Real Review: Lexi-Comp 28

The medical community has long been a major supporter of smartphones, largely as an evolution of our adopting point-of-care software on PDAs. The importance of the healthcare market continues to be significant even today, evidenced by the efforts made to show how medical software (as show by Epocrates on Classic) could still be accessed even before the Pre was released.

Well, the release of the Pre and Classic came and went, and many of us felt the webOS platform was in dire need of a native med/pharm reference solution. Back in August, Derek reported that Lexi-Comp was indeed being developed for webOS; I was recently given an opportunity by them to take the pre-release beta for a spin and write up a Real Review.

Before I go any further, I want to make it clear that the software I’m currently testing in indeed a beta, eg. not the final production version.As such, the refinement and optimization process continues. Also note that not all of the features are yet included Nonetheless, even if they released this as is, most of us would be quite pleased.

Setup

On the first launch of Lexi-Comp, you’re met with a table of contents containing over 30 major medical/dental categories. Not only is there the detailed pharm reference guide, there’s also Pharmacogenomics, ID, Labs/Diagnostics, 5-Minute Clinical Consult, Stedman’s, Harrison’s Practice, Toxicology, Med abbreviations, and Advanced Protocols among others. The amount of data available here is nothing short of astounding, particularly if you’re coming from the Palm OS ecosystem. (If you’re not a healthcare practitioner, that list probably doesn’t mean much to you. Just trust me, the healthcare providers reading this just got giddy.)

The reference data is stored natively on your webOS device, so all of you hospitalists don’t have to worry about any data dead zones when you’re rounding. In fact, Lexi-Comp works just fine in airplane mode if you’re trying to conserve battery.

Use

Honestly, I could do a several page write-up on this piece of software and still leave details untouched. To put it succinctly, Lexi-Comp is like med school in an app. The breadth and depth of information is exactly what you would expect from a desktop-class medical reference. It’s simply great.

Also, every practitioner does things a little differently. The cardiologists are going to be looking up different things than the orthopods. With that in mind, trying to do a thorough review of the content available here would be like trying to review the content in an encyclopedia. Instead, I’ve included a ton of screenshots to try and convey just how much information we’re talking about here (it’s staggering), and I’m going to spend a lot of time reviewing the mechanics of use.

The biggest hurdle in daily use is encountered with starting up the app. Load time for Lexi-Comp is most definitely on the long side. Just the other day, another doc and myself wanted to look up a medication at the same time. He grabs his iPhone and launches Epocrates while I launch Lexi-Comp. I was still on the splash screen while he was typing in the med. I've given feedback to the folks at Lexi-Comp working on the webOS app, they're aware of the load time issue and are actively working on it.

Of course with webOS, multitasking allows you to leave the app open and have quick access to it. This is great, because once the app is loaded, it flies. Unfortunately, I've found although app isn’t an incredible memory hog (I'm lookin' at you, web broswer), I still ran into the "too many open cards" error on occasion. At its worst, I'd get the warning on trying to have Lexi-Comp and one other app open. This would lead, not unlike the browser, to tossing Lexi-Comp and reloading. Again, the developers aware of the issue and working on it, so I'm hopeful that it will get shored up before the app gets to final release.

That said, it was short work to quickly reference meds during clinical encounters. The app is nice and quick once it’s up and running. I’d typically stay drilled down to the Lexi-Drugs category as my starting point. From there, just start typing, and it starts searching (like a search in email).

After you’ve selected whatever topic you’re interested in, it jumps quickly to that topic’s data page. From there you’ll find a convenient pull down menu on the right side of the header for rapid access to whatever info you’re looking for. There’s also tons of convenient cross-referencing hyperlinks to related content. Looking at a drug, there’s adult and pediatric dosing, pricing info, FDA warnings, etc - all the usual suspects. But there are also cross-references to receptor profiles, other drugs in the class, even PubMed reference links. Looking at an infectious disease, it’ll give you links to what labs you need to draw, and even how to do a venipuncture. Like I said before: med school in an app, but also cross-referenced like your books and notes never could be.

Of particular importance to me is the inclusion of user notes, which can be added to any topic.  Using integrated notes, you have the (potentially, see below) perfect place to put in clinical pearls, writing them right alongside all the other data you'd want to have handy the next time you look something up. This allows every practitioner to modify their app to make it relevant to how they do things, and puts the pertinent information they entered right in front of them when then need it.

As I'm fond of saying though, it's not all roses. One of the most noticable rough edges in the app are the interspersed reference tables. I can understand the challenge: the Pre's (or Pixi's) screen is only so big and table boxes can only be so small. As a result, you often find yourself scrolling left and right as well as up and down trying to view the information you need. Then to confound things, on some of the very large tables, you may lose track of which row or column you're on and have to scroll all the way back to the edge of the table to reorient. They've done a smart thing trying to maximize the utility of the available real-estate by making the entire app viewable in landscape, but I found myself wishing repeatedly that I could pinch to zoom or have floating column and row headers to keep myself oriented. According to the folks at Lexi-Comp, pinch-zoom functionality is also being developed, but won't be available at the initial release.

Another consequence of these tables is that the non-table text content, while formatted to fit neatly into the available width of the screen, is still left-right scrollable. This results in all sorts of unnecessary left-right kinetic-scroll bouncing when you’re just trying to scroll up and down. It’s a very minor issue as the text automatically re-centers itself with every scroll, but it’d add to the refinement of the app if they could lock text only columns so as to prevent any unnecessary side-to-side movement.

Conclusion

This is a challenging app to review. The amount of content is nothing short of massive, and it's a given that other people working in healthcare will use it in vastly different ways than I do. Also, it's a beta, so some of the issues I noticed may be worked out to a great deal by the time it goes live.

I personallly have nothing but praise for the amount of information available, and how rapidly the app can be navigated. The core functionality of the app is quite solid. Even in its current state, it's a pretty huge win for webOS to have this app on board. If they can speed up the initial loads, handle memory utilization a bit better to minimize the risk of "too-many-card-errors," it'd be even better. Add some kind of backup/sharing system for user notes, and you'd have perfection.

I've included a bunch of screenshots to go with this article, largely to give a flavor for just how immense the amount of data available through this app is. I figured a picture's worth a thousand words, so here's twenty thousand or so.