Pharmacist: Epocrates app is flawed, should be removed from iTunes

The popular new Epocrates Bugs + Drugs app used by physicians as an antimicrobial susceptibility reference is flawed and should be removed from Apple's iTunes store, so argues an iMedicalApps article written by Timothy Aungst, Pharm.D., professor at Massachusetts College of Pharmacy and Health Sciences.

"While look and functionality are key components of an app, the content of an app is what really matters, and that is where Epocrates has made significant errors in several areas," concludes Aungst. "Putting the wrong information into clinical hands that rely on such products has the potential to be damaging and harmful. Getting antibiotics correct is imperative, as a wrong decision can lead to an infection worsening, further treatment, hospitalizations or even death."

Launched early last month, the free app provides geolocated bacterial resistance data sourced from athenahealth's cloud-based EHR to support clinical decision-making at the point of care. "Historically, this information is gathered from hospital in-patient data," states the Epocrates Bugs + Drugs site on iTunes. "This app goes beyond the hospital setting and help clinicians identify superbugs in areas their patients live by incorporating lab data from over 15 million patient records sourced from athenahealth's cloud-based EHR."

Epocrates and athenahealth announced on Oct. 31 that the Bugs + Drugs app hit the 100,000 download mark and was the top free medical app in Apple's App Store in its first week of release, earning high marks from users. However, according to Aungst, the initial release of the app was plagued with "completely incorrect information." For example, the author noted that the app identified several organisms as susceptible to antibiotics which, to Aungst, make no sense pharmacologically.

Following comments and reviews on the iTunes store and in Twitter by multiple clinicians, Epocrates revised several of these errors, Aungst points out. Nevertheless, he also found that the Epocrates app "did not address certain infections that may be a concern, such as the so called 'superbugs' (e.g. MRSA, VRE, ESBL) or other pathogens such as Clostridium difficile."

Moreover, Aungst takes issue with the app's claiming susceptibilities of "100 percent" for some pathogens that make no sense. "This is especially the case in pathogens where we know that resistance is relatively high and the susceptibilities percentages put forth by the app just seems clinically wrong," he writes.

In related news, a recent report from the IMS Institute for Healthcare Informatics analyzed more than 43,000 healthcare apps available on iTunes and found that the vast majority have limited use and simple functionality, with most apps doing little more than providing information. The report also revealed a lack of evidence of the clinical benefits of the apps, without which app use will not be able to move from "a novelty into the mainstream of healthcare" nor realize its full potential.

Earlier this year, a study published in the Journal of Cancer Education looked at smartphone apps as a source of cancer information and found a "lack of cancer-related applications with scientifically backed data." Among the 77 apps in the study identified on the Apple iTunes store, only a little more than half of the apps provided scientifically validated data, while a mere 79 percent of the apps uploaded by healthcare agencies were found to be backed by scientific data. 

In an effort to ensure the information contained in medical apps available in its App Store are appropriately validated, Apple has asked a number of developers to release or update apps rejected on the basis of incomplete metadata, and is requesting information from developers regarding the source of the medical information contained in their apps.

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