Real Review: Epocrates 28

A few months ago you may remember my Real Review of Lexi-Comp beta for webOS. I concluded then that the app (which was a major leap forward in medical software on webOS) was exceptionally good, functioning largely as Med School in an app. Fast forward a few months, and following a prolonged hiatus from the app catalog, Lexi-Comp returned to provide healthcare practitioners with a much needed reference app.

But oh how quickly the landscape changes. Shortly after the return of Lexi-Comp, a webOS version of Epocrates, perhaps the most ubiquitous medical reference app made has also become available with a slightly different approach to medical reference on the go. In this review I'll describe my real-world experience with Epocrates over the last several days, comparing the salient points with my experience of the current trial version of Lexi-Comp.

Navigation

If there’s one place where Epocrates is clearly ahead of Lexi-Comp, it’s navigation. Throughout the app, nothing is ever wider than the screen, so there’s never any left-right scrolling. This means there’s also never any rubber-band left-right action as you’re trying to scroll vertically, as opposed to Lexi-Comp where finger scrolling routinely boomerangs the text off the sides of the screen.

Upon launching Epocrates, you're met with a splash screen as the app it loads its databases (which takes ~15 seconds or so. In comparison, the launch time for Lexi-Comp was comparable at 17 seconds.). The app then opens to a main screen which is organized as a vertically scrolling list divided into 3 main categories: Favorites, Tools, and Other. Favorites is a customizable category where you can add one-click access to any topic within the app including meds, calculators, or treatment algorithms. Tools gives you access to Drug Reference, Tables, or MedMath, which is an extensive list of calculators. Other gives you access to your navigation history within the app, and to the help menu.

Two other interesting features are present on Epocrates’ main screen. The first is a search bar at the very top of the screen. Epocrates doesn't utilize the "type-to-search" feature that is present throughout the rest of the OS, so you have to tap the bar before you begin typing. Otherwise a search from the main screen can pull up topics from anywhere within the app, which is quite nice. If you've drilled down into a subcategory, say meds, then the search bar will only search within that category. It's a convenient shortcut, and one that I used quite frequently.

The other, more curious feature on the main screen is a large random banner advertisement of some feature of the app. For example, looking at my screen now, the banner that says, "InteractionCheck enables you to check for interactions among up to 30 drugs at a time| Start using InteractionCheck >." This will likely serve as a means of getting people to upgrade to a more full-featured version of the app, but otherwise it's relatively useless.  This is because you never know what it's going to be displaying on the banner each time you're on the main screen, and 99% of the time, you're looking at the app for a very, very specific reason (a drug, calculator, or whatever).  Hopefully full featured versions of the app won't have this.

Both Lexi-Comp and Epocrates have a button to jump back to their respective main screens from anywhere in the app (the ‘e’ button in Epocrates, and the ‘Library’ button in Lexi-Comp), but Lexi’s Library screen isn’t as useful. Users only have a choice of selecting from one of two menus there, with more navigating required to get to additional information. Epocrates makes a lot of use of its main screen, allowing you to access favorites, tools, history or searches as I described above.

Looking at medications, users will find that they're met with clean, high contrast text. There is good use of varying font sizes, colors and boldface to make finding the info you need onscreen easier. Opening up a medication brings dosage forms and dosing guidelines front and center, without scrolling or jumping. Lexi-Comp on the other hand requires you to scroll past a few dozen other items including alters, safety issues, brand names, pharmacologic category, pregnancy risk factors, contraindications, drug interactions, storage, and pharmacodynamics/kinetics (just to name a few) before you can see the dosing info. Alternatively, in Lexi-Comp you could tap on "Jump," but you would still have to scroll down the alphabetical list past 14 other choices to get to dosing. Both of these options are inconvenient during a patient encounter.

Content

First and foremost, both Epocrates and Lexi-Comp are well known in the healthcare community as reliable sources of reference information. That said, there was a noticeable difference in the level of depth offered by each company’s webOS app. As I said above, there’s a med school’s worth of data in Lexi Comp, whereas in Epocrates the information is focused more toward what is valuable to have at the bedside.

For example, in Epocrates, topics within each medication listing are collapsible and include Adult and Pediatric dosing, Black Box Warnings, Contraindications/Cautions, Adverse Reactions, Drug interactions, Safety/Monitoring, Pharmacology, Manufacturer/Pricing, and Pill Pictures. In terms of level of detail, it's substantially less than Lexi-Comp offers, but covers the vast majority of information you'd want to have at your fingertips. . By comparison, looking at the listing for aripiprazole in Lexi-Comp, I was literally 2 taps away from a 300 page practice guideline PDF on the treatment of Schizophrenia. In fact, there are countless hyperlinked PubMed citations throughout Lexi-Comp; allowing you to expand your knowledge base in an almost limitless fashion right through the app. No such linkages were available in Epocrates.

Comparing the interaction checkers within each app, Lexi-Comp had more depth, including herbal medication interactions. I spoke with a representative from Epocrates about the level of depth, and they informed me that they fully intend to keep updating and expanding content after release. As it stands however, Lexi-Comp is clearly ahead in both the breadth of special topics and in the depth of content available within and through the app for each topic.

On the other hand, Epocrates has a pill pictures and pill ID feature which allows you to show patients what medicine you're talking about, or use the app to figure out what an unknown pill is based on it's shape, color, and markings. Both Pill Pictures and Pill ID are incredibly useful on a day-to-day basis, and both are absent from Lexi-Comp.

Epocrates also includes MedMath, with ~40 different calculators available. The interfaces are clean and finger friendly, and anyone migrating from the iPhone, Windows Mobile or an older Palm device will find their familiar favorites here. The only oddity is that the Pre/Pixi's hardware keyboard can't be used to enter in data to the calculator, so you have to use the smallish onscreen buttons. Not a big deal, but certainly somewhere there's room for improvement. By comparison, there are no calculators in Lexi-Comp, so you'd have to invest in another app to have that functionality.

The biggest feature missing from Epocrates user defined notes. Depending on how you use the app, this may not be a big deal for you, but previous iterations of Epocrates (for Palm OS) did allow you to enter and share notes right in the app. As I mentioned in my earlier review of Lexi-Comp last year, this allows you to customize the app to your own practicing style, placing clinical pearls about medications or procedures right where you’d want them to be; in the reference page itself. While Lexi-Comp’s user notes are stuck on the device (and I’m not sure they’d survive a hard reset), Epocrates doesn’t allow notes at all, which is a significant step back. In speaking with representatives from both Lexi-Comp and Epocrates regarding the utility of this feature; both informed me that they would “pass along” the information to the devs. As it stands, neither app has a great notes feature, but something is better than nothing, putting another check in favor of Lexi-Comp.

Conclusion

Epocrates has a great deal of experience providing medical reference software on handheld devices, and it clearly shows with the decisions they've made in the webOS app. If Lexi-Comp is med school in an app, Epocrates is a doctor's bag in the field. It may not have the depth of citations or special topic tables that Lexi-comp provides, but it does have rapid access to the vast majority of information and practical tools practitioners will need at the bedside. It has an inarguably higher level of fit and finish, and an also boasts additional highly useful features (pill ID, MedMath) that Lexi-Comp simply doesn't have.

In the ideal world, the app would have Lexi-Comp's level of detail with Epocrates' polish. As it stands, the choice will come down to whether you want considerably more reference data and the ability to add your own notes, with less convenient navigation and an absence of many practical features, or a more lightweight information set with an abundance of additional tools that's significantly easier to navigate during a patient encounter. Either way, practitioners can breathe a sigh of relief that they have high quality reference apps from trusted sources available on the webOS platform, and pick the app that suits them better.