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Dr. William "Bill" Dirkes, an EM physician, created the QuickEM app, a quick bedside reference tool that provides the differential diagnosis, history, physical exam, tests, and treatment recommendations for over 50 of the most common ER chief complaints.

Medical students or interns rotating through Emergency Medicine face the numerous diseases and complaints that present in the emergency room, they're often unprepared for. 
Most Emergency Medicine resources they could use are cumbersome or time-consuming, and not suitable for the chaotic ER setting.
This is the reason why Dr. William "Bill" Dirkes, an EM physician, created the QuickEM app, a quick bedside reference tool that provides the differential diagnosis, history, physical exam, tests, and treatment recommendations for over 50 of the most common chief complaints present to the emergency room, as well as over 30 most useful clinical decision rules in the ER, tips for medical students and interns, drug doses and recommended learning resources.

QuickEM app was reviewed on SteadyHealth, receiving a favorable score and our recommendation. The app was also mentioned in our list of the best Emergency Medicine apps for doctors and students.
We now had the opportunity to talk with Bill Dirkes, the app creator,  and ask him several questions about the QuickEM app, as well as his future plans.

Can you tell us the story behind your mobile app? Where did the idea for your app come from? What served as your inspiration for the app?

As a medical student and intern in the emergency department, I felt frustrated at times with the lack of a quick bedside ED reference. Textbook chapters were too tedious to read in the fast pace of the emergency department and the breadth of complaints was too large for me to study everything in advance. So the initial goal was simply to walk someone from a patient's chief complaint all the way through the patient's treatments and disposition with all of the clinical decision tools that one may need along the way. QuickEM has now grown as I've progressed through residency and now as an attending to include information that I need as rapidly as possible such as medication doses as well as quick tools such as a respiratory rate calculator that I use at bedside particularly in peds.

How did you build the content that's contained in the app? Does the information in your app come from evidence-based resources, such as scientific literature, peer-reviewed articles and case studies?

Clinical decision tools are always derived from the primary literature to ensure accurate representation of the information, particularly the inclusion/exclusion criteria. Other information within QuickEM is derived from textbooks and review articles.    

What impact has your app had on clinical practice so far? We'd appreciate if you could share some stats on how frequently your app is used worldwide.

Over 32,000 users have installed QuickEM. I don't collect any personal information so I don't know how frequently users are using the app. Despite QuickEM being initially designed for medical care within the United States, over half of users are international, with most international users being from Asia.

What are the tools and technologies used to build your mobile app (both cloud- and client-side)? Was it native or cross-platform development? Did you consider other technologies?

Initially, QuickEM was built on a free cross-platform development tool called Titanium to allow for rapid development for both iOS and Android platforms which was fantastic at the time. QuickEM is now native code which improved speeds (cutting app loading time in half), allowed more flexibility in terms of a development cycle, and improved the stability of the app.

What were the main challenges you had to overcome when developing your app? Could you please single out the biggest technical challenges, product challenges, marketing challenges, and support challenges?

The greatest challenge is that QuickEM is a hobby/passion in my free time and has almost completely been built from the ground-up by a single person. I've had to design logos and icons, develop the content, and develop the code. I've always wanted the app to be free for medical students so that the information can reach a broad audience and I don't want to implement ads within the app. I've since launched "premium" in-app purchase to help fray development costs for the external developers hired previously, but the income doesn't come close to actual expenditures. I hope to add far more content and features, but simply need external help for accomplishing this. Due to the limited budget, it's challenging to advertise as well. The app is currently only spread by word-of-mouth and websites such as SteadyHealth. An additional challenge is that app updates are stalled on iOS because Apple will not allow medication doses anymore. Support for the iPhone X was implemented day 1 of release but can't be shared with users until an updated app is approved. Unfortunately, medication doses will need to be removed from the app for Apple to approve any update. I have been trying to develop an alternative content so users who paid for this feature don't feel stiffed.

Could you single out the 3 biggest mistakes you made when developing the 'QuickEM' app?

First, the app was rushed to market and was incomplete at launch. There are still a number of sections that require improvement and tweaking. Second, trying to do everything myself has proven very challenging. Third, always ensure features work seamlessly. When QuickEM first launched the premium add-on, a bug prevented users from actually purchasing the content and numerous users were justifiably frustrated and the app ratings reflected this.

When it comes to medical apps, sooner or later the issue of data protection and security always comes up. How do you make sure that user data is secure?

I've intentionally never collected user data. Although collecting email addresses and other information could prove commercially useful, such an endeavor would alienate users and be antithetical to the initial goals and spirit of the app. QuickEM does allow users to save notes, but these notes are saved locally and don't contain any user-specific or device-specific information.

What's next for your app? Are there any new features, functionalities, or upgrades planned for future updates?

The most requested features are more explanations on why/when to order certain tests/treatments and a means of adjusting text size within the app. In addition, due to Apple not allowing any further updates for iOS until medication doses are removed, I am creating new content to replace this section of the app. Most likely, this will either be a quick reference guide for ultrasound or a diagnostic assistant for rashes. Both of these projects have been in progress for months and still require a lot more to be clinically useful and to beat existing products. In addition, I hope to add a quick walk-through guide for procedures as well as create a quick reference for all things orthopedic within a few years time.

We are excited about the technologies and what they might hold for the healthcare and the future of medicine. What do you think this technology-driven, human-centered future holds for mobile health and how do your app plan to contribute?

It's exciting to see all of the directions mobile apps are taking to help patients and healthcare providers alike. I can't predict how medicine will be practiced in 50 years other than to say that I anticipate it will be very, very different from modern medicine. In the near term, however, I hope that QuickEM continues to assist healthcare providers with caring for patients using the latest evidence-based care possible.

Could you share some word of advice with other mobile app developers? What steps they should follow in order to make a successful app?

Spend as much time as you can improving everything prior to launch. A polished product speaks volumes and first impressions matter.

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