Joshua Steinberg, MD, is a family physician and residency faculty, who also develops some of the best medical apps for primary care.
These apps are designed as decision-making tools that can be used at the point of care by healthcare professionals, medical residents, and students. Each app provides guidance for managing a certain medical condition or disease, ranging from pre-operative evaluation to pneumonia treatment.
There are currently 20 apps listed under Dr. Steinberg's name on Apple store, 6 of which are, as of recently, also available for Android smartphones and tablets.
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?
Every app has a story behind it.
Pneumonia Guide came from my experience of struggling to learn the protocols in the ATS/IDSA pneumonia guidelines of 2005 and 2007. I followed an approach taught by my colleague Dr. Chris Bernheisel at Univ. Cincinnati's Christ Hospital family medicine residency. I programmed it first for Palm OS, my first point-of-care app ever, and then programmed it for iOS.
Health Maintenance Checklists comes from my experience as an educator of student and resident physicians. All know what to do for an acute problem visit, but none know the principles of what to get done at a well child checkup or other health maintenance visit. So I and two other educator clinicians decided to make a point-of-care tool to help our trainees implement the principles we teach.
I wrote OB Wheels for one reason: to help my resident physician trainees stop screwing up setting the due dates for our prenatal care patients! The single simple screen about how to set the due date is the most important part of the app (which appears in no other app, to my knowledge). The other parts of the app get all the regular use and look like the main use of the app, even though I know that they aren't the main reason for the app. The calendar calculator was a great challenge and education in programming dates, while the physical OB wheel implementation was a glorified 2nd grade arts and crafts project which I did just for the fun and challenge of it.
EBM Stats Calc I wrote because most of us doctors avoid the fine details of math, especially when it comes to making diagnoses. But a great case came up which prompted me to program a tool. A young woman tested positive for Chlamydia, but challenged me and my medical student, "I don't think I have chlamydia, what is the chance the test is wrong?" There was no good app to permit using sensitivity, specificity, and pretest probability to arrive at post-test probability and positive/negative predictive value, so for fun I wrote one.
Step-by-Step Febrile Infant I wrote because (a) I don't know these protocols very well as this issue comes up only occasionally in my pediatric practice, and (b) I thought it would be fun to collaborate with the primary researchers overseas, as I did on my Gout Diagnosis app. Both Gout and Step-by-Step are somewhat esoteric topics, which usually dissuades me from pursuit of an app, but I was intrigued by distant collaboration with clinicians, researchers, and educators, and it was a good experience.
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?
The content in all my point-of-care decision support apps comes explicitly from robust peer-reviewed evidence-based medical literature and authoritative guidelines.
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.
I have over 500,000 downloads worldwide. I don't keep more detailed use analytics, as this is a hobby for me. But I do know the impact. Every student and resident in my program pulls out the Health Maintenance Checklists app to do a Well Child Checkup, a Prenatal Visit, or an adult's Annual Physical, and thus they know the scheme for health maintenance and have good concrete ideas about what to do at the valuable visits. Every resident consults the pneumonia guide app for initial antibiotics and aspects of workup and management on the many patients we admit for pneumonia. Every resident uses the calendar calculators in the OB Wheels app (although, maddeningly, many still get the due date wrong despite the scheme being right there in the app to help them, but they overlook it). And I get feedback from fellow clinicians and educators around the country at regional and national conferences telling me how useful and impactful my apps are for them and for their residents.
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?
I use Xcode for iOS because that's all I know, and I can barely do it. I'm not much of a programmer, even for an amateur. I wish I knew a cross-platform tool like Phone Gap to build for iOS and Android, but I don't. It would take a lot of time and work to learn a new platform, and I don't have that kind of time since this is a hobby and I have a real full-time job as a doctor already.
I collaborate periodically with a student from local state university comp sci department. That's how I have Android apps, which otherwise I don't know how to develop.
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 biggest challenge is conceptualizing how I want to adapt the medical material in a way which smoothly provides as much decision support as a clinician needs, no more, no less. The second biggest challenge is trying to implement my user experience vision within the limits of my meager amateur programming skills.
I have no marketing and support challenges. I do no marketing and my apps are simple enough that they don't need any support!
Could you single out the 3 biggest mistakes you made when developing the app?
3 biggest mistakes? Hmmm, not sure what to say. I don't think I've made mistakes on the 5 apps that Steady Health has reviewed.
Maybe instead of citing unlucky missteps, perhaps I can mention my lucky breaks. I've been very fortunate to find eager programming collaborators at the nearby State University of New York Binghamton and Syracuse campuses. Every time I've worked with comp sci students, I get done more than I could have done myself and I learn a little bit more programming and problem solving as well. As much as I like to hunker down and bang out work myself, most of my apps are collaborative either on the content or the programming, and collaboration lets me get done much more than I could on my own.
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?
Easy. No data. Really. My apps are decision support. There is little or no data involved, and none of it is stored, none of it is associated with PHI (protected health info like patient names, ages, date of birth, a medical record number, etc.).
What's next for your app? Are there any new features, functionalities, or upgrades planned for future updates?
I try to do periodic updates of the content of my apps. I just updated Pneumonia Guide for the HAP 2016 guidelines, and I suspect there will be a CAP update soon as well. I’m also in the middle of updating the Contraception app. A clinician wrote to me that it would be nice to have guidance on how to handle missed or late birth control pills, a birth control patch which falls off, and the like. It’s a great idea, so I’m adding it. Aside from that, I don't have any updates for these 5 apps planned soon.
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?
No opinion. I'm focused on decision support one patient at a time.
Could you share some word of advice with other mobile app developers? What steps they should follow in order to make a successful app?
Other developers are way smarter and more experienced than I am, so I probably have little useful to tell them!
I would say that my one advantage at developing apps is that I am a physician, so I know what physicians know, what they don't know, and what they need from decision-support tools. A developer will have the best chance of success by starting with the physician user in mind, identifying the problems he or she faces, and designing solutions that clinicians understand and enjoy.