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Epocrates Bugs + Drugs: Looking at a Mobile App in Motion

by Anne Meneghetti, MD, Executive Director of Medical Information, Epocrates

Looking back on the two months since the launch of our stunningly beautiful Epocrates Bugs + Drugs app, a lot has happened. First, a lot of people have paid attention — we’ve topped 100,000 downloads, and more than 90,000 unique users have accessed the app. Second, we already gave the app a data refresh to clear some inconsistent data pockets. Our web-based format streamlines updates and ensures the app is always running the latest available data set. In general, we have received overwhelmingly positive feedback from clinicians who use the app to discover sensitivity data for the locations where their patients live. We’re hearing that we’re solving a real pain point. Nationwide community-based antimicrobial sensitivity information has never before been presented and now, with Epocrates Bugs + Drugs, clinicians can access geo-targeted data to reference as part of their decision-making process.

Amongst the feedback, we’ve heard that clinicians are surprised how prevalent MRSA is in their community — evidenced by the oxacillin and nafcillin resistance signature seen in Staph aureus isolates in their regions. We’ve heard that clinicians have incorporated information from Bugs + Drugs in empirical treatment of UTIs. We’ve also heard from a few pharmacists, with feedback along the lines of “cool app design,” but questioning how practicing clinicians might use the data. We recently heard from one pharmacist reviewer with the website iMedicalApps, who was able to check out and review the app — unfortunately, he did so before the data refresh. He suggests ideas for feature enhancements and questions whether clinicians can make use of the data. We love these creative and important suggestions, and welcome more; however, we wish he reviewed the latest app data, and hope he still will. Since app launch, we’ve gone through a lot of great feedback, which is critical for a new app “in motion” — one that’s always improving. In fact, it was through feedback that Bugs + Drugs was born; clinicians who use our ID Treatment Selector app asked for sensitivity data, and we were delighted to provide Bugs + Drugs in response, as one supportive element in a complex decision process.

Let’s look at some of the feedback from this recent critical review and some of the arguments made:

Bugs + Drugs is not a clinical decision-maker in isolation — You’re right! There is nothing more valuable to point-of-care decision-making than sound clinical judgment. We believe Bugs + Drugs is a high-value app, but would never suggest that it replace the thoughtful judgment of a clinician treating a patient. Health care professionals would never rely solely on a biogram, whether the sensitivity data is hospital- or community-based; there are just too many factors to consider that an app could never account for in managing infections. Clinicians are trained to consider the patient, first and foremost. Patient-specific factors, evidence-based recommendations, co-morbid conditions, anatomical site of infection, care setting, route of therapy, dosing considerations, synergy of agents, and total costs are among the many vital considerations. We agree, clinical scenario is paramount.

Bugs + Drugs is a different animal than inpatient biograms — The pioneering value of Bugs + Drugs is that there is no true comparator — resistance data based on patient residential zip code, incorporating largely outpatient data, have never been publicly available before.

Unexpected bug-drug pairs — Since our data refresh, we’ve not heard much on this topic. As would be expected from unfiltered lab data, not every data point may be relevant to specific patient scenarios.

Resistant organisms — MRSA, VRE, and other resistant infections are included in the app, and clinicians can see the signatures under the Staph aureus and Enterococcus isolates, which may not be intuitive for some; however, we designed the app in line with how many other biograms display information.

Feature enhancements — We’ve heard some great suggestions to speed ease of data use, including filters for age groups, IV vs. oral, and inpatient vs. outpatient data. We love these ideas, and encourage such suggestions.

So, we are now two months into this pioneering experience of available geo-targeted antimicrobial sensitivity data. We are deeply grateful to the medical community for the warm, positive response and welcome ongoing input to make it better. Epocrates Bugs + Drugs is clearly an app in motion, and we are more committed than ever to the journey of advancing mobile tools for health care.

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Comments

Submitted by David Schoenbaum - Sunday, December 27, 2015

Please get this on android asap....I saw the app when I asked a student I precept to call a local hospital to have them fax over their latest antibiogram! And I thought I was tech savy! I did not know this existed. Great Work! Too bad my beautiful new Galaxy 6 wont run it.

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