Health IT, Hospitals

Pharmacist finds ‘significant errors’ in popular Bugs + Drug app

Physicians might be using more mobile healthcare apps, but the question of trust is one […]

Physicians might be using more mobile healthcare apps, but the question of trust is one that still looms. An example of that comes this week in the form of a pharmacist’s biting review of an app from the powerhouse team of Epocrates and Athenahealth.

The app in question, Bugs + Drugs, pairs Epocrates’ clinical content with data from the millions of medical records that Athenahealth hosts in the cloud to help doctors identify pervasive bacteria types in their area and choose the most appropriate antibiotics for different infections.

In a thorough review of the app over at iMedicalApps, Timothy Aungst points to several flaws in the app that he suggests make it dangerous for clinicians to use in practice. He’s an assistant professor of pharmacy practice at Massachusetts College of Pharmacy and Health Sciences and an editor for iMedicalApps.

Many hospitals, he writes, use internal antibiograms to track what organisms are susceptible to what antibiotics based on their own data. So in theory, the app is a great idea and it’s beautifully built, he writes. But…

 “First, the initial release of the app was plagued with completely incorrect information. As seen, the app identified several organisms as susceptible to antibiotics that make no sense pharmacologically. For instance, ertapenem should not be used for Pseudomonas aeruginosa.”

When it launched in  October, the app quickly became the most popular free medical app. Several reviewers on the iTunes App Store praised the design of the app, but a few also mentioned similar concerns about accuracy. A revised version corrected several of those obvious errors, but some issues still remain. Aungst writes that he compared sensitivity data on the app with two hospital antibiograms and found significant disparities.

“Infectious disease specialists struggle on a daily basis to keep the overprescribing of our last bastions of antimicrobials at bay. Giving an app that suggests taking a hammer to a glass pane as treatment will have consequences. Just because E. coli may be 99% sensitive to imipenem, does not necessarily mean it is the right antibiotic of choice. The app needs to incorporate the rationale and due diligence of proper education of what may be a rational treatment to use, and not blatantly throw out information.”

Read the rest of his thoughtful review along with the response from Epocrates and Aungst’s recommendations on how to improve the app over at iMedicalApps. He told me on Twitter today that he’s been glad to see the companies make significant improvements to the app.

Dr. Anne Meneghetti, the executive director of medical information at Epocrates, responded to several of the issues presented with a post of her own.

“We’ve heard some great suggestions to speed ease of data use, including filters for age groups, IV vs. oral, and inpatient vs. outpatient data. We love these ideas, and encourage such suggestions.

So, we are now two months into this pioneering experience of available geo-targeted antimicrobial sensitivity data. We are deeply grateful to the medical community for the warm, positive response and welcome ongoing input to make it better. Epocrates Bugs + Drugs is clearly an app in motion, and we are more committed than ever to the journey of advancing mobile tools for health care.”

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