 is the president of Dowling Medical Director Services, a private health care consulting firm specializing in quality improvement, clinical informatics, and health care policy affecting specialty care. He is the former medical director of a large, metropolitan, single-specialty urology group in Fort Worth, Texas.

Robert A. Dowling, MD

Whether you embrace, resent, or harbor mixed emotions about the adoption of information technology in your practice, physicians and patients now have a number of tools at their disposal for data collection, education, documentation, and even improving health. Technology in general has become highly portable and mobile, and spawned the widespread adoption of mobile applications. According to a May 2013 press release from Apple, “Customers are downloading more than 800 apps per second at a rate of over 2 billion apps per month” from the Apple App Store alone.

	With such an overwhelming number of choices, it can be daunting to find apps that have practical use for urologists or their patients, and also work well. In this article, I will provide some direction and references to help you find the right app for your purpose.

	If you already use mobile technology, a good place to start is your platform’s app store. Searching the Apple App Store, for example, with the keyword “urology” returns about 60 apps, most of which are free. Clicking on any app will allow you to quickly view a description, read reviews and ratings, and link out directly to similar apps. It took me about 15 minutes to separate the wheat from the chaff.

	The website UrologyMatch posts reviews of urology apps for mobile devices (

). When I accessed this in October 2013, I found about 20 apps reviewed, with the most recent posting from December 2012.

	There are other websites I would recommend when you are shopping for urology apps. One of the most comprehensive compilations of apps for the practicing physician is by Epocrates (now owned by athenahealth, 

). Applications available free of charge or by subscription include drug databases, dermatology atlases, CME apps, National Comprehensive Cancer Network guidelines for prostate cancer, medical Spanish apps, and more. The apps are available for iOS or Android platforms. Drugs.com also has some inexpensive apps related to medications and drug references (

). The AUA also maintains a virtual app store where you can find links to apps for publications, AUA guidelines, member directories, and more (

	Finally, two resources offer helpful information on apps designed for patients. 

 recently published an article about the top 10 apps that physicians recommend to their patients; while this piece is oriented to the primary care physician, watch for specialty-related articles on the subject (

“Patient Apps for Improved Healthcare” from the IMS Institute for Healthcare Informatics is an in-depth report about the role of consumer apps in disease prevention and treatment that includes lists of top-rated apps (downloadable at 

Some apps benefit physicians and patients

	There are a few apps that deserve special attention because they solve everyday problems for urologists and their patients, and may even save time and money. Maintaining an accurate medication list is a common challenge, especially when patients receive a prescription from another physician but are unable to remember the drug’s name. An app that has been getting some attention to solve this problem is ID My Pill (

). The app leverages the use of the built-in phone camera to take a picture of the pill and instantly identify it; designed primarily for patients, I see an important use for this in the office as well. There are other apps without the camera feature that can help identify a pill (eg, 

	Another very popular app is drawMD Urology (

). This app allows physicians to draw on an image for patient education, then save, e-mail, or even export the image (see related article). There are over 30 mobile “charge capture” apps in the Apple App Store, many of which are free but have no reviews. If your EHR or practice management software vendor does not have an affordable solution, you may wish to try out an app and do away with those index cards to avoid missed hospital charges.

	Bottom line: We simply don’t have time to keep on top of the rush of information technology and all the applications of its use. Most of us carry a smartphone or tablet because we have grown dependent on its functions and easy user interface. Adding a few simple apps to those devices can return time, money, and even satisfaction on our busy days. Use some of the tools provided here to do your own shopping, and check out the app for 

 to get monthly news from the leading news source for urologists.
	 

Articles

With such an overwhelming number of choices, it can be daunting to find apps that have practical use for urologists or their patients, and also work well. In this article, I provide some direction and references to help you find the right app for your purpose.

Mobile apps offer many benefits to busy urologists

	The evaluation and management of patients with urinary tract infections occupies a significant amount of time, energy, and resources in the typical general urology practice. One large clinical data set demonstrates that urinary tract infection (ICD-9-CM code 599.0) is the seventh most common diagnosis code employed by urologists (almost 6% of all office visits).

	In this article, I will examine and question the phenomenon of “the urine drop-off”-having the patient with suspected UTI collect a urine sample at home and drop it off at the practice-in the context of best clinical practice, common sense, and basic office efficiency.

	While no precise data are available, most would agree that a significant number of phone calls in and out of the urology office deal with symptoms of a UTI. Among this population are women with uncomplicated lower urinary tract infections, children and older adults with complicated UTIs, postoperative patients, patients with indwelling or intermittent catheters, and others. As the urinalysis has become a “vital sign” in the urology practice-obtained on almost every patient as part of their clinical intake-many practices have developed workflows for obtaining or even requiring a urine specimen on a patient who calls with symptoms of a UTI.

	What is the available clinical guidance on whether a urinalysis or urine culture is necessary in the evaluation and treatment of patients with symptoms of a UTI? A good summary of three available clinical guidelines for the management of lower urinary tract infections can be found at the 

	While one of the guidelines is silent on the subject of diagnostic testing, there is consensus between the other two that women with symptoms of recurrent uncomplicated UTIs can be treated without lab tests if they have been previously evaluated and are aware of their symptoms. Many such patients exist in a urology practice, and for that subpopulation there is clinical guidance that dropping off urine is not indicated.

	Would dropping off urine actually change the evaluation or management of a patient? There are many scenarios where it might: One example is deferring the treatment of a patient who is not acutely ill, perhaps with a history of drug-resistant infections, until the results of a urine culture are returned. There are other scenarios where a urine test-especially a urinalysis-might not change the treatment decisions at all: a patient who has undergone transurethral resection of the prostate and is on broad-spectrum antibiotics who calls with a fever, for example. No two patients are alike, but before asking a patient to drop off a urine specimen for testing, it is reasonable to consider whether the results would change your clinical decision making.

	Are the results of a urine drop-off accurate and reliable? The predictive value of a dipstick and microscopic urinalysis compared to a urine culture on a properly obtained urine specimen is well studied; it is not a highly accurate test to confirm or rule out a UTI under the most controlled circumstances (

http://www.aafp.org/afp/2005/0315/p1153.html

). Collection of a specimen outside the office introduces additional influences on accuracy of both urinalysis and culture: The method of collection cannot be observed or controlled; the jar may not be clean or sterile; and the storage time and temperature can significantly affect the results. These sources of contamination should be carefully considered when asking a patient to drop off a urine sample and predicting the value of the information so obtained.

	Is the result of the urine drop-off alone sufficient information needed to make the next decision, and can it substitute for an office visit? Patients who cannot adequately describe their symptoms might best be assessed with professional history-taking skills during a face-to-face encounter. A patient with a new physical finding-a swollen testicle, for example-may require a physical exam by a qualified provider.

	Other patients may have a constellation of symptoms and findings that cannot possibly be determined on the phone and require more than a urine specimen for decision making. Unless the urine specimen is the only piece of critical and missing information, an alternative to the urine drop-off should be considered.

	Other questions you may wish to consider: Is the urine drop-off a reimbursable or even profitable service line? Does your staff perform insurance eligibility checks on services for these patients? Does dropping off a urine sample create the potential for workplace safety issues (urine on the floor), specimen handling issues (front office staff), patient safety issues (labeling), and/or liability issues (scope of practice of office employees)?

	Also: Is it more appropriate or convenient for a patient to drop off the urine sample at a qualified lab facility rather than the busy urologist’s office? Is it really more or less efficient (than an office visit) to return a phone call, request a urine specimen, process the specimen, send the results to a busy provider for review, phone the patient back, and initiate therapy remotely in your practice?

	Bottom line: The urine drop-off has probably evolved because it is perceived as a convenient alternative to the office visit, and it is an appropriate approach to the management of select patients. However, this workflow has the potential to be inappropriately generalized in a busy practice. Urologists should create or review policies that can guide their staff to know when it is, and when it isn’t, necessary and appropriate to ask a patient to “drop off a urine.”

In this article, I examine and question the phenomenon of “the urine drop-off”-having the patient with suspected UTI collect a urine sample at home and drop it off at the practice-in the context of best clinical practice, common sense, and basic office efficiency.

Robert A. Dowling, MD

Articles

Mobile apps offer many benefits to busy urologists

Do ‘urine drop-offs’ make sense in your practice?