Where's the beef? (Musings on 2 transfusion-related iPad apps)

Where's the beef? is a follow up to an earlier blog, Tough Titty and other iPad apps (Musing on 'revolutionary' apps for TM; Jan. 2011). The title derives from a TV advertisement initially shown in 1984.

A second blog on iPads was inevitable when I finally caved and got one last month after much pondering of the question, "What does an iPad do and why would you want one?" My answer comes at the end of the blog.

So, 18 month after the launch of the iPad in April 2010, how many transfusion-related apps exist for it and similar devices (Blackberry, iPhone, other tablets)? Unfortunately, not many judging by a quick scan of Apple's iTunes app store.

Number of iPad / iPhone apps:

• Total: 140,000+
• Medical: 100s if not 1000+
• Transfusion-related (in the broadest sense): 10-15
• Transfusion-related for TM professionals: ~4

Disappointing, but not surprising: Transfusion-related apps for the public (as opposed to transfusion professionals) predominate. Examples (all costs in US $):

• Blood Type Diet ($3.99) Lots of these
• Blood Types of My Kids (0.99¢) Hmm...wonder who may want this one?
• Blood Type Forecast (free) Not worth it at any price / includes wrong answers

MUSINGS
A few thoughts on two free TM apps for transfusion professionals:

#1. Transfuse (Mayo Clinic)

Although not a physician, I tried a few clinical scenarios and did okay compared to others who had played (could be anyone). For one scenario I made no choices and pressed the Next button for everything and scored close to the others who had tried it. Hmmmm.....

Pros: Interactive; nice graphics

Cons:

• Choosing the number of units to transfuse from a list of blood components and drugs soon becomes repetitive.
• Ditto for the laboratory / physiologic thresholds to transfuse a particular blood component.
• Minimal feedback except for comparison to the score of others.

Bottom line: Having been interested in computer-assisted learning (archaic term) for decades, I find apps like Transfuse to have the same fatal flaws as earlier e-learning efforts:

• Inflexible, repetitive, and borrrring

Apps is a sexier term than computer-assisted but cannot compensate for intrinsic flaws in learning design. Educational tools like Transfuse are suited to convey basic learning such as knowledge and application, but more of a challenge for higher level skills such as analysis and evaluation.

Because it's an iPad app from the famed Mayo Clinic, and one of the first apps for TM, Transfuse has glitz but does not quite deliver, at least by my educational standards.

As an e-learning tool, it ranks near the more primitive end of the spectrum - a fancy package that may leave users asking, "Where's the beef?"

I would love to hear from others who have used Transfuse but

• I can't get no satisfaction (Rolling Stones mega-hit of 1965)
• #2 on Rolling Stone magazine's "500 greatest songs of all time"

#2. IVIG Guidelines & Calculator (ORBCoN, Transfusion Ontario)

• Downloads: Blackberry | iPhone, iPod touch, iPad

Initially developed for smartphones, ORBCoN's IVIG app is lean and mean, i.e., has no unnecessary elements. The interface is attractive with easy navigation.

The app's purpose is to make IVIV guidelines easily accessible at the bedside and in patient care areas since access to a PC on a clinical ward is generally limited and docs use smartphones.

The ORBCoN app is a handy reference tool for IVIG guidelines and dose calculations that comes without pretensions and delivers on its promise.

Bottom line: Keeping with a meat analogy, the IVIG app is more like lean turkey than a fatty beef patty in a fast-food burger.

• Definitely 'Good vibrations' (Beach Boys 1966 classic)
• #6 on Rolling Stone magazine's "500 greatest songs of all time"

LEARNING POINTS

1. Many medical apps exist for the iPad and similar devices, but when it comes to apps for transfusion professionals, the shelves are almost bare.

2. The paucity of TM apps makes sense. Transfusion medicine is a relatively small field that barely finds time in the medical curriculum, despite the fact that many physicians prescribe transfusions.

3. To produce worthwhile educational apps is costly. It requires a team of subject matter experts, experienced educators and instructional designers, graphic designers, IT professionals, and representative users. That's just to develop a basic prototype, to say nothing of piloting, evaluating, revising, etc.

4. Stand-alone educational tools must be much better designed for clarity than face to face learning where a user's questions can be answered immediately.

5. Given today's health care funding, funds for even basic professional development such as attending conferences has all but disappeared. Transfusion-related tablet and smartphone apps are a stretch even if they support (i) cost saving and (ii) patient safety initiatives such as improved blood product utilization (or 'blood management', the preferred term of the TM consultants).

6. Accordingly, many transfusion-related apps are meant for the general public where expectations are minimal. Indeed, current apps tend towards the nutball territory of how your ABO blood group can affect personality and diet.

ADDENDUM

"What does an iPad do and why would you want one?"

What does an iPad do?

Initial reaction to the iPad ranged from "a product without a use" to embarrassing fawning over the latest addition to Apple's family. I fell into the skeptical first camp.

Now that I have one, the iPad allows me to check my twitter feeds and the latest news much more quickly than turning on desktop or laptop computers. It's oh so EASY.

Best of all, producing videos is an absolute snap. Touch the camera icon, slide option to 'video', select which camera to use (front or back), frame your subject, touch the start/stop video button (and again to end recording). Four screen touches in <4 seconds and you can create a crystal clear video.

Recently I used the iPad to videotape a group of apartment-bound seniors giving messages to a friend in hospital and then showed them her videotaped response from her hospital bed. Priceless!

Why would you want one?

Frankly, I bought an iPad on intuition without knowing the answer, but now it's clear. The gadget is FUN. Pure and simple fun. That it speeds up tasks I used to do anyway is a value-added goodie.

THANKS

Thanks to the Mayo Clinic and ORBCoN -Transfusion Ontario for offering their TM apps free of charge. Such generous sharing is much appreciated.

And here's to you, Mr. Jobs. Autocratic egomaniac, visionary, genius? Probably.....

• The astonishing career of Steve Jobs (The Economist)
• Steve Jobs, the magician (The Economist)

P.S. I love my iPod nano too....

Other TM Apps

• Fetal IV Transfusion Calculator ($19.99)
• Blood Transfusion Risks ($2.99)
• Medical Apps Index (iTunes)

As always, the views are mine alone. Comments are most welcome BUT, due to excessive spam, please e-mail me personally or use the address in the newsletter notice. 

'Tough Titty' and other iPad apps (Musing on 'revolutionary' apps for TM)

This month's blog discusses how the over-hyped iPad and similar tablets could be used to improve TM practices. The title includes a reference to the 1968 Beatles classic

• Revolution

Two items motivated this blog

1. Clinical chemistry blog (Aargh! - the dreaded discipline with all the automated instruments) Recently, I came across this blog from the AACC:

• Explosive growth of send out testing: Can we curb the monster?

and wondered how ideas for curbing the cost of expensive molecular testing outsourced to reference labs could be applied to transfusion medicine. It interested me as a follow-up to last month's blog:

• Snip, snip, the party's over? (Musings on the seductive rise of DNA typing of blood groups)

One strategy that amused was a scheme for pop-up prices to appear when a clinician was making an electronic test order. The pop-up could contain product or test utilization information and one to four dollar signs ($ - $$$$), as is common for hotel and restaurant listings.

The blog outlines several approaches to minimizing the cost of send-out tests and is worth reading, as is this related resource:

• The send-out testing boom. How can labs take control?

2. Slew of news items on the iPad frenzy extending to medical schools, as exemplified by

• Will iPad transform med school?

Seems there are many medical apps being developed (See Further Reading below) and I wondered how future iPad applications could be used in transfusion medicine. One potential use that came to mind was IVIG utilization.

The IVIG Challenge
In Canada (and elsewhere) an enormous amount of time, expense, and expertise has been applied to IVIG utilization. Canada's per capita use of IVIG grew by ~115% between 1998 and 2006, making Canada one of the world's highest per capita users, with most growth attributed to off-label use.

In 2008 Canada's use was still more than twice as high as the UK, and marginally higher than even the USA. Source:

• Nahirniak S, Hume H A. Guidelines for the use of IVIG for primary immune deficiency and solid organ transplantation. (editorial) Transfus Med Rev: 2010 Jan; 24(1, Suppl1): S1-S6.

As would be expected, IVIG utilization is a major focus of Canada's NAC and utilization management programs are operated by various provincial blood coordinating offices such as that of the BC PBCO.

Often utilization schemes involve personal gate keeping by physicians who are TM specialists, all of whose decisions must be standardized, an effective but high maintenance solution.

As well, strategies that involve education and training of clinicians is a hard slog, as discussed by Dzik:

• Dzik S. Use of a computer-assisted system for blood utilization review. Transfusion 2007;47(s2): 142S.

In brief, the author's hospital used multiple blood utilization strategies, including a computer-assisted system with

• Computerized physician order entry
• Computer-assisted blood utilization review and feedback

Dzik acknowledged that the computer program was rudimentary and needed to improvements. For more details, see this Sept. 2007 blog:

• What's up doc? Welcome to docovigilance

Iggy, the IVIG app

In the future, perhaps we will have Iggy, an IVIG app available to clinicians on their iPads, iPhones, etc., which may even be networked to the hospital or regional health IS. When a doc orders IVIG via an electronic order system, the Iggy app would kick in. Can't you just see it?

Hey, dude, that's $10,000 and that's just for starters! Are you really, really sure the patient will benefit? What's the evidence? Read all about it here. Oh, and dude, you are the only one to order this product for this condition in this health region in the past year. In case you were wondering, this distinction is not good. Text or Skype and we can discuss.

Other useful apps

How about these as potential TM apps?

1. Abacus - The RhIg app for those who are mathematically challenged and cannot calculate the correct number of RhIg vials to inject.

• Paxton A. Bringing new rigor to RhIg calculations. Cap Today May 2008.

2. Frappuccino - The 'FP doesn't cut it' app for all those docs who use frozen plasma inappropriately.

• ORBCoN (Transfusion Ontario). Frozen plasma toolkit

3. Prefried - The app envisioned by John Judd, who cautions that prewarm technique was never meant to be used to determine the clinical significance of antibodies and can prewarm away clinically significant antibodies.

• CBBS e-Network Forum. Prewarmed testing can cause a laboratory to miss detecting a clinically significant red cell alloantibody

4. Tough titty - The 'You don't need a titration' app for docs who request an anti-D titre in pregnant women who received RhIg at 28 weeks and show a 1+ anti-D at delivery.

• CBBS e-Network forum: Justification for requesting routine antibody identification and titer on women who have received RhIG during pregnancy

Bottom line

So.... How about TM professionals getting together with geeky app developers to create medical applications for iPads and other tablets that can improve transfusion medicine practice? To use a cliche, for once let's get ahead of the curve. The iPad is over-hyped but the potential is there.

I would love to hear your ideas for transfusion-related iPad apps, off the wall and funny or serious. Comments are most welcome BUT, due to excessive spam, please e-mail me personally or use the address in the newsletter notice. 

Further Reading

Mostly news about the iPad and its application in medical schools

Added Feb.1, 2011: Clinical pathology laboratories should prepare for the iPad era (Dark Daily, 24 Jan. 2011)

Stanford School of Medicine to give iPad to all incoming medical students

Is the iPad helping to modernize medicine?

Will iPad transform med school?

Associated Press looks at iPad use at Stanford's medical school (click on video)

Age of e-medicine

UCI also receive iPads

iAnnotate PDF – First iPad app required by Stanford School of Medicine

Top 5 medical apps for the iPad

25 iPad apps for health care

Medical applications

See how easy it is - tutorials

Please check the comments - good stuff! Thanks to those who contributed.