Six Mobile Apps to Make Prescribing Easier

www.aafp.org/fpm November/December 2018 | FPM | 11

CME

DAVID REBEDEW, MD

Six Mobile Apps to

Make Prescribing Easier

These apps can help you more eectively make

medication decisions on the go.

ABOUT THE AUTHOR

Dr. Rebedew is a family physician at Monroe Clinic

in Albany, Wis., and a faculty member for the

University of Illinois Rockford Family Medicine

Residency. Author disclosure: no relevant ﬁnancial

aliations disclosed.

hysicians and other clinicians use a wide range of mobile

applications in their practices, and prescribing apps are

the most common.

Most prescribing apps are tied to online

pharmaceutical databases, the use of which can decrease mor-

tality and the number and length of hospital stays.

The scope, com-

pleteness, accuracy, and ease of use of various databases has been

studied extensively.

This article focuses on six commonly used pharmaceutical apps

that were reviewed using FPM’s “SPPACES” criteria. Key features,

including interaction checking, drug monitoring information, dos-

ing information, and pill identiﬁcation, are summarized in a tabular

format (see “Prescribing app comparison,” page 13).

MEDSCAPE

The Medscape app is a comprehensive

resource for medications, diseases,

and medical calculators.

Source: WebMD Health Corp.

Platforms available: Android 4.0.3

or later (hp://bit.ly/2Nhe3ik); iOS

10.0 or later for iPhone, iPad, and iPod touch (hps://apple.

co/2PyVfN2).

Pertinence to primary care practice: Medscape is listed

as one of the most commonly used medical apps in multiple

studies.

1,3

The app provides an extensive resource for clini-

cians, including data on more than 8,000 medications and

7,600 diseases or conditions as well as step-by-step proce-

dural articles and image collections. It also oﬀers a consult

service that allows users to confer with other physicians on diagno-

ses and treatment options and provides continuing medical educa-

tion (CME) for some of its activities. The drug interaction checker

can compare up to 30 medications, herbals, or foods simultaneously.

Authoritativeness/accuracy/currency of information: The app

was developed with the help of physicians, PhDs, and pharmacists

and relies on the medication database RxList and pricing database

WebMDRx. Studies have rated Medscape as the most comprehensive

individual user of the website. All other rights reserved. Contact copyrights@aafp.org for questions and permission requests.

12 | FPM | November/December 2018 www.aafp.org/fpm

app for geriatrics

and best overall resource

for pediatrics.

A 2016 study determined

the app had the best interaction checker

and dose calculator among the 59 apps

reviewed.

An earlier test ranked Medscape

as having the most complete and accurate

medical calculator.

Medscape has been

downloaded more than 10 million times

and has won multiple awards. The app was

last updated in September 2018 (iOS) and

October 2018 (Android).

Cost: Free.

Ease of use: Finding information about

dosing, interactions, side eﬀects, warnings,

use during pregnancy, formularies, pricing,

and administration is quick and easy, and

the search function has an autocomplete

feature. However, users cannot search for

medications and herbals phonetically. The

procedures portion of the app is lengthy

and not ideal for point-of-care use. There

is no search feature in the conditions sec-

tion, so numerous taps and scrolling are

required. Users can bookmark frequently

viewed articles. The app is available in

English only.

Sponsor: WebMD LLC

Rating: ★★★★★

This is an essential app for

identifying pills and is a good

overall medical reference.

UP TODATE

UpToDate is one of

the most widely used

clinical decision support

resources for medication

and disease management.

Source: UpToDate Inc.

Platforms available: Android

4.1 or later (hp://bit.ly/2P4uejq);

iOS 8.0 or later for iPhone, iPad,

and iPod touch (hps://apple.co/2woQkFH).

Pertinence to primary care practice:

Users can earn and track free CME credit by

searching topics in UpToDate. They can also

print from the app, email topics or graphics

to patients or colleagues, and bookmark

commonly viewed topics. The interaction

checker can compare more than 50 medica-

tions simultaneously. UpToDate sets itself

apart by providing overdose treatment,

symptoms, and toxidromes for both medica-

tions and household products. It also oﬀers

monitoring parameters, a fea-

ture matched only by Epocrates.

Authoritativeness/accuracy/

currency of information: The

app, which uses pharmaceutical

information from the databases

of Lexicomp, Medi-Span, and

Facts & Comparisons, claims

that more than 1.3 million clini-

cians worldwide use UpToDate.

Use of the UpToDate database

has been associated with

reduced length of stay and

lower mortality.

Ninety-six

percent of the recommenda-

tions in UpToDate are concordant with the

Grading of Recommendations Assessment,

Development, and Evaluation (GRADE)

framework.

It was the top-ranked resource

for pediatric hospitalists in 2015.

More than

6,500 physicians are involved in the process

of creating, editing, and updating the app’s

information, according to UpToDate. The app

was last updated in September 2018 (Android)

and October 2018 (iOS).

Cost: Downloading the app is free, but

using it requires a subscription to UpToDate

Online, which also provides access via

KEY POINTS

• Prescribing apps are the most common mobile apps used by

physicians and other clinicians.

• Physicians can use prescribing apps to choose the best medication

for speciﬁc patient conditions based on ecacy, side eects, inter-

actions, and other factors.

• Some prescribing apps also provide easy access to medical calcula-

tors, pill identiﬁers, alternative medicine information, or education

materials to share with patients.

APP REVIEW CRITERIA

S — Source or developer of app

P — Platforms available

P — Pertinence to primary care practice

A — Authoritativeness/accuracy/currency

of information

C — Cost

E — Ease of use

S — Sponsor(s)

APP REVIEWS

www.aafp.org/fpm November/December 2018 | FPM | 13

computer and costs $519 for one year, $929

for two years, or $1,229 for three years.

Ease of use: The app shares the same

categories of information as the full website,

but it requires quite a bit of scrolling. The

medical calculators are complete and opti-

mized for smartphones. The app is available

in English and several other languages.

Sponsor: Wolters Kluwer Health

Rating: ★★★★★

This is an ideal resource for pharmacoge-

nomics information and drug interactions,

especially among oncology medications.

CLINICAL

PHARMACOLOGY

Clinical Pharmacology

is an extensive medi-

cation database for

use by clinicians and

pharmacists.

Source: Elsevier Inc.

Platforms available: Android 4.0.3

or later (hp://bit.ly/2NgdcOH); iOS 8.0

or later for iPhone, iPad, and iPod touch

(hps://apple.co/2NgjRIA).

Pertinence to primary care practice:

Many local pharmacists use this resource

for answering pharmaceutical questions.

The app sets itself apart by listing

inactive ingredients and is one

of only three apps that describe

what to do if a patient misses

a dose. It provides pictures of

various medications and speciﬁes

how to tailor doses based on gen-

der, weight, and ethnicity.

Authoritativeness/accuracy/

currency of information: This app,

whose Gold Standard database

is run by pharmacists, is used in

more than 2,000 hospitals and

35,000 retail pharmacies. It was a

top performer in the 2018 Best in

KLAS report for clinical decision

support

and was rated in one study as the

best database for clinical decision support.

The app was last updated in December 2017.

Cost: Downloading the app is free, but

using it requires an institutional subscrip-

tion to Clinical Pharmacology.

Ease of use: The app is initially diﬃcult

to navigate but gets easier with familiarity.

Compared with other apps, it requires more

PRESCRIBING APP COMPARISON

Medscape UpToDate Drugs.com Epocrates

Clinical

Pharmacology

Tarascon

Pharmacopoeia

Antibiotic resources X X X X X X

Calculators X X X X

Dialyzability information X X X

Drug interactions X X X X X X

Formulary information X X

Guidelines X X X X X

Herbal interactions X X X X

Inactive ingredients list X

Missed dose guidance X X X

Monitoring parameters X X X

Overdose treatment

guidance

X X

Pharmacogenomics

information

X X X X X

Pill identiﬁer X X X X

Pricing information X X X X

Rx images X X X

14 | FPM | November/December 2018 www.aafp.org/fpm

taps but less scrolling to view indications.

Sponsor: Elsevier Inc.

Rating: ★★★★★

The app’s nuanced information is pri-

marily of interest to pharmacists, but this

is still a great app for clinicians.

DRUGS.COM

Drugs.com has a multitude of infor-

mation on diseases and medications

as well as a symptom

checker.

Source: Drugs.com

Platforms available:

Android 4.4 or later (hp://bit.

ly/2P4j9im); iOS 9.0 or later for

iPhone, iPad, and iPod touch

(hps://apple.co/2P1kt5m).

Pertinence to primary care

practice: Drugs.com is the app

version of a website that has

more than 25 million U.S. visi-

tors per month and frequently

is the ﬁrst website that appears

in searches for certain medica-

tions. With the app, patients

can use a symptom checker, record their

medications in My Med List, and perform

phonetic searches for medications. The

interaction checker can track more than

50 medications and foods at once. Other

unique features include its list of top 40

drug searches, drug popularity rankings,

user ratings and commentaries, pregnancy

safety warnings, alcohol eﬀects and warn-

ings, recent alerts from the U.S. Food and

Drug Administration (FDA), and a drug

comparison tool. The drug comparison

tool considers price, half-life, number

of medication interactions, and disease

interactions. Drugs.com is also one of only

two databases with overdose treatment

(UpToDate being the other database with

this information).

Authoritativeness/accuracy/currency

of information: The app has information

on more than 24,000 prescription medica-

tions, over-the-counter medications, and

natural products compiled from mul-

tiple sources, including Wolters Kluwer

Health, Cerner Multum, Micromedex from

Truven Health, the American Society

of Health-System Pharmacists, and the

Physicians’ Desk Reference. Micromedex

has been rated highly for clinical deci-

sion support,

pharmacogenomics data,

antibiotic completeness,

and medication interac-

tion tracking.

14,15

Drugs.com

provides monographs from

the FDA and the American

Hospital Formulary Service

Drug Information as well

as articles from the Mayo

Clinic. A.D.A.M. Inc. supplies

the app’s health encyclope-

dia, which was developed by

physicians and is reviewed

by a content review board

of physician specialists.

The symptom checker was

created by Harvard Health

Decision Guides, which draws on the

expertise of 9,000 faculty physicians at

Harvard Medical School. Many of the app’s

underlying databases are updated at least

quarterly. The app itself was last updated

in May 2018 (Android) and September 2018

(iOS).

Cost: Free; removing ads costs $1.99 for

three months or $4.99 for a full year.

Ease of use: Finding information

requires a lot of scrolling because the data

is compiled and not synthesized. This is

compounded by ads placed within the text.

Looking for medications by condition or

class is a very useful feature. The app is

available in English only.

Sponsors: The app is produced by

Drugsite Trust, which is privately held and

administered by two New Zealand phar-

macists. The app is not aﬃliated with phar-

maceutical companies, but it does feature

pharmaceutical advertising.

Rating: ★★★★★

This is a free, unbiased resource for

patients and institutions with limited

resources to view medication information

and check interactions as well as compare

medications head-to-head with both objec-

tive and subjective data.

Prescribing apps are the most

common mobile apps physicians

and other clinicians use.

APP REVIEWS

www.aafp.org/fpm November/December 2018 | FPM | 15

EPO C R ATES

Epocrates is an exhaus-

tive reference for

medications, pricing,

medical calculators, dis-

ease information, and

herbal supplements.

Source: Epocrates Inc.

Platforms available: Android 4.0 or later

(hp://bit.ly/2wx5yse); iOS 9.0 or later for

iPhone, iPad, and iPod touch (hps://apple.

co/2C2YlpM).

Pertinence to primary care

practice: Epocrates is one

of the most commonly used

apps by both clinicians and

medical students.

Users can

view national and regional

health insurance formularies,

coordinate care with HIPAA-

compliant text messaging, and

ﬁnd specialists for consults or

referrals in the provider direc-

tory. The app is one of the few

to include safety and monitor-

ing parameters. Unfortunately,

it does not list the frequency

of side eﬀects by percentage for each

medication. It does list oﬀ-label or prescrip-

tion-strength uses and includes dosing

recommendations found in generic mono-

graphs. Beyond medications, Epocrates

also provides numerous guidelines that

list key points organized by specialty. It

also includes numerous calculators such

as unit and dose converters, medical equa-

tions, clinical criteria, and decision trees.

Note, however, that these resources are not

searchable. Lastly, Epocrates oﬀers picture

quizzes and numerous tables featuring

content based on Advanced Cardiac Life

Support, Pediatric Advanced Life Support,

Glasgow Coma Scale, Beers List, Rapid

Sequence Intubation, and other resources.

Authoritativeness/accuracy/currency

of information: Epocrates uses a number

of sources for its information, including

GoodRx for pricing, MedCalc 2000 for

calculators, and Therapeutic Research

Center’s Natural Medicines Inc. for dietary

supplements and natural medicines. The

company claims its app is used by more

than 1 million health care profession-

als worldwide and half of physicians in

the United States. In studies, Epocrates

was determined to have the best medica-

tion interaction accuracy.

14,17

For depth

and accuracy of antibiotic treatment

recommendations, Epocrates was equal

to Sanford Guide while outperforming

Johns Hopkins Antibiotic Guide, 5 Minute

Clinical Consult, and 5 Minute Infectious

Diseases Consult.

The disease references

are created by the British Medical Journal

group. Medications in the underlying data-

bases are updated quarterly with herbals

updated annually. New medica-

tions are not added until they

become commercially available.

The app itself was last updated

in October 2018.

Cost: The basic app is free;

Epocrates Plus, which allows

users to search by disease, view

ICD-10 and CPT codes, review

herbal medications, and gain

insight into lab values, costs

$174.99 a year.

Ease of use: The interface

is easy, and users can save

favorites and write notes. The

drug interaction checker can

track 30 medications and herbals at once

but is slower than other apps when add-

ing medications. The app is available in

English only.

Sponsors: Epocrates Inc. and

AthenaHealth Service

Rating: ★★★★★

This is the best overall reference app,

especially for looking up medication infor-

mation and drug interactions and review-

ing guidelines.

TARASCON PHARMACOPOEIA

Tarascon is primarily for view-

ing pharmaceutical dosing and

indications.

Source: Atmosphere Apps Inc.

Platforms available: Android 4.4

or later (hp://bit.ly/2NyjPw3); iOS

9.0 or later for iPhone, iPad, or iPod touch

(hps://apple.co/2NyjT).

Pertinence to primary care practice:

In its printed versions, Tarascon is already

a trusted resource for medication dosing

information. The app includes data for more

than 4,500 medications as well as some use-

ful drug reference tables, a few calculators,

and information from Consumer Reports’

16 | FPM | November/December 2018 www.aafp.org/fpm

“Best Buy Drugs.”

Authoritativeness/accu-

racy/currency of information:

The use of Tarascon was pri-

marily studied in personal digi-

tal assistants and rated as one

of the top performers for sen-

sitivity in drug interaction.

19,20

The data is reviewed by mul-

tiple pharmacists, physicians,

and PhDs as well as a peer-

review panel of 50 clinicians of

multiple specialties. It has no

aﬃliation with any pharmaceu-

tical companies. The underly-

ing database is updated weekly, but the app

itself was last updated in September 2018.

Cost: Free for 30 days; a one-year sub-

scription costs $39.99.

Ease of use: The app features succinct

descriptions, which signiﬁcantly reduces

scrolling. For each medication, the app lists

information on cost, metabolism and excre-

tion, and safety in pregnancy and lactation.

The app is available in English only.

Sponsors: Jones & Bartle Learning

Rating: ★★★★★

This is a great app for quickly ﬁnding

FDA-approved and oﬀ-label use and dosing

information for medications.

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Send comments to fpme[email protected], or

add your comments to the article online.

The scope, completeness, accuracy,

and ease of use of various online

pharmaceutical databases has

been studied extensively.