Apps & appropriateness: Cardiac societies put guidelines, AUC at docs' fingertips

Put down those papers: Professional societies are continuing to move guidelines and AUC into the electronic age. Following the release of other recent guideline and AUC tools, the American College of Cardiology (ACC) unveiled a pilot version of a free clinical guideline app on Nov. 10.

“We thought that it would be important to have the guideline content available in mobile form so that it could be used at the point of the delivery of care,” John J. Ryan, MD, of the University of Utah in Salt Lake City, and the ACC Heart Information and Technology Committee member, told Cardiovascular Business. “That was the real impetus: in order to get the premier content and premier knowledge developed by the college to the bedside and into physicians and clinicians hands when they’re caring for the patients.”

The pilot app currently encompasses three guidelines published jointly by the ACC and the American Heart Association (AHA): management for heart failure, treatment of blood cholesterol and assessment of cardiovascular disease risks. Ryan said that these particular apps were selected because they represented the most recent and updated versions of the guidelines. Two other guidelines on valvular heart disease and atrial fibrillation will follow in December. 

The ACC is not alone in developing apps for clinical use. With clinics and physician’s offices becoming increasingly electronic, many professional societies are likewise making guidelines and AUC more accessible by creating tools and apps to supplant old pocket guides. The American Society of Echocardiography released a version 2.0 of its mobile Echo App in July.

The Society for Cardiovascular Angiography and Interventions (SCAI) developed several apps in recent years, including a PCI decision support app made available in July. Tools like the SCAI coronary revascularization AUC app, PCI risk assessment tools and diagnostic cardiac catheterization AUC app are included in SCAI’s Quality Improvement Tool Kit.

Kalon Ho, MD, MSC, of Beth Israel Deaconess Hospital in Boston, said in an interview with Cardiovascular Business, “[Societies] used to publish these little handbooks that you could stack in your coat pocket. Now you can get those on your smart device. You don’t have to carry around those 10 booklets anymore.” Ho is also vice chair of the SCAI Quality Improvement Committee and the mind behind the development of several of SCAI’s quality improvement tools.

Both Ryan and Ho said user-friendly, straight-forward ways to access guideline information help clinicians streamline practice and communicate with patients. Change has, Ryan said, “really been driven by clinician demand. Our skills have changed over the last decade with the increasing penetration of smartphones and the access of information.”

Society apps needed to move away from strictly PDF copies of guidelines to more dynamic media, Ho said, since a PDF isn’t necessarily more usable. With that in mind, he said, “What we wanted to do was integrate all of the AUCs together as much as possible so that if your patient has heart failure, chest pain and peripheral artery disease, you could plug in all the variables into one place and right there are all of the things you might think of doing to the patient. Something like that would be helpful for risk assessment. That’s the way we ought to be moving.”

“Having an app which filters down to the content we’re actually looking for, relevant to the patient we’re at the bedside of or we’re seeing in clinic, is the main reason why,” Ryan said. “In many regards, it can be used as an educational tool to show the patient this is the reason we’re making the recommendations we are and that this is endorsed by important, nationally and internationally recognized organizations such as the AHA and ACC.”

These changes have been driven by increasing technological ease in the clinical setting, but also by changes in governmental oversight. Ho noted that free AUC and guideline apps help clinicians receive the decision support required by Medicare in order to receive funding for imaging like CT MR angiography and MRI.

While none of the available apps currently are integrated with EHRs, both Ho and Ryan foresaw that eventuality. Currently, to add data from these apps to a patient’s record, physicians must copy and paste. However, as Ho noted, to facilitate integration, developers of EHR systems need to be on board. Getting AUC apps and EHR systems together, though, “could increase the utility of the guidelines in the app in the future,” Ryan said.

The free apps are available through iTunes, GooglePlay or individual society websites.