Is it always better for a doctor to order tests for a patient – you know, just to be on the safe side? Not if you ask Dr. Rahul Mehta, a resident in internal medicine at the University of Calgary.
Mehta is part of a growing pushback in the medical community against the practice of ordering too many tests – like imaging for lower-back pain, or electrocardiograms – which can end up driving up health-care costs without delivering an actual benefit to the patient. "Sometimes it's faster to order a test than to sit down, do a history, do a physical exam, and actually talk to the patient," he says.
In fact, going through med school, Mehta and fellow student Aravind Ganesh noticed that physical exams were getting increasingly sidelined as clinical tools. In fact, hands-on physical exams are exactly the skill that doctors need to deliver better care. And, he says, they've come up with just the app to help.
Mehta and Dr. Ganesh are the doctors behind SnapDx, an app that aims to step clinicians through an array of physical exams. "Essentially, it's a software tool that allows physicians to quantify their physical exam,' says Mehta. In its current release, SnapDx lets doctors choose an exam from a list, and steps them through it, both providing up-to-date best practices on how to do it, and asking them to input the results so the app can use them to make a recommendation on next steps.
For a given test, SnapDx might ask the physician a series of questions, to be answered by performing a physical exam on the patient. As the doctor enters the answers – which might be "yes" or "no" to whether a symptom is present, or might be a numeric reading. Not only does the software recommend the most current way to perform the exam, it calculates a probability that further testing is required, and that ordering a new test is justified.
SnapDx came to be after Mehta reached out to Hisham Al-Shurafa, a serial entrepreneur with a history in the medical space (and the co-founder of Startup Calgary, an organization dedicated to boosting his city's startup scene). Now the company's CEO, Al-Shurafa quickly realized that the best-practices that medical societies and associations are continually releasing were almost algorithmic in nature: a series of procedures to be followed, rather than an appeal to a doctor's intuition.
"I was looking at these guidelines, and I was seeing flowcharts and algorithms written out in text," he says. "We can easily convert this into a doctor's workflow."
Currently, SnapDx contains the digitized wisdom of about 130 medical studies; forthcoming versions will contain diagnostic workflows drawn from guidelines issued by societies that publicize best-practices, as drawn from the latest research. Mehta says that it's not possible for general practitioners to stay abreast of these developments in exam techniques in every specific field; uploading them into an app offers a way to stay current.
Mehta says the app – which is freely available on the App Store – is already in use in 500 clinics worldwide, and the company is expanding its offerings. And as for doctors themselves? Mehta says, as with any group of professionals, there's been a "heterogeneity of responses": There are eager adopters, and then there are practitioners who might not be eager to have their opinion informed by an iPhone.
"There's the 30 per cent who are like, 'I love it, when can I use it?'; the 30 per cent who are like, 'okay, in the course of time,' and the 30 per cent who are like, 'I'm going to stick to my hammer.'"