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更新时间:2013-12-3 13:29:06 来源:华尔街日报中文网 作者:佚名

Health-Care Apps That Doctors Use

Cardiologist Eric Topol says he knew medicine had reached a turning point when patients started emailing him the results of do-it-yourself electrocardiograms.

心脏病医生埃里克·托波尔(Eric Topol)说,当病人开始通过电子邮件给他发送他们自己测出的心电图结果时,他知道医学已经到达一个转折点。

With the help of a smartphone, a software application and a portable device that reads a person's heart rhythm, anyone can get an instant EKG reading on their phone screen.


'I am getting emails from people saying, 'I'm in atrial fibrillation -- what do I do?' ' Dr. Topol says, referring to a type of irregular heartbeat. 'Whoa! The first time I saw that in the subject line of an email, I said, the world has really changed.'


Mobile apps for smartphones and tablets are changing the way doctors and patients approach health care. Many are designed for the doctors themselves, ranging from handy databases about drugs and diseases to sophisticated monitors that read a person's blood pressure, glucose levels or asthma symptoms. Others are for the patients -- at their doctor's recommendation -- to gather diagnostic data, for example, or simply to help coordinate care, giving patients an easy way to keep track of their conditions and treatments.


Doctors say many of the apps are useful time savers, and have the potential to make health care more efficient by speeding diagnosis, improving patient monitoring and reducing unnecessary visits to a physician or hospital. Still, the field has a way to go, doctors add, particularly when it comes to making good use of all the patient data being generated.


Here are some of the apps doctors are talking about most. Some are free; others cost several hundred dollars for a year's subscription. Those that combine an app and a wireless monitor cost from $80 to $200.



One of the oldest and most established medical apps, Epocrates gives doctors basic information about drugs, the right dosing for adults and children, and warnings about harmful interactions. It has replaced many a copy of the Physician's Desk Reference.

EPOCRATES是历史最长最知名的医疗应用之一,它为医生提供药物的基本信息,适用于成人及儿童的适当剂量以及对有害的药物混合反应的警示信息。它已成为许多《医师案头参考》(Physician's Desk Reference)的替代品。

Made by Epocrates Inc., a unit of Athenahealth Inc., Watertown, Mass.

由马萨诸塞州沃特敦市(Watertown) Athenahealth旗下的Epocrates公司开发。


This app provides reference material doctors can consult when making treatment decisions. David Bates, an internist at Brigham and Women's Hospital in Boston, says he has used it recently to look up treatment approaches for patients who have failed to respond to existing hypertension therapies, and for information on the drug combinations needed to treat a bacterial infection called H. pylori.

此款应用提供可供医生在做出治疗决定时查阅的参考资料。波士顿布莱根女子医院(Brigham and Women's Hospital)的内科医生戴维·贝茨(David Bates)说,最近他使用了该应用查询如何治疗现有高血压疗法对其不起作用的患者,还用它查找了治疗幽门螺旋杆菌感染所需的药物组合的信息。

Made by Wolters Kluwer NV, the Netherlands.

由荷兰Wolters Kluwer公司开发。


Every doctor needs help reaching diagnoses. Here, doctors enter symptoms, and the app lists possible diagnoses as well as medications that could cause the symptoms.


The app was developed by the parents of Isabel Maude, a 3-year-old British girl who died in 1999 after being misdiagnosed. Robert Wachter, professor and associate chairman of the department of medicine at the University of California, San Francisco, says he's intrigued by Isabel and similar diagnostic tools. But Dr. Wachter also believes the apps aren't finely tuned enough to recognize that some symptoms are more important than others in reaching a diagnosis.

该应用由一个名为伊莎贝尔·莫德(Isabel Maude)的英国女孩的父母开发,这个女孩在1999年、三岁之时差点儿因误诊丧生。加州大学旧金山分校(University of California, San Francisco)教授及医学系副主席罗伯特·瓦赫特(Robert Wachter)称,他对Isabel及类似的诊断工具很感兴趣。不过,他也指出这些应用还不够精细,不能意识到在做诊断时某些症状要比其他症状重要。

'It's part of what I trained 20 years to do -- to tell which [symptoms] are irrelevant and which ones are important,' he says. 'That's really hard to say to a computer.'


Jason Maude, chief executive officer of Isabel Healthcare Ltd., says the tool 'is not to replace the doctor but to be an adjunct. The tool comes up with list of possibilities, and it's then the doctor's job to work out the probabilities.'

Isabel Healthcare的首席执行长贾森·莫德(Jason Maude)说,该工具“并非要取代医生,而是要成为一个帮手。它会列出各种可能性,接下来弄清楚它们的概率就是医生的工作了。”

Made by Isabel Healthcare, Haselemere, England.

由英国黑斯尔米尔(Haselemere)的Isabel Healthcare公司开发。


This portable heart monitor and app -- one of the programs that opened Dr. Topol's eyes -- runs on a patient's smartphone to produce electrocardiograms. Patients place their fingers over the monitor's sensors, which wirelessly communicate with the phone to produce the EKG.


Dr. Topol, director of the Scripps Translational Science Institute in La Jolla, Calif., says he recommends this or similar apps to patients with irregular heart rhythms. Very often, he says, the main benefit is in reassuring patients that everything is fine.

托波尔博士还是加州拉荷亚(La Jolla)斯克里普斯转化医学研究中心(Scripps Translational Science Institute)的主任,他说他推荐心律失常的患者使用这款或类似的应用。他说,它的主要好处在于可以让病人确信一切顺利。

Made by AliveCor Inc., San Francisco.



People with trouble sleeping can use this app to record their blood-oxygen level during the night -- data that can help a doctor diagnose whether they have sleep apnea.


Sleep apnea is caused by the abnormal narrowing or blockage of the airways that allow air to flow into the lungs, which causes sudden drops in oxygen in the blood. Obese people often suffer from the problem because excessive fat tissue can thicken and narrow the wall of the windpipe.


To use the app, patients go to bed wearing a fingertip sensor, which wirelessly links to the phone and keeps track of their blood oxygen levels. Dr. Topol says he advises obese patients who have sleeping problems to use this and similar monitors, which he says are better than many expensive sleep studies conducted at hospitals.


Made by iHealth Lab Inc., Mountain View, Calif.

由加州山景城(Mountain View)的iHealth Lab公司开发。


Doctors can look at X-rays and other images on a smartphone or tablet when they use this app. Some doctors say the app is handy for viewing images as soon as they're available, no matter where the doctor happens to be.


But Neville Bamji, a gastroenterologist at Mount Sinai Hospital in New York, says the image resolution of such apps isn't yet good enough to be used to make a diagnosis.

纽约西奈山医院(Mount Sinai Hospital)肠胃科医生内维尔·班吉(Neville Bamji)称,此类应用的图片的分辨率还不够高,还不能用于做出诊断。

'I don't think I'd make any diagnostic decisions based on an iPhone image. I'd be really worried if my doctor were doing that,' he says.


Made by Calgary Scientific, Calgary, Alberta.

由加拿大阿尔伯塔省卡尔加里(Calgary)的Calgary Scientific公司开发。


A smartphone becomes an otoscope, the instrument doctors use to look into the ear, thanks to this app and optical device. Doctors say it's useful for recording videos of a child's ear and then showing the images to family members to explain their diagnosis.


Jessica Kaplan, a pediatrician in San Francisco, says that can help cut down on unnecessary use of antibiotics. When parents see an image of a child's ear at an initial visit and again at a follow-up appointment, they realize 'Oh, wow, we didn't need antibiotics,' says Dr. Kaplan, who says she has used the CellScope Oto in her practice for about six months.

旧金山儿科医生杰茜卡·卡普兰(Jessica Kaplan)称,它可有助于减少对抗生素的不必要使用。卡普兰博士称,家长在初次就诊和再次复诊看到儿童的耳部状况时,他们就会意识到“哦,哇,我们本来不需要用抗生素”。她说她已在工作中使用了约六个月的CellScope Oto。

Developed by CellScope Inc., San Francisco.



This infection-control app collects and rapidly displays data on whether hospital staff are being scrupulous about washing their hands. Most hospitals have unofficial observers of whether doctors, nurses and other staff are following hand-hygiene guidelines. Many are not.


The app gives observers a way to send their observations via a wireless device to a central database, where the results can be calculated and shared with all staff the same day.


'If you see the data one month later, it doesn't change behavior,' says Philip Polgreen, an infectious-disease physician at the University of Iowa medical school who helped develop the app. But if people see the information by the end of their shift, they tend to take it more seriously, he says.

爱荷华大学(University of Iowa)医学院传染病医生菲利普·波尔格林(Philip Polgreen) 协助开发了该应用,他说:“如果你在一个月后才看到数据,它不会让你改变行为。”但是,如果大家在当班结束时就看到这些信息,他们往往会更认真地对待它。

The app can chart one hospital ward against another, or one hospital against another, to compare compliance. About 20 U.S. hospitals use it.


Made by the University of Iowa, with support from GOJO Industries Inc., the maker of Purell hand sanitizer.

由爱荷华大学在Purell洗手液的生产商GOJO Industries的资助下开发。


Using this app, breast-cancer patients enter and track details of their disease and treatment, from the size of the tumor to the presence or absence of estrogen receptors.


Marisa Weiss, an oncologist in Philadelphia and founder of Breastcancer.org, a patient support group that developed the app, says it helps patients grapple with the flood of information when first diagnosed. It also helps them stay on top of details as they consult various doctors, from surgeons to radiation oncologists.

费城肿瘤科医生、Breastcancer.org的创建者玛丽莎·韦斯(Marisa Weiss)称,它有助于患者处理在初次诊断出疾病时涌来的海量信息,还有助于他们在看不同的医生(如外科医生和放射肿瘤医生)的过程中掌握详细信息。Breastcancer.org是一个患者支持团体,也是该应用的开发者。

Made by Breastcancer.org, Ardmore, Pa.



Increasingly, doctors are using their phones to take photos of a patient's condition -- such as a rash or wound -- and to upload the images to the patient's electronic medical record. One problem: That could violate health-care privacy laws if the doctor leaves the photo on his or her personal phone.


CliniCam, a new app developed for use at Brigham and Women's Hospital, sends such photos directly to the patient's electronic medical record without storing them on the phone.


'Pictures are often exceptionally helpful,' says David Bates, an internist at the hospital who has tried the app. 'It is much easier to describe things like skin lesions, rashes and wounds with pictures than with words,' he says. The app holds particular promise for plastic surgeons, who use photos routinely, he adds.


Developer Adam Landman, also a doctor at Brigham and Women's Hospital, says the app is designed specifically to work with the medical records system at his hospital. Making the app more widely usable is a long-term goal, he says.

其开发者亚当·兰德曼(Adam Landman)也是布莱根女子医院的一名医生,他说这款应用是专门为与该医院的病历系统配套使用而设计的,他们的长远目标是让它的可用范围更加广泛。

Made by developers at Brigham and Women's Hospital, Boston.