvement.  As with any website that relies on a large number of reporters/reviewers, there is some variance in the quality based on the reviewer.  I haven’t found any reviews that are bad, just some are better and more thorough than others.  Perhaps a little more explanation or transparency regarding how they determine the accuracy or validity of medical app might be helpful, or a standardized checklist about the things they look at.  I realize evaluating the latest UpToDate app is different compared to an app on EKGs.  UpToDate already has an established proven product where as there is more to investigate and validate with an app that isn’t a version of an already established product.

The authors believe the medical community needs to be more involved with regulating medical apps.  They suggest:

  1. Official certification marks guaranteeing quality
  2. Peer review system implemented by physicians’ associations or patient organizations
  3. Making high quality apps more findable by adding them to hospital or library collections

1.  I like the idea of having an official certification indicating quality, but there are two things that must be addressed prior to that.

First you have to get the organizations to actually take responsibility for looking at apps that are in their area of expertise. The field is already cumbersome, I am not sure many organizations are able to handle that. Although I have found that several journals have now included app reviews.  While they can’t come close to scratching the surface of medical apps, these journals often have MDs, RNs, MPTs writing reviews and evaluating the content.  Specifically I have found some good reviews in the physical therapy and nursing journals.

Second, there is growing problem with fake certifications. If an app is created by a company or people who already don’t care about its accuracy or is a plagiarizing a product, they probably have no qualms about lifting the image of the certification and posting it on their website.  They could create their own certifications to fake (but legit sounding) orgs and post those on their app’s site too.  Official certification is a good idea and I like it but there needs to be more to it to make sure it truly represents quality.

2. I personally believe the writers at iMedicalApps.com are on their way to something of a peer review system.  Right now they only have one person review an app.  While that completely makes sense from a writing perspective, perhaps they can implement some sort of peer review process where more than just one person is reviewing the app, yet still retain the one voice post for ease of reading.  Perhaps they could  reach out to a few medical professionals who are leaders in their field to review specific apps.  Thus giving the reviewed app a little bit more weight.  This along with astandardized check list or illustrating how they review the medical accuracy of an app would make the information on their site even more important and provide an excellent way of separating the wheat from the chaff.

3. An online repository of approved apps would be great.  Some hospital IT departments that have mobile device policies have this, but they seem to be only hospital type apps like Citrix or database subscription apps like LexiComp, PubMed, UpToDate, etc.  While these apps are important, there is little worry about apps like LexiComp, UpToDate, or PubMed because they were well established medical information products before their app.  Their app is just an extension of their verified product.  I don’t see a lot of  IT departments that have investigated having a pool of apps that aren’t hospital specific or from database subscriptions.  Additionally, IT would either need to rely on an outside sources like iMedicalApps or content experts within the field in that hospital to build the app pool.  IT would have no way of verifying the authenticity and validity of an app on pediatric emergency medicine.

Finally, getting hospitals to buy bulk licenses to apps is tricky at best.  With exception of a few places like Epocrates, Unbound Medicine, Inkling, and Skyscape (many of those companies dealt with institutional subscriptions before app stores….remember PDAs?) there are very few places that sell or license apps to a group of people.  The purchasing of apps was created as an individual service.  Now academic medical centers may have a foot in the door with iTunes U, but I have heard that discussions with Apple and their app store and hospitals is an “interesting” process.  The same principle applies to library repositories.  Instead of IT aggregating the apps, the library would do that.  There are a lot of library’s that already have great lists suggesting various medical apps.   But the vast majority of medical libraries have app resources guides, suggesting apps that the individual must buy.  Also just like with an IT repository of apps, the librarian must rely on sites like iMedicalApps.com or their own physician suggestions to ensure they are listing quality apps.

Like I said it is the Wild West when it comes to medical apps.  That is because the whole app industry is a new frontier.  There are quality and accuracy problems with other apps in the app stores. A pedometer app with errors is not going to kill somebody, but an inaccurate medical app can.  Yes, the medical community needs to get involved in evaluating apps, but so does Apple and Google.   Right now Apple’s iTunes store feedback and ranking system while good for games, is not adequate for medical apps and can easily be subject to fraud.  Additionally, Apple is extremely tight lipped about its app store rules and regulations.  Some apps have extreme difficulty getting approved, while others fly through approval process only to be mysteriously removed later.  There is no transparency to the Apple App Store.  For example, there is no information about the app Critical APPraisal which was determined to be a plagiarized version of Doctor’s Guide to Critical Appraisal.  The app was available in the App Store July 2011.  However, if you searched today for the app, you wouldn’t be able to find it in the App Store, it simply disappeared.  Unless you happen to read the article in BMJ, iMedicalApps.com, or a few other British publications, you would have no clue as to why the app was removed.  When it comes to dangerous apps, disappearing them from the App Store is not good enough. You must have transparency when it comes to medicine.

**Update**

According to an updated BMJ article, the doctors accused of plagiarizing The Doctor’s Guide to Critical Appraisal to use in their app Critical APPraisal, have been cleared of plagiarism by the Medical Practitioners Tribunal Service.

“A regulatory panel rejected charges by the General Medical Council (GMC) that Afroze Khan, Shahnawaz Khan, and Zishan Sheikh acted dishonestly in knowingly copying structure, contents, and material from a book, The Doctor’s Guide to Critical Appraisal, when developing their Critical APPraisal app, representing it as their own work, and seeking to make a gain from the material.”

Shahnawaz Khan and Afroze Khan were also accused of dishonestly posting positive reviews of the app on the Apple iTunes Store without disclosing that they were co-developers and had a financial interest in the app.  The GMC found that Shahnawaz Khan  no evidence that he knew that the app, which was initiallly free, would later sold for a fee. His case was concluded without any findings.  However, the GMC panel found that “Afroze Khan’s conduct in posting the review was misleading and dishonest.” Yet they considered this type of dishonesty to be “below the level that would constitute impairment of this fitness to practise.”  The GMC panel said it was an isolated incident and did not believe it would be repeated in which they “considered his good character and testimonials attesting to his general probity and honesty and decided not to issue a formal warning.”

 

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1 comment - What do you think?  Posted by KraftyLibrarian - September 18, 2013 at 10:30 am

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Plagiarism of Medical Text in Medical Apps

In a recent post, Timothy Aungst from iMedicalApps.com sheds more light on the trend of copying established medical textbooks and repurposing it in a medical app that they sell on iTunes.  Aungst cites a recent report in BMJ, where three doctors, “Afroze Khan, Zishan Sheikh, and Shahnawaz Khan face charges of dishonesty in knowingly copying structure, contents, and material from the Doctor’s Guide to Critical Appraisal, by Narinder Gosall and Gurpal Gosall, when developing the app, representing it as their own work and seeking to make a gain from the plagiarised material.” Not only did the doctors plagiarize the text, but according to Aungst and BMJ the doctors also sought to increase their ratings within iTunes by writing reviews of their own apps without disclosing an conflict of interest.

This type of plagiarism is not new. In fact as Aungst states iMedicalApps.com Editor, Tom Lewis, discovered several apps in iTunes that plagiarized other works.  (I wrote a brief post about Tom’s finding while I was on vacation last year.) I can see from Tom’s comment that while he never heard directly from Elsevier regarding the issue, YoDev apps LLC had all of their apps pulled from the App Store.

Copying and re-posting a book online or through bit torrents for free is so 2005.  Welcome to the new world where plagiarizing can make you money. All you have to do is steal the content and sell it in an app.  They are also sneakier than they were in 2005.  They aren’t selling the app under the original book title, they are changing the name and trying to market it as something totally different.   Hmm it seems requiring users to use personal logins to view the PDF is really working to curb copyright violations.

***Update***

According to an updated BMJ article, the doctors accused of plagiarizing The Doctor’s Guide to Critical Appraisal to use in their app Critical APPraisal, have been cleared of plagiarism by the Medical Practitioners Tribunal Service.

“A regulatory panel rejected charges by the General Medical Council (GMC) that Afroze Khan, Shahnawaz Khan, and Zishan Sheikh acted dishonestly in knowingly copying structure, contents, and material from a book, The Doctor’s Guide to Critical Appraisal, when developing their Critical APPraisal app, representing it as their own work, and seeking to make a gain from the material.”

Shahnawaz Khan and Afroze Khan were also accused of dishonestly posting positive reviews of the app on the Apple iTunes Store without disclosing that they were co-developers and had a financial interest in the app.  The GMC found that Shahnawaz Khan  no evidence that he knew that the app, which was initiallly free, would later sold for a fee. His case was concluded without any findings.  However, the GMC panel found that “Afroze Khan’s conduct in posting the review was misleading and dishonest.” Yet they considered this type of dishonesty to be “below the level that would constitute impairment of this fitness to practise.”  The GMC panel said it was an isolated incident and did not believe it would be repeated in which they “considered his good character and testimonials attesting to his general probity and honesty and decided not to issue a formal warning.”

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1 comment - What do you think?  Posted by KraftyLibrarian - September 17, 2013 at 10:46 am

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The Journal App Wars

I have doctors asking about all four journal browsing apps; Docwise, Docphin, Read, and Browzine (click links for reviews on each app. The reviews were either done by me or guest librarians who had access to the app).  A few of the requesting doctors have used one of the above products, but it seems the vast majority of the doctors haven’t used any of the apps and are asking based on word of mouth. 

The four apps are very similar.  To me it is a bit like comparing PubMed vs Ovid Medline, both do the job well but differently.  You also have people who prefer one over the other.  One is free while the other is not. 

The biggest difference is that three of the apps show the abstracts and tables of contents to almost every medical journal known to man (I over exaggerate of course).  The full text is provided if the library/institution as a subscription to that journal.  However, there is no clear branding or explannation of what journals the library/instituion owns because Docwise, Docphin, and Read don’t know.   If a doctor views the table of contents for the Journal of Big Toe Science in Docwise, Docphin, or Read  (which is not owned by the library), the doctor is denied the full text.  Last time I checked, there was no clear message as to why they can’t get the full text. Docwise, Docphin, or Read didn’t say soemthing like, “Your library doesn’t subscribe to this journal therefore you can’t access the full text.” Docwise, Docphin, and Read do not know the library/institutions holding or access methods.

Browzine does know what the library/institution owns.  Because the library submits the list (with access methods) to Third Iron (the company that owns Browzine).  Browzine only shows those journals to doctors. There is no guessing as to whether it is available full text to the doctor.  If it is in Browzine, it should be available full text.

Let’s pretend that my hospital library provided proxy access to resources. (Most hospital libraries don’t have proxy servers to provide access to journals or other resources.)  I could have my pick of these apps to provide to my users.  My question for librarians is: Do I list all four apps and let them decide what they want?  I have a very strong feeling (based on 15 years of answering doctor’s library questions) that doctors are going to be complaining about Docwise, Docphin, or  Read not providing the full text.  After all, if the library recommended a product that connects users to the full text, shouldn’t everything be full text?

What do other libraries do?  Do you list all of the apps and let the users decide?  Do you worry that there might be confusion among the apps because they are so similar but slightly different? Do you worry that doctors might feel frustrated when they can’t get the full text? Would doctors even bother ordering the unavailable article (going outside of the app to do this) through the library? 

I appreciate your thoughts and comments. Because sometimes I feel with these journal apps I am being asked to pick between Coke and Pepsi, Ovid and PubMed.  I know the difference between them, but my users don’t. Does it matter?

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3 comments - What do you think?  Posted by KraftyLibrarian - August 20, 2013 at 12:22 pm

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The Doctor’s Instagram

The app Figure 1 has been getting a lot of press recently.  I learned about it a few weeks ago but I am just now getting around to mentioning it here.

Figure 1 is being called the Instagram for doctors.  It is a crowdsourced  images database app.  The crowd happens to be doctors, and the images happen to be medical images.  The app is a collection of medical images submitted by doctors to share, collaborate and learn from.  Doctors are verified using their institutional email address.  The app takes patient privacy very seriously.  It has a face detection program that automatically blocks out the face in a submitted photo and it includes other editing tools to remove other identifying features.  A HIPPA authorization digital consent form is also included.  Patients click the agree button then sign screen/form.

You don’t have submit any images to benefit from the app according to their site. “First of all, you can still access the images that others are posting so that you can learn from them, use them as a reference for your own practice, or comment on them so that others can learn from you.”

David Ahn at iMedicalApps posted a great review describing the positives and negatives of this novel app.  He notes some of the limitations of the app are the indexing of the images and lack of identifying information.  Ahn discovered upon doing a search for heliotrope rash that the first seven results were “clearly not a heliotrope rash.” As librarians know, indexing images is tricky.  Ahn noted Figure 1  also pulls images from outside medical websites (non-user submitted images) and a link to the website instead of the submitter’s name is listed.  However the outside images have “no captions, markings, or even any clear diagnosis listed.”  Besides the obvious problems with lack of identifying information, Figure 1 displays user submitted images before web scraped images.  As Ahn illustrated with the heliotrope rash, this can cause problems because the correct image (scraped from the web) was buried below the 7 incorrect ones (user submitted ones).

Additionally, I find doctors not only want to see and share images, but they often want to include them in presentations and slides for teaching purposes.  Right now you can only share the images through the app.  Emailing a colleague an image gives them a simple email (below) requiring them to use Figure 1 to see the image.  Making it so Figure 1 images can be used in presentations would make this Instagram like app even more useful to doctors and medical professionals.

 figure1email

This is a very new app. It appears they launched in May 2013, so it isn’t surprising that there is some room for improvement.  I don’t know of any products or apps that are perfect 3 months from their launch.  Yet as of today, it is the 5th most downloaded app in the Medical category of iTunes and according the MedicalApps post, the app is outpacing Landy’s projections.  So, given its popularity I expect to see some improvements relatively soon.

What I found to be interesting was Dr. Landy describing to Ahn his reason for creating this app.

Dr. Landy wondered how he could quickly access a medical image database to assist in identifying new clinical pathologies. This question eventually led him to create Figure 1. Like many physicians, he was not satisfied with the paywalls of private medical image libraries or with Google Images’ lack of medical selectivity.

Furthermore, when it came to sharing medical images with his peers, he found e-mail inefficient, as images would often get drowned out amidst ballooning inboxes. As a result, he helped create Figure 1, a free, crowdsourced medical image sharing resource that is quickly and easily accessible for health care practitioners.

Finding good medical images has always been a booger, and Dr. Landy is right about the frustrations of pay walls.  I would extend it a bit further to say that not only is the paywall part is a barrier to finding medical images, but the siloed nature of these medical image sites is a massive barrier as well.  Even if somebody has paid for these medical image sites, there is no repository or online catalog of all the image packages bought from different companies.  That makes searching for images difficult even if you paid for them.

I am curious to see how Figure 1 evolves and what impact it will have on doctors finding images.  I am also curious to see how/if subscription companies with medical image silos might adapt as a result of apps like Figure 1.

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Be the first to comment - What do you think?  Posted by KraftyLibrarian - July 24, 2013 at 11:06 am

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#Medlibs App & Tablet Share Site

There have been quite a few people who have emailed me personally saying they are looking forward to the discussion and they have things to share or want to know if anybody has something to share.

So from now and until we chat (tonight 6pm Pacific/9pm Easter) please comment with your URLs and other things you want to share to the group.  I will do my best to approve comments quickly so you can see them.  I promise that I will also add the comments as well as other URLs mentioned in the chat to the #medlibs blog.

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2 comments - What do you think?  Posted by KraftyLibrarian - March 7, 2013 at 4:51 pm

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Chat About Apps and Tablets Tomorrow on #Medlibs

Tomorrow (Thursday 3/7/13) at 9:00pm est, I will be hosting the #medlibs chat on apps and tablets.  What are you doing with apps? Are you creating a library specific app, catalog app, etc? Or do you have a good app guide that you want to share with others?  Is there a push for tablets within your institution, if so which one?  Can tablets access the EMR so that your docs & nurses can treat patients and do research with one device?

What other trends do you see or want discussed about apps and tablets?  Let me know?

Here are some sites you might be interested prior to the #medlibs chat.

Setting up iPad lending program
  • Nova Southeaster University Health Professions Division Library http://bit.ly/HApZqW – tips, resources
  • University of Groningen Central Medical Library http://bit.ly/15vCVqE -finding medical apps, information on adding bookmarks, (side bar has a lot of info)
  • Setting up a library iPad program: Guidelines for Success – http://crln.acrl.org/content/72/4/212.full Full text article in ACRL News by Sara Thompson at Briar Cliff University
  • Continuing the conversation: Integrating iPads and tablet computers into library services http://bit.ly/wgnMRS -ALA Tech Source article by Daniel Freeman

Policies and Procedures

App Stuff

Hope to see you on the chat tomorrow!  If you haven’t participated in a chat before, the easiest way to do it is use the cite TweetChat, login with your Twitter password and the follow #medlibs.

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Be the first to comment - What do you think?  Posted by KraftyLibrarian - March 6, 2013 at 3:43 pm

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Docwise: The Fourth and Final Journal App Review

If you are reading this review please make sure you read the reviews on Browzine, Read, and Docphin to make an informed decision as these products are all very similar to Docwise. These apps help users view and read journals on the iPad. Docwise is another such app and the review below by Joey Nicholson is the last of the apps to be reviewed in genre. I want to thank Joey for his very thorough review. Hopefully after reading over the four reviews you will learn about each of the products and have the information to choose a product.
Docwise Revew
by Joey Nicholson
Docwise comes from new contenders in the medical journal app market. It is co-founded by two MIT alums, who both went on to pursue further education in healthcare (one is a practicing surgeon). They bill it as “a personalized e-journal for physicians” and as “the efficient way to stay up to date on all your medical news”. Currently, this app is only available for the iPad.
Once you download the app, you need to register for an account by adding your personal information. Since it is designed as a “physician, dentist and NP community”, the app will link to your National Provider Identifier (NPI) profile so that it can create a beginning journal collection tailored to your speciality. For those of us that aren’t physicians, we can still get in by using the manual registration option.

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In the manual registration, you are asked to provide your specialty and subspecialty. These items are required so that the initial journal collections you are shown are tailored to what you do and your interests. Theoretically, this should take some of the effort out of pulling together all those journals that someone may want to read by already having them grouped by topic. I selected preventive medicine and public health to start.

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Once you’ve indicated your speciality, the next screen presents your starter collection. For public health, the collection isn’t very large and should probably be expanded to include something like the American Journal of Public Health as a core title. But, the three titles that come up are relevant.
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From here you can tailor what it is you want to see in docwise. They have this broken down into three categories. You can add specific journals, you can add news feeds, or you can add topic areas.
Adding new journals to your personal collection is very easy, assuming you know in what category the journal of your choice is placed. Under Preventive Medicine, you can quickly hit the plus signs to add AJPH, BMC Public Health, and several other relevant journals. A search box here would be nice, I couldn’t find Academic Medicine under any of the journal specialty categories.
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A feature that I really like is the ability to add news stories to this, not just academic journals. There is a decent selection of top health-related news sources, including New York Times Health, Fitness, and Medical Research, and feeds from ClinicalTrials.gov and the CDC.

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Next you can enter topics in which you are interested. By using key words that you put in, docwise will create a topic feed and pull in articles from any journal on these terms. What isn’t clear about this from a librarian perspective, is where these key words are being searched. Title? Abstract? Full text? MeSH terms? PubMed? GoogleScholar? Once you are done adding journals, news, and topics you swipe that menu away and click done.

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While you can start reading abstracts and free articles that you happen upon right away, the next logical step is to add your institutional login information. To do this, you have to hit the Menu icon in the top right and then hit the gear icon in the bottom right to access your settings.

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Currently not all institutions are available in the institution login drop-down menus. While it doesn’t say this outright, I assume that you can use the link to email them and they would add your institution. Fortunately for me, one of the developers is a surgeon at my institution, so we are already in there.

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Once you’ve set up your institution, you can start reading your articles. In my case, I am routed to my library’s remote access login web page when I try to read a full article. I enter my user name and password and am taken directly to the article. Since this service is based on how the library sets up their remote access, this will vary depending on the institution. After I enter my login information once, it does retain it for a while. I can continue to read articles without having to enter my login information again. But, if I put it down for a while or come back to it another day then I had to enter it again.

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The home screen default displays headlines from a variety of your selected resources. The layout looks much like Flipboard or Read by QxMD.
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When you click on an article title/abstract of interest, you are taken to see the full abstract in a built-in web browser. One downside of this is that you must be connected to WiFi or 3G to browse or read articles, there is no clear way you can save them for reading offline. The available options are to share on Facebook or Twitter or to email to yourself.
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It would be nice to be able to open the PDF of the article in iBooks (or whatever PDF reader one chooses to use) to save it for offline reading and reference. You are also given the option of adding an abstract to your reading list or to your library. However, when I tried to access these offline I was unable to access the library at all and the reading list only provided the abstract, not the full article (even though I had already opened and read the PDF).
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The default sort order in the headline view is date of publication. If you’d like to browse within a particular issue of a journal, this is fairly easy. You can click on your menu on the top right and select your journal of interest. When you go into an individual journal, you can click on the journal title at the top to see the table of contents arranged by date. Page numbers would probably also be useful to display here, but I still often see references to specific pages and like to double check.
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Once you click on an article, you will see an intermediary window where you are given options to add the article to your favorites, add it to your library for offline reading, or set up an alert to tell you when it is available for free. However, this is not perfect. Through no fault of the developers, information on when and where specific articles become free is often spotty and incorrect. Several of the articles I tried are currently available for free, but the journal as a whole is not.
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Coming back around to the topic search that I set up on medical education, it is very unclear why these articles come up in the search. I do get a lot of articles, but I am unclear why. Not everything from Academic Medicine or Academic Emergency Medicine is included, and what is included only shows you the journal title in the Flipboard-type view, not in the table of contents view. This is a confusing feature that could be improved by a few tweaks, such as including the journal titles and page numbers in the table of contents view and specifying where and what you are searching.

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One confusing point is that depending on the journal, you are given a different look when you click to read the abstract. The caveat to this may not be immediately noticeable to any given physician. Articles that are in open access journals (BMC Public Health, PLoS One, etc) will link directly to that journal’s web site from the main view. This does not give you the option of adding an article to your reading list or saving it to your library. There is a work-around if you want to do those things. You can go into the individual journal’s table of contents, select the article from there, and then you are presented with the same view you will see for other articles.

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Unfortunately for many, there is no indication of which journals/articles are open access and which journals would be behind a pay wall. Users who do not have an affiliation that will pay for their access will have a more difficult time accessing articles and navigating which ones are freely available. It does seem that most of the health and medical related news items are freely accessible. One potential improvement could be a “Specialty” area that includes any open access journals or free content, although I’m sure that would be burdensome and complicated to maintain accurately.
Overall, I think the app has a very nice design and is easy to use. It integrates well with a variety of library remote login systems and is free to both users and libraries. It could definitely use a few improvements to enhance the quality and reliability of the features, but this will probably come in time. From my point of view, having news items included is one of the best features. I find that our users often read the popular media health care stories anyway, so it makes a lot of sense to include them in this app. This app will likely continue to improve as users suggest additional helpful and new features.
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3 comments - What do you think?  Posted by KraftyLibrarian - January 30, 2013 at 2:35 pm

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Review of Docphin: App to View & Read Journals on iPad

Previously I reviewed two apps (Browzine and Read)  that help users view and read journals on the iPad.  There are two additional apps that I will be profiling on this blog.  Docphin and DocWise are similar journal apps for the iPad.  Thankfully Alison Aldrich has agreed to test and review Docphin (below) and Joey Nicholson will be reviewing DocWise.  My hope is to get all of the reviews posted then later try and do a comparison chart of the products.

So without further ado, her is Alison’s review of Docphin.

Review of Docphin
by Alison Aldrich

Earlier this month, Krafty reviewed Browzine and Read, two journal reader applications for iPad. Today I’m writing about Docphin. Docphin is of similar ilk to Browzine and Read but with a few interesting differences. 

The “phin” in Docphin stands for personalized health information network. Docphin was founded in 2010 by some entrepreneurial physicians looking to address that all-too-familiar information overload problem. Docphin users customize their experience by choosing the journals and news sources from which they would like to receive updates.Sounds like an RSS reader, right? Docphin attempts to add value over something like Google Reader by suggesting sources based on specialty, simplifying access to full text, and making it easy to comment on and share sources via social media channels. 

Access to Docphin is restricted to those with email addresses at one of approximately 100 U.S. academic institutions that have requested activation. Activation is free and does not necessarily involve anyone from Docphin communicating with the library, so you may have access to Docphin without knowing it. Check by entering your university email address.

 Once your institution is on board, signing up for an account is straightforward. Enter your level of education (attending, fellow, resident, medical student, or other) and between one and three medical specialties of interest to you. Docphin suggests news feeds based on your selections, but you have the final say over the sources you choose.

An important note: Docphin does not cover every journal. It draws content from around 250 journals, so about 5% of the journal titles indexed in PubMed. A Docphin representative explained to me in an email message that journal titles were selected after consultation with hundreds of practicing physicians, including Docphin’s official team of Ambassadors, about what would be the highest impact titles in each specialty. 

In addition to journals, Docphin also draws content from about 250 twitter feeds, many from organizations (publishers, government organizations such as the CDC, AAMC, etc.) and a few from individual physicians. There are a handful of mainstream news media feeds available, too. 

I set up my profile to watch four internal medicine journals, two public health journals, and news feeds from ABC and the New York Times. My home screen looks like this in a regular web browser:

docphin1
And here’s how it looks in the iPhone app:

docphin2
 

Back to the regular web version, in the right column, I see articles that are trending among Docphin users right now. Clicking a journal title smoothly overlays this screen:

docphin3

I have the option to view the article (this prompts me for my proxy server login), share the citation via social media, like it, comment on it, or mark it as a favorite. I have the option to create my own keyword tagging scheme to keep the articles I tag as favorites organized.

From my home screen, clicking to the Search tab allows me to search by keyword within all of Docphin’s Journals and News collections, practice guidelines from the National Guidelines Clearinghouse, UpToDate, News, Images, and Videos. The UpToDate search does not prompt me for a proxy server login.

Docphin sends regular email alerts about new content from the sources you chose. Email alerts can be turned on and off under Privacy Settings.

Things I Like

The interface is clean and navigation is smooth.

For the journals it covers, Docphin works quite well with my institution’s proxy server as long as our subscription access is direct from the publisher. The system breaks down when it comes to journal content we get through a third party vendor such as EBSCO or Ovid. Those articles were unavailable to me through Docphinfrom off campus. 

I like the integration of Twitter feeds and trends data. Docphin does well to acknowledge these alternative modes of information discovery.

I also like that mainstream media feeds are included. I don’t know many residents who have time to catch the evening news. Docphin could help them stay a step ahead of what their patients are hearing and reading.

 
Things I Would Like To See

Right now, Docphin can only be accessed through a web browser or an iPhone app. There is no iPad-optimized Docphin application yet, although one is coming. An iPad app will make it much easier to interact with Docphin PDFs on the go.

I would also like to see a collection development policy of some sort.It’s difficult to get a global sense of what Docphin covers because journal titles and Twitter feeds are siloed into lists by specialty. I would like to see a master list of journal titles somewhere.

Docphin does cover a number of open access journals, and of course abstracts are freely accessible. Why not open up this level of content to those outside of registered institutions? This seems like a strategic decision, I’m just not sure what’s behind it.

 
Other Thoughts

In many ways, Docphin reminds me of another social scholarship website making headlines lately: Mendeley. Both work with proxy servers to simplify full text access. Like Docphin, Mendeley attempts to encourage discussion around individual articles and to expose metrics about who’s reading what. Granted, the discussion part has not exactly caught on yet. There are many, many articles and few discussions. Still, I like the idea of a discussion platform that is independent of publishers—sort of a universal online journal club.

I have been impressed with Mendeley as a PDF and bibliographic citation management tool. These features combined withDocphin’s newsfeed personalization capabilities would make for a very unique product I think.

 
Bottom Line

Docphin is worth a look, and another look once the iPad app is released. The developers have been quite successful at growing the business through their networks of newer physicians and medical students. Your physicians and medical students need to understand, though, that while Docphin is an excellent current awareness tool, it is not the place to go for a comprehensive literature search due to its limited journal coverage and limited search functionality.

For further reading:

TechCrunch article: http://techcrunch.com/2012/05/11/docphins-dashboard-for-doctors-expands-nationwide/

 An interview with Docphin co-founderMitesh Patel: http://www.imedicalapps.com/2012/08/questions-mitesh-patel-docphin-medical-journal-tool/

 Another Q&A with Mitesh Patel: http://www.healthtechinsights.com/emerging-health-technology-spotlight-qa-with-mitesh-patel-of-docphin/

 

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2 comments - What do you think?  Posted by KraftyLibrarian - January 24, 2013 at 1:58 pm

Categories: Apps, iPad, Journals and Books   Tags:

Read QxMD: Another Journal App for Your iPad

Recently I have been more atune to medical apps because I am in the process creating a libguide featuring medical apps.  From what I can tell, there are three main apps out there that try and provide full text access to institutional journals subscriptions via the iPad.  They are Browzine, Read, and Docphin.

Last week I reviewed Browzine, today I am going to review Read by QxMD.  Next week Alison Aldrich, will provide a guest post about Docphin.  (I usually try to use all of the products reviewed on my blog, but in this instance Docphin doesn’t work with the way my library provides off campus access and they don’t provide access to free journals.  So, I can’t try it. Alison has graciously agreed to try and write a guest post about it. -Thank you Alison!)  If possible, I will take the reviews and try and compare the three apps against each other.

Read is produced by QxMD which makes several medical apps. It is founded by “medical professionals” and is dedicated to “creating high quality, point of care tools for practicing health care professionals.”  They are partners with Cardio Exchange, Society for Vascular Surgery, Vascular Study Group of New England, American Academy of Family Physicians, and the Canadian Society of Nephrology.

It is also important to note their app is free and is available for the iPad as well as the iPhone (did not see an Android version). Their site promotes “seamless automatic one-tap access to full text PDFs available” for a lot of universities (full list scroll to bottom) including Johns Hopkins, Harvard, Washington University, and Yale. Despite advertising the institutions using Read, they do not include information on their website for librarians to add their institution. You have email them to add your institution, according to a tweet from QxMD .

After you download the app you are asked to create an account by adding information about your profession, specialty and institution.  I find asking for profession and specialty to be annoying but I realize this is for their usage stats. If your institution is not listed you can still use the app but you will get a warning that you will only be shown free papers (Take note because this will be confusing later on).

signin

Since my institution isn’t listed (it wasn’t listed for Browzine either, so we have a pretty equal comparison) I proceeded anyway without adding my it.

institution;

Next you are asked to select the specialties you would like to follow.  I chose Family Medicine because I know a few titles off the top of my head that are Open Access and would have free PDFs.

specialties

Once you select a specialty you are then asked to select journals to follow.  The first set of journals are ones within the specialty then you are presented with an A-Z list of all journals.  After selecting the journals you are also presented with a list of “collections” to follow. It appears they only have NEJM collections (which are subscription based and NOT free).

journals to pick

collections

If you are paying attention to my screen shots and with the fact that my institution is NOT subscribed you will notice that there are an awful lot of listings for non-open access titles.  For example: Almost all of NEJM’s stuff is available to only to paid subscribers. While Annals of Family Medicine  and the journal Family Medicine are free and have no embargo period on their most recent issues, that is not the case with the rest of the journals.  American Family Physician and Family Practice are not free and have an embargo on the current 12 months.

Personally I find this to be an area that has great potential to be very confusing to users.  If the first screen says “By not selecting an institution you will be shown only free papers,” then as normal average person (not somebody who understands nuances institutional subscriptions, free Open Access articles, and embargo periods, which most doctors don’t) I would expect that everything I see from the first screen forward would be free.  In other words since I told the app I don’t have an institution AND it told me I will only be shown free papers, then I would expect the app to be smart enough to only show free journals or papers.  Instead, I am able to see free papers and subscription papers side by side, only when I click on them do I realize whether they are available. (If it isn’t available I get message indicating I can’t download the PDF)

Now you might be saying, well this whole mess is pointless if your institution subscribed to Read. No it isn’t pointless. In fact, I think it gets even messier, because no institution subscribes to every journal.  There will be occasions where a user is logged in as your institution and selects a journal that your library doesn’t subscribe to (but is available on Read’s list).  The average user doesn’t know what the library subscribes to and will become frustrated when they tap to read the full text of an article and it can’t download the PDF.  Who do you think they will call when that happens? The following discussion plays in my head even now, “But it is listed on Read and your library is listed Read, so why isn’t it available?”

A listing of all possible journal titles that isn’t synced to a library’s holding list nor has the ability to only show free article for those not affiliated with an institution is confusing.  Doctors don’t know what articles are free and what aren’t without trying to first get the PDF.

 After you are done selecting the journals you are presented with a very helpful guide explaining your screen lay out.  This is necessary because there is a lot going on.
help

The display is set up similar to a Flipboard style of browsing, showing “Featured” articles by default.  There is no clear explanation as to what determines an article to be “Featured.”  As I mentioned I selected these specific journals:  Annals of Family Medicine, Family Medicine, American Family Physician and Family Practice.  However, the bottom right article is from the European Heart Journal which I didn’t pick.  (Sorry it is the journal is very faint, I couldn’t get it any darker.) I am not opposed to having featured articles, I like the idea because it allows people to become aware of articles outside of their normal journals.  But, I would like to know where they get featured articles from. Is it based on a rating system or something else? (My guess is it based on their algorithm they mention in a comment on iMedicalApps.)

flipboard 1

Tapping Journals at the top bar allows you to flip through the articles within your selected journals.  The Collections tab just allows you to view the NEJM Collections (which currently are the only collections available and are not free).  The outline icon (underlined in yellow on image below, next to the star) is the Topic Reviews button.  It allows you to browse through “1000′s of outstanding topic reviews” which are organized from broad to narrow subjects  Again it is important to note that not all of the articles listed as topic reviews are free.

subject

Tapping the star allows you to select articles as your favorites which you can tag with your own words or from a pre-selected list for easier retrieval. Below tagged an article Family Medicine, and while I was starting to type another word the auto suggest popped up.  The auto suggest while dynamic is a bit limited and I’m not sure where they are getting the rather long terms/descriptions.  It appears they are either journal article titles and/or topic review subjects.

tagging

IF you have a subscription, downloading the article is very easy, you just tap on the title and it tries to download the PDF.  You can email the PDF (if you have access), tweet it, share it on Facebook, add a comment, star it (which saves it as a favorite), or rate it with a thumbs up or down. If you can’t download the article you get the message “Paper could not be downloaded” and you are encouraged to either view the citation in PubMed or Add Proxy.  If you don’t have access to the full text you can still email the citation, tweet, Facebook it, comment, star it, or rate it.

no pdf

Finally users have the ability to directly search PubMed while within Read.  This would be useful if you read an article on a specific topic and you wanted to quickly search PubMed to see if there were other articles on the same topic.  However the search is so limited, it would just be better to use PubMed app you already have on your iPad or go to PubMed using your iPad browser.  I did a quick and dirty search on heart attack.  I have no idea what algorithems it uses when searching the text word heart attack but I get completely different results when searching PubMed directly. (I looked both within relevance and publish date, neither of which seemed to be close the the PubMed results.)  I searched using the MeSH term myocardial infarction and got similar puzzling results.

Finally, there is an issue regarding timeliness.  While Read displays the current issue for some journals, that is not the case with all journals.  For example the current issue for the Annals of Family Medicine (a free Open Access Journal) is January/February 2013, yet the most recent issue displayed on Read is the November 2012 issue. The same is the case for Family Medicine, and The Journal of Family Practice.  This is a problem within what I call the core journals as well. While BMJ, JAMA, JACC, and NEJM have the current issue available Lancet is two issues behind. Since many of the journals are current this could be an issue as to when their software hit the journal sites, perhaps it just needs tweaking with certain journals.  When many of the journals have the most current issue, it can be difficult to try and discover the ones that don’t. Kind of like find an needle in a haystack but the need moves, because the software does eventually get the most recent issue.

(I don’t remember noticing this within Browzine because their display was slightly different so I wasn’t as aware of the timeliness of the citation as I am within Read.  I will have to double check how timely Browzine is.) 

The good news is this app is free to users and free to libraries who want to make their journals available.  However, those libraries without straight forward proxy servers might have difficulty registering with Read. They would really need to contact QxMD to see if the two systems work together.  Doctors who like the idea of Flipboard for their medical journals will be happy with the display and function of Read. 

According to the comments made by Read on an iMedicalApps review, they feel their algorithmic curation of the literature is perhaps the greatest strength of Read. “Rather than simply relying on our users to tell us which journals they want to read, we use a combination of machine learning, semantic analysis, crowd-sourcing and proprietary algorithms to figure out which articles our users should likely be reviewing.”  I think it is  matter of personality as to whether doctors end up liking Read’s selections based on their algorithms or whether they prefer a different method of selecting/reading their articles.  However if Read’s algorithm determines what users should likely be reviewing then I have to wonder why their algorithms chose editorials, not articles, to display on the first Read page for JAMA. Are JAMA editorials more important that articles?

I think Read has a lot going on with it and a lot of potential but I am concerned about the fact that it only contains a few of the BioMed Central and PLoS titles which are Open Access and possible confusion regarding what is available full text and what isn’t.  In theory I know doctors shouldn’t care whether an article is full text, if it is relevant they should find a way to get it.  However, theory doesn’t always work in reality.  I have seen more doctors ignore relevant articles because they weren’t full text or they couldn’t figure out how to get the full text.  I have doctors who won’t click an order it button to order an article (FOR FREE) from our library because they don’t want to deal with it. I think there needs to be a better way for Read to work with institutions so that doctors clearly know what journals are available to them and what aren’t. Doctors assume that if they input their institution then what they see is what the institution gets, which is not always the case.

 

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11 comments - What do you think?  Posted by KraftyLibrarian - January 15, 2013 at 12:11 pm

Categories: Apps, Electronic Access, iPad, Journals and Books   Tags:

The Future of ePub Browsing

Sunday I got an email from my county library, Cuyahoga County Public Library, about their new online journal platform called Zinio.  Zinio is a company that allows my public library to provide access to many of their magazine subscriptions on to my iPad (as well as other devices) in an easy to read format. 

Here is a screen shot of the magazines that I selected to have on my iPad to read, all courtsey of my Cuyahoga County Public Library card.

 zinio

I was also in the process of finding apps for our medical library’s libguide.  I sent a tweet out asking for suggestions and some people including Third Iron responded.  Third Iron is a company that produces the product Browzine.  Their company which is has many executives with library degrees or significant library experience, works to make online journals available in an easy browsing experience for the online user.

Tuesday I spoke with Kendall Bartsch about Browzine, what it does and how it might work for our library.  Browzine is very similar to Zinio.  Where Zinio is magazines, Browzine is scholary publications and with its share, email, download, features, (not available in Zinio) it quite frankly blows Zinio out of the water. 

Browzine allows people to browse scholarly publications and read the table of contents to the recent issues of journals.  It works with various publishers such as Springer, Wiley, AMA, Nature, etc.  It also works with Open Access publications.  Users download the free Browzine app (currently iPad only but they are working on Android).  When they login to Browzine it asks them to select their library.  If their library has a subscription to Browzine they can login and access their library’s subscriptions via the iPad. 

Browzine is a very new company, they have quite an impressive list of libraries who are either trialing the product or have a subscription, including Welch Medical Library, Medical University of South Carolina, Northwestern, and Washington University.  If your library doesn’t have a subscription to Browzine, or if you want to try it out and play with it you can still download the free app and select Open Access titles which enables you to view the table of contents and PDFs of the open access publications and journal articles. 

There are a ton of Open Access titles and if your library subscribes to Browzine then there are a ton of publisher titles that users can access.  With that large of a number of journals it would get tedious to scroll through or search for your favorite journals that you like to keep up with.  That is why you are able to save those journals in your own personal library shelf.  So when you access Browzine you can go directly to that shelf instead of searching through a bunch of other journals.

Here is a screen shot of Open Access titles in Biomedical and Health Sciences -Medical Science. If your library has a subscription your library’s name is where Your Library Identity is and your list of journals will be more than just the OA titles.  (Note: there are MANY OA journals, the picture below is just a small slice from the OA Biomedical & Health Sciences -Medical Sciences category.)

 oalib

Here is a screen shot of my “favorite” journals that I like to read.  (Pretend I am doctor or researcher who likes to read these scholarly publications.)

 mylib

Here is a screen shot of the table of contents for one of my favorite journals. The yellow inbox indicates I have saved that article on my iPad.

toc

Here is a screen shot of the PDF of an article from the TOC and the options for emailing, saving, sharing, etc.

output

Browzine is compatible with iAnnotate (a popular PDF annotating app) and DropBox and Box as well as other programs. 

To say I was blown away was an understatement.  Finally now after all these years, people will be able to browse the table of contents easily AND connect to the article via the library’s subscription in an extremely easy way.  The concept of my own personal bookshelf is great.  The ability to export the articles is essential and thankfully is easy to do with Browzine.  Currently Browzine does not provide notifications when a new issue is available, however that is a feature that they are adding shortly.  When that does happen, users will see a little red bubble with a number next to their journals. 

As cool as Browzine is, they don’t work with every publisher yet.  (Publisher availablity list here.)  Also Browzine won’t work with database provided journals.  So for example, journals you get full text through CINAHL aren’t going to be available through Browzine. Perhaps that may be why LWW is not on Browzine? (LWW requires institutions to access journals through Ovid.)  However, for databases like ClinicalKey, which is an Elsevier product and has all Elsevier journals, one has to wonder if that will be in Browzine or if it will be considered a CINAHL (ClinicalKey and Browzine are both so new who knows).  If it is considered a CINAHL then that would be a shame since some libraries may look at ClinicKey as their Elsevier journal provider. 

While Browzine currently only does journals, I can see where this type of easy access can be applied to ebooks.  eBooks suffer from much of the same silo content problems as ejournals.  Each publisher has their own way of displaying and providing access.  You have to bounce around from provider to provider to view the ebook on your iPad (or even your laptop).  There is no easy way to find and access ebooks for medical libraries.  Most of our users don’t know how to find ebooks.  They sometimes check the catalog, but even then that is only a brief snapshot of some of the titles available.  PMC titles and other ebook collections aren’t always in the catalog because you are either waiting for the MARC records from the provider (in the case of large aggregators like Clinical Key with hundreds of titles) or you are simply unaware of the latest title that was added to the online collection. 

If we could get our ebooks to display like Browzine displays ejournals, I will jump for joy and quite possibly stop my ranting on the inaccessibilty of ebooks in the medical library. 

 

 

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6 comments - What do you think?  Posted by KraftyLibrarian - January 9, 2013 at 4:25 pm

Categories: Apps, Electronic Access, iPad, Journals and Books, Technology   Tags:

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