Physician, Teach Thyself (To Code)
The Case of Nephrology on Demand

Health Tech | While the health tech devices and apps that we cover are more often than not the brainchildren of physicians, rarely do we meet doctors who also had the computer science or engineering skills to build their own. A professor at the East Carolina University School of Medicine, Tejas Desai, MD, did just that to create his iTunes App, Nephrology on Demand (NOD). We had the chance to speak with him about NOD and how he created it. We were also able to use the app ourselves, and we can recommend it for those who want to brush up on nephrology or apply the useful clinical guidelines and calculators.

What is the problem that Nephrology on Demand solves?
Nephrology is one of the more difficult disciplines in medicine to understand. It relies less on memorization and recall and more on logical thinking in order to make successful diagnoses. In clinical practice, a practitioner must also be adept at performing mathematical calculations to accurately assess various aspects of kidney function (more than just eGFR). Nephrology On-Demand Plus (NOD+) helps practitioners (of any level) perform the necessary mathematical calculations at the point-of-care and offers high-yield teaching content to help refine one’s thought processes. NOD+ consolidates learning and delivering kidney care into one streamlined, user-friendly app.

How did you come up with the idea to develop this app?
Learning happens on-the-go and practitioners are always on-the-move (from one exam room to another, one bedside to another). An app specific to the mobile learning needs of practitioners was needed: one that would teach new nephrology concepts in easy-to-absorb media formats and simultaneously allow for point-of-care assessments of a patient’s kidney function. An app that could bring together learning and point-of-care delivery was the driving force behind creating NOD+.
Can you describe how you, as a clinician, managed to produce NOD?
I’ve always enjoyed logical thinking; it’s one of the main reasons why I chose a career in nephrology. Computer programming is a lot like nephrology in that both rely heavily on logical thinking to reach a desired outcome. With the help of online programming courses, I learned how to program in Objective-C in 15-minute intervals. Similar to interval training, “interval studying” was the best way to manage a busy practice, the education of my fellows (I’m the fellowship director of a Nephrology Fellowship Program), and family life. Four years of interval studying led to the final product: Nephrology On-Demand Plus.

What has the reception been like so far from the clinical community? How many users do you currently have?
Both the nephrology and non-nephrology medical community has welcomed NOD+. Since May 4, 2014 (our launch date), NOD+ has been updated 16 times with new content and features in each iteration. It has been reviewed by users in India, Mexico, Slovenia, Canada, the UK, Greece, and the U.S. Over 95% of the reviews are five stars, with many users commenting on how they like the regularly updated content, push notifications, and the special features in the app. The best measure of popularity is the number of times the app has been used since its initial launch date: 80,743 times (from May 4, 2014, to May 5, 2015).

Can you specify how cardiologists and/or their patients may benefit from NOD?
The heart is a prime example of an organ that is affected by and exerts an effect on the kidneys. The heart and kidneys are linked by many interdependent physiologic processes. Integrating nephrology and cardiology together would help in understanding how each organ effects the other. NOD+ teaches nephrology in short, quick bursts—ideal for busy cardiologists and nephrologists. The app also offers sophisticated mathematical models to quantifiably predict how one’s kidneys will respond to various external influences. These are features that many busy practitioners will find useful.

What are your plans for the next year? Five years?
We want NOD+ to be a model medical education (meded) app. By integrating point-of-care features with great teaching content and leveraging specific iOS features (like APNS), NOD+ can lead the way for the next generation of physician-created apps. In the next 5 years, the NOD+ team will be focused on expansion and collaboration. The team is looking to venture into other app platforms (Android, Windows Mobile) and working with local chapters and grass-roots organizations to help spread their messages of healthy living; all the while maintaining our independence from outside funding sources.

Shiv Gaglani is an MD/MBA candidate at the Johns Hopkins School of Medicine and Harvard Business School. He writes about trends in medicine and technology and has had his work published in Medgadget, The Atlantic, and Emergency Physicians Monthly.

Keywords: CardioSource WorldNews, ACC Publications, Nephrology, Technology

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