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Nine Smartphone Apps to Improve Your Practice

Bruno S. Oliveira, MD Posted: 10/05/2010

Introduction Smartphone use in the United States and abroad is on a vertiginous rise. [1] These mobile devices are malleable, multifunctional tools that can be helpful to many professionals, including healthcare workers, who can benefit from integrating smartphones and apps into their daily routine. I am a rheumatologist working in private practice. Despite not having a formal background in computer science, I have a special interest in software applications (apps) with the potential to streamline my workflow while preserving quality of care. Below is an overview of 6 problems faced by clinicians and 9 smartphone apps to help address these problems. I have used the android operating system (OS) throughout this article to showcase software. Most apps are also available on other operating systems such as iOS (iPhone, iPod, and iPad), BlackBerry (RIM OS), webOS (Palm), and Windows Phone 7. By in large, the apps shown in this article are free. Nevertheless, you can often get premium features for a fee. Problem 1: File Organization and Access Many healthcare workers in the United States use more than 1 computer each day. They may have a computer provided by their employer along with a home laptop or desktop, and for many, the divide between one's work and home no longer exists as work is often done from home. Inevitably, this results in the creation of multiple versions of the same file on more than 1 computer. Many choose to juggle with pen drives to try and keep files in synch. Others prefer to use email to maintain the latest version of their work. To complicate this problem further, computers will commonly have different folder arrangements, making it difficult to locate saved files. One solution for this problem is an app and Web service called Dropbox.[2]
Dropbox

Dropbox is a service that creates a folder in your computer or phone labeled "Dropbox." Anything that you "drop" in this folder gets synched with a Web server (the so-called "cloud") and synched back to any other computer or device on which you have Dropbox installed. Any changes made to any of your Dropbox folders or files (ie, editing a document saved inside your Dropbox) will be instantly synched to all your computers and devices. The folder structure in your Dropbox is constant in all your devices, making it easy to locate files. Below are screenshoots from a Mac laptop, a Windows desktop, and a browser (cloud storage) showing the same folder architecture and files (Figure 1).

Figure 1. Dropbox folder architecture for Mac and Windows. By using services like Dropbox, users can effectively access their files from anywhere without worrying about forgotten pen drives (been there, done that!). Files are available even via computers without Dropbox installed by accessing the Dropbox Website (shown above). Dropbox on mobile phones also gives users complete access to all of their Dropbox folders (Figure 2).

Figure 2. Dropbox on a smartphone. Dropbox files are backed up in multiple locations (home, work, and remotely in the cloud). So if a user's computer is wiped out by, say, a natural catastrophe, their files will survive on a remote server. Nevertheless, I would not recommend Dropbox as your only backup strategy; locally backing up files is a good idea as well. I use Windows Home Server (WHS) to back up my home Windows desktop and Time Machine from Apple to back up my laptop at work. With this backup plan, I have my files on a Windows desktop at home, on a WHS computer at home, on a Mac laptop, on a storage drive hooked up with Time Machine at work, and in the cloud on Dropbox servers. You can never have enough redundancy! I find Dropbox particularly useful to archive medical journal articles. Many library journals are only available through an in-network hospital/clinic computer. Access to medical journals is typically not available from home (unless you personally subscribe to them). Articles can be saved into a user's Dropbox for further reading from home or on a mobile device. Another useful feature is that folders can be shared with others. I have evangelized my nurse to use Dropbox. She creatively made a folder with pre-authorizations for biologics and other medications. All nurses in our department have access to this folder and can contribute to it. This has expedited the process of getting preauthorizations done for us. Nurses and doctors don't have to go online and search for these often hard to find forms every time a denial comes in.

Dropbox synching may take a lot of Internet bandwidth, especially if you are syncing media files for the first time. I recommend that you clear the use of the program with your IT department before using it at work. Make sure it does not infringe on the appropriate and meaningful use of computer resources at your institution. Alternatively, you can selectively synch only certain folders (like a work-related folder). Another option is to open more than 1 Dropbox account (ie, one work-related and another for personal use with your pictures, videos, and other personal files). Some alternatives to Dropbox include: SugarSync; Mozy; Live Mesh; and ZumoDrive.
LogMeIn

LogMeIn [3] (Figure 3) is a service that provides remote access to your registered computers. After installing LogMeIn on your computer you can remotely gain access to it. LogMeIn users can access their work computer from home to, for example, save articles from medical journals available only through one's school or hospital. These papers will instantly be available in a user's other devices, including smartphones. Again, I would first make sure your IT department does not have any objections to this application. One unforeseen consequence with LogMeIn is that you may wind up doing a lot of troubleshooting on family member computers (provided they have Internet access)! Below is a screenshot of the LogMeIn app for the Android (Figure 3).

Figure 3. LogMeIn for the Android. LogMeIn competitors include: pcAnywhere; GoToMyPC; TeamViewer; and Windows OS and iOS (limited functionality). Problem 2: Information Capture Ideas pop up at the most inconvenient and unexpected times, especially when you don't have a means of jotting them down. Being able to capture them can prove to be very useful. Another need faced by clinicians is archiving online content for future reference, which can be a cumbersome process. To address both of these issues, I use a service called Evernote.
Evernote

Evernote (Figure 4) allows users to practice "ubiquitous capture of information." After installing this app on a mobile device and computer, users can immediately archive anything they see, hear or think.

As shown below, Evernote allows users to retrieve and archive snapshots, voice recordings and plain text on smartphones. PDF files and pictures can also be uploaded, in which text is searchable. Notes are organized in notebooks and/or tags for easy access in the future and all pieces of information are housed on remote servers. All content is available on a user's smartphone or any computer with Internet access. Evernote is an especially great companion at a conference. For example, users can take snapshots of slides or poster presentations, the text in which will then be searchable. Additionally, users can type or add their own voice memos of important meeting highlights.

Figure 4. Evernote smartphone interface. Evernote desktop software is available for Windows and OS X. By installing it on a user's computer, all notes will be backed up locally. This can also add useful redundancy to your back-up plan. Some alternatives to Evernote include: Clipmarks; Zoho; Google Docs; and Microsoft OneNote.
Scan2PDF

Used in conjunction with Evernote, Scan2PDF[5] (Figure 5) is an app with great potential. As opposed to the default screen capture mode in the Evernote app, this app takes pictures of documents and converts them into PDF files, allowing users to scan a multi-page article and save it as a single file.

Figure 5. Scan2PDF smartphone interface. Problem 3: Information Overload It is almost impossible to keep up with the volume of available news and information, whether it's general news, medical news, or information from specialty journals. Three ways healthcare providers can stay current with medical news are by subscribing to email newsletters, visiting a journal's Webpage, or waiting for printed copies of their journals. Using any of these methods requires a certain amount of initiative because these methods can be extremely time-consuming. One possible solution to help with this information overload issue is to use Feed/RSS readers. Feeds or RSS (Really Simple Syndication) are essentially Website broadcasts in which users can retrieve information and articles from sites of interest all in one place. This prevents users from having to check multiple sites and emails to ensure they didn't miss anything important. Nearly all major news channel and medical journal Webpages offer Feeds/RSS.
Google Reader

To access my subscribed Feeds/RSS, I prefer Google Reader[6] (Figure 6), a Web-based service accessible from any computer browser.

Users can subscribe to any number of Feeds/RSS and I chose to organize my news according to context (ie, internal medicine journals, rheumatology journals, general news, sports, etc.). The screenshot below is from my Google Reader's Webpage. On the left are folders with my subscriptions, each indicating the number unread items left. After selecting one of the feed folders, the list of papers or news from that subscription appears in the right panel.

Figure 6. Google Reader Web Interface. Again, the beauty of a Feed reader is that it queues up all of a user's news in one place. Google Reader is also available on smartphones by accessing its mobile page, which requires no app installation (Figure 7).

Figure 7. Google Reader for smartphones. As an added feature, articles marked as read on a user's mobile device will be removed from the unread count on the Web reader. There are many alternatives to Google Reader, including: Bloglines; Netvibes; Newsgator; FeedReader3; and FeedDemon.
Twitter

Twitter [7] can also be used to stay current with contemporary events. Most news channels have Twitter accounts with breaking news. Just "follow" them and news-seekers are all set. News delivered through Twitter actually tends to flow faster than that delivered through Feed readers. Problem 4: Effective Time Management I have discussed clinician time management in a recent post on my Medscape blog, All Joints Considered. I'm exploring this problem again because I see many healthcare workers struggling with time and task management. I borrow the main time management principles from David Allen's Getting Things Done (GTD) system. GTD is based on 5 key elements: Collect, Process, Organize, Review, and Do. Collect: tasks should be recorded at the time you think about them; Process: recorded tasks should include action verbs (eg, read, do, get, review, call, etc); Organize: have 1 task list instead of multiple lists and have priorities clearly defined, such as with a number system. Also, create different tabs/folders/subfolders according to location or situation (eg, Personal, Work, Study, etc); Review: the whole system will collapse if you don't routinely review it. This seems obvious but tasks will not get done by themselves. Try to review your most important tasks everyday and all your tasks once a week.

The average person has close to 100 tasks in their list at any given time (if universal capture is practiced). Using memory alone to record, organize and review your tasks can be daunting and inefficient; and Do: actually get things done. A service that can accomplish all of the above is Remember the Milk.[8]
Remember the Milk

Remember the Milk (RTM) (Figure 8) allows users to record tasks on the go with their smartphones. Tasks can be typed or, on Androids, dictated, and assigned to specific lists; furthermore, priorities can be designated as can locations and due dates. Because smartphones are location-aware devices, whenever you enter certain predetermined geo-location (like your home or work), RTM will populate the tasks for that location.

Figure 8. Remember the Milk for smartphones. RTM is web-based, so all tasks entered in a user's smartphone are synched online and vice-versa. The Web browser interface allows users to see their tasks from any computer with an Internet connection. RTM also features a reminder system that can send text messages or email alerts before a task's due date. Other task management products include: Todoist; Microsoft Outlook; Google Tasks; and Toodledo.

Problem 5: Outdated Phone and Voicemail In my opinion, mobile and landline companies do not offer voicemail systems up to speed with other areas of communication technology. Let me make my case: 1. Phone messages are relatively hard to retrieve and store: after a user dials his/her voice mail number, he or she must proceed through several prompts to access messages. 2. Storing messages for future reference is expensive: most people delete voice messages after listening to them, so they don't incur extra carrier charges. 3. Users can't read voice mail: sometimes, it's impossible to stop and write down a phone number or address; hence, a voice mail transcription would be useful. For example, in places like a theater, answering a cell phone or listening can be out of the question and inappropriate -- a transcription would come in handy! 4. Text messages are expensive: anyone with teenagers will agree. 5. International calls are difficult to make: anyone who's made an international call with a calling card knows what I'm talking about. Often callers have to dial > 25 numbers and if a mistake is made along the way, it's back to square 1.
Google Voice

Google Voice (GV) assigns users a new number. If someone calls a user's GV number, calls are directed to any of that user's preselected phones. Specific times and days of the week can be set for phones to ring. For example, users can set their cell phone and work numbers to ring only during weekday working hours, while setting their home phone to ring, say, in the evening. Voice mail prompts (for when a user doesn't pick up a call) can be personalized according to contacts or contact groups. As an example, I have a professional voice message for work-related contacts and personal messages in Portuguese for my parents from Brazil. GV also transcribes voice messages for free, a service available on the Internet through GV's inbox or via a user's smartphone. Also, messages are stored indefinitely and can be searched by caller name, phone number or through content in the transcribed text. Users can also read transcriptions or listen to voice mail directly through their Gmail accounts. Text messages through GV are free. Plus, users can receive and answer text messages directly through a Gmail account or GV inbox. Users can also use Gmail plus GV as a voice-over-IP service, similar to Skype, in which users can make and receive phone calls to and from your GV number directly through their computer. Making an international call with GV is as easy as calling friends in your town. After adding the contact information to your Google account, you can make international calls with 1 click. The international rates of GV are very competitive and similar to those of other services. GV is available on Androids (Figure 9) and Blackberries; however, Apple does not offer this application. The GV app allows users to read or listen to their voice messages, as well as type and read text messages.

Figure 9. Google Voice for smartphones. Some possible alternatives to GV, depending on your particular needs are: Phonebooth; Skype; Line2; 3jam; Youmail; Voxox; and RingCentral. Problem 6: Password Management It can be very difficult to recall the passwords for all of the various websites and subscriptions we as clinicians are often signed up for. Security experts recommend having long passwords (12 characters or more) with combinations of letters, numbers, and symbols. Generating such strong passwords requires lots of imagination. It goes without saying that users should not use the same username and password for all Websites and subscriptions. Nevertheless, many people do just that and weak passwords are very common. A recent survey [10] revealed the most commonly used passwords that should be avoided are 123456, 12345, 123456789, Password, iloveyou, princess, rockyou, 1234567, 12345678, and abc123. I kid you not! Securely storing passwords is challenging. Pencil and paper may work for some, but this requires users to carry

passwords with them. Also, this method is also not secure, nor is saving passwords in a word document named "Passwords." A way to tackle this issue is to use password management software, such as KeePass.
KeePass

KeePass (Figure 10) can safely store passwords on your desktop (Mac or Windows) and is available in many mobile operating systems; the program can also generate strong passwords and autocomplete logins, passwords and forms. To enter the program, users must enter a master password. The desktop KeePass software can be synched with the KeePass app on smartphones. By syncing passwords, users can have them with them and securely stored at all times. Don't worry, the KeePass mobile app is also password protected and encrypted.

Figure 10. KeePass for Macs and smartphones. There are several alternatives for password management, including the following: Lastpass; eWallet; 1Password; and Roboform. Bringing It all Together: Case Examples Now that I have shown what these 9 apps can do individually, it is time to use them together. Below are some case examples: 1. Saving the KeePass database file in a Dropbox folder will allow users to access their passwords via any computer in which Dropbox is installed. I also save the KeePass software itself in the Dropbox folder. By doing so, I don't have to install it in multiple machines. The Dropbox mobile app can sync the KeePass database file to smartphones so that users don't have to sync it manually. 2. From Google Reader users can send tasks to Remember the Milk or articles to Evernote. Emails can also be directly sent from a user's inbox to RTM and Evernote. This can help clear out a user's inbox to achieve that Nirvana state, "inbox 0." 3. As discussed previously, users can access their work computer from home with LogMeIn and drop any

number of items in their DropBox -- this way these files are instantly available via a home computer or mobile device. 4. GV transcribed voice messages and text messages can be forwarded from a GV inbox or Gmail to RTM or Evernote. As an example, a GV message may contain instructions for a task with multiple steps. Instead of typing or copying everything into RTM, users can just forward the message to their RTM account. The possibilities for combining these smartphone apps are endless. Please contribute via the comments other apps you find useful or suggest additional ways to combine the apps presented above. Or if you have another analogical way to get things done, please share it!
References

1. Schonfeld E. U.S. mobile web usage grew 110 percent last year; Apple dominates, Android no. 2. Techcrunch.com. Available at: http://techcrunch.com/2010/01/05/quantcast-mobile-web-apple-android/. Accessed September 10, 2010. 2. Dropbox Website. Available at: http://www.dropbox.com. Accessed September 10, 2010. 3. LogMeIn Website. Available at: https://secure.logmein.com. Accessed September 10, 2010. 4. Evernote Website. Available at: http://www.evernote.com. Accessed September 10, 2010. 5. Scan2PDF Website. Available at: http://www.koma-code.de/index.php? option=com_content&task=view&id=39&Itemid=82. Accessed September 10, 2010. 6. Google Reader Website. Available at: www.google.com/reader. Accessed September 10, 2010. 7. Twitter Website Available at: http://twitter.com. Accessed September 10, 2010. 8. Remember the Milk Website. Available at: http://www.rememberthemilk.com/. Accessed September 10, 2010. 9. Google Voice Website. Available at: https://www.google.com/voice. Accessed September 9, 2010. 10. Telegraph Website. Available at: http://www.telegraph.co.uk/technology/news/7042205/Top-ten-internetpasswords-to-be-avoided.html. Accessed September 10, 2010.

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