Developer of top apps discusses the risks and roles of medical apps

Issue: January 2013

ByMatthew J. DiPaola, MD

ByOrrin I. Franko, MD

This month, we interview Pieter Kubben, MD, developer of NeuroMind and OrthoRef, the #1 neurosurgery and orthopedic spine apps in the world. He is also Associate Editor-in-Chief and Information Technology Editor for Surgical Neurology International and developer of mobile applications and clinical decision support systems.

Orrin I. Franko, MD; and Matthew DiPaola, MD

Orrin I. Franko, MD; and Matthew DiPaola, MD: Please tell us about yourself and your background as a physician and app developer.

Pieter Kubben, MD: I am a senior resident in neurosurgery at the Maastricht University Medical Center in The Netherlands. I started experimenting with developing for mobile devices in 2003, and when the first iPhone was released, I wanted to have some medical content on it. I learned how to develop iPhone apps and NeuroMind (http://dign.eu/nm) was released in early 2010. My efforts were recognized by some leading websites, and soon my app became the #1 iPhone app for neurosurgery in the world. I released a major upgrade including decision support in 2012, and there is now a version of NeuroMind for Windows 8.

The same technology that made NeuroMind a success has been implemented for orthopedic surgery. The result is OrthoRef (http://dign.eu/or). In essence, you get all the content that is also in NeuroMind for free. I charge a little extra for the typical orthopedic content, and OrthoRef is now also available for iPhone, iPad, Android and Windows 8.

Matthew DiPaola

Orrin I. Franko

Franko and DiPaola: What excites you about creating medical apps?

Kubben: It is a combination of medicine and technology mixed with art and creativity. I also like to draw (or doodle) a little, but the creative results of my app development are also useful in daily practice. I like to “play” with mobile devices but, in the end, it should not just be some tech toy. It should add value to your clinical practice.

Franko and DiPaola: What do you see as the potential risks of using medical apps?

Kubben: As with any other tool, the physician remains ultimately responsible. I do believe in decision-support systems, but I do not believe in decision-making systems. Decision making is done by a physician, a nurse or the patient, but not by a medical device. I think that apps can help us in the field of knowledge management, but the availability of all this technology does not mean you can stop thinking.

Franko and DiPaola: How do you see mobile apps integrating (or not integrating) into medical education and clinical practice?

Kubben: I think app integration will be much more common in the future. The Healthcare Information and Management Systems Society (HIMSS) now has a dedicated branch for mobile computing (mHIMSS: http://mhimss.org). Patients want the best possible care, and if that requires new technology because the amount of knowledge is too overwhelming for an individual caregiver, that is acceptable. Medical students will learn to use technology to supplement their knowledge, and this will evolve into clinical practice.

Franko and DiPaola: Are you developing any apps for patients at this time?

Kubben: No, not yet. I am currently focusing on medical practitioners for practical reasons. This is the group, I know best. As my activities shift into the spectrum of interactive guidelines and decision-support systems, patient input will become more important. In the end, I think that a clinical guideline should be interactive and available to both caregivers and caretakers. I strongly believe in patient autonomy, and this can be supported by giving them access to the same knowledge that we offer to caregivers. We may need to adapt some terminology, but the system’s logic and reasoning remains the same.

Franko and DiPaola: Any last comments, advice or opinions you would like to share with the orthopedic community?

Kubben: I hope that when orthopedic surgeons develop new guidelines they keep decision support in their mind background and create flowcharts. They can be complex if that is required for accuracy, but large amounts of narrative texts are challenging to work with. Start thinking “if-then” or go for flowcharts.

For more information:

Matthew DiPaola, MD, is an assistant professor and shoulder and elbow specialist in the Department of Orthopedics at Wright State University in Dayton, Ohio. He is a writer for iMedical Apps and co-founder of Touch Consult, a developer of team-based medical software to improve signout. He can be reached at matthew.dipaola@wrightstatephysicians.org.
Orrin I. Franko, MD, is a PGY4 orthopedic resident at UC San Diego. He has an interest in promoting mobile technology within orthopedic surgery and founded the website www.TopOrthoApps.com to help surgeons and trainees find the most relevant orthopedic apps for their mobile devices. He can be reached at orrin@toporthoapps.com.
Pieter Kubben, MD, can be reached at pieter@kubben.nl.
Disclosures: DiPaola, Franko and Kubben have no relevant financial disclosures.