At about the time that Nathan Bender received his MD degree from Georgetown University Medical School, he acquired another credential – one that still surprises him when this family medicine resident, now in Texas, finds time to give it a moment’s thought.

In his last semester in Georgetown, Bender briefly morphed into a software developer of sorts. As part of a class assignment, he created an application for Apple’s iPhone®, which the company then accepted as an approved “app” on its website store and released in April. During the week it was available for free – it now costs 99 cents - more than 2,000 medical students downloaded it. Bender’s app promptly shot up to the top 20 list for iPhone® health care applications.

Dubbed “ShotRecs,” the app is designed to help a physician or nurse keep up with vaccines needed by children, adolescents, and adults. The format of 2009 immunization schedules for different age groups and varying medical conditions mirrors that used by the U.S. CDC, which is a colorful, easy-to-read, rapid reference guide.

As Bender says himself on his app description on the iTunes website: “The familiar viewing format is intended to maximize the health care professional’s ability to access the necessary information in a timely manner.”

ShotRecs is a perfect example of how, nowadays, physicians are increasingly able to navigate mountains of medical information using programs on their smartphones and on the web. The goal is to improve medical care by providing ready access to medical informatics, including evidence-based medicine. Decisions about medical care depend on the latest information and facts, and these tools provide those facts at hand in easy to use ways, says Steve Schwartz, MD, associate dean for informatics at the Georgetown School of Medicine.

Schwartz pioneered the use of smartphones at the medical school six years ago, when, as director of the family medicine clerkship at Georgetown University Hospital, he required that his medical students use a Palm Pilot®. Now all Georgetown medical students are using Apple’s handhelds, and that “platform” is particularly ripe for medical applications, he says. “Apple encourages a grassroots system of building applications. Any medical student, or health care provider, can try to write one and submit to Apple for widespread use,” he says. “How wonderful is that?”

Bender, a Long Island native, didn’t think of himself as a “software guy” - he never took any computer classes at Dartmouth College, where he was an undergraduate. But the elective course in primary care informatics that he decided to take in his final year of medical school sparked his interest in the uses of medical information.

The course “explores the special informatics requirements of working in the primary care setting with short encounter times, limited on-site technical staff, and a focus on continuity of care, a broad range of problems that often do not have a specific diagnosis, preventive care, and optimal chronic disease management in a patient centered environment,” says Alan Zuckerman, MD, who teaches it.

Students spend one or two months observing the use of computers in clinical practice, acquiring informatics knowledge and skills through readings and tutorials, and working on a research project or application development.

“Informatics will play an increasing role in the careers of Georgetown School of Medicine graduates and we should expect some of our students to become leaders and innovators in the field,” says Zuckerman, an assistant professor in Community and Family Medicine and in Pediatrics.

Mobile technologies are an important tool for education and bringing information technology to the point of care, he says, so in the past students have worked on web applications or PDA projects. Bender was the first to choose to do an iPhone® application, and he consulted with both Zuckerman and Schwartz about the right project to pick.

“The goal of medical informatics is to allow us to have better care for patients and reduce medical errors. I wanted to see how realistic this is, and what I could do,” Bender says. He chose to transfer vaccination guidelines, jointly drafted by three organizations – the American Academy of Pediatrics, the American Academy of Family Physicians, and the CDC – into an iPhone® app. This is a basic kind of medical application, he says. “It provides immunization information. It doesn’t aid in medical decision making.”

He accomplished the task in less than three weeks using a $100 Apple software development kit and a book about the basics of software coding. “After spending several days reading the book, I knew I could do it,” Bender says. “Still, I surprised myself because I had real doubts in the beginning that this was possible.”

He did everything over the internet, including submitting an application to Apple to accept the new medical app, developing a website associated with the application (which features a photo of his 20-month-old daughter), choosing icons, etc. “It took three days just to get those ancillary tasks accomplished.”

“It is a very handy little application,” says Schwartz. “It gives clinicians 98 percent of the information they need to know about administrating vaccines.”

“It was a huge pleasure to work with Dr. Bender on this project and see him leave something important behind for his fellow students to use in their education,” Zuckerman says. “An important goal for the elective is to have students prepare materials to teach their colleagues about technology or use technology to more effectively teach colleagues about medicine.”

After his current internship at the Memorial Family Medicine Residency program in Houston, Bender wants to work in an intercity underserved population. He says he will find the time to update his ShotRec application as needed, and perhaps add a few more features. But he knows that this work falls more into the “labor of love” category than into a business venture. He receives 70 percent of the 99 cents download fee, but he has only made about $300 so far.

“All I know is that I will use it to keep up with my patient’s vaccinations,” Bender says. “And that will help me provide good medical care.”

By Renee Twombly, GUMC Communications