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HEALTH TECH SHIV GAGLANI MDCalc: Aiming to Be the Go-to Source for Medical Calculators O ne of the most popular uses of smartphones in health care is for point-of-care clinical decision support. There are hundreds of medical calculators and guideline apps, and MDCalc has recently added their own app to this list. I had the opportunity to speak with the leaders of MDCalc and emergency physicians, Dr. Graham Walker and Dr. Joe Habboushe. The two met in residency at St. Luke’s–Roosevelt Hospital in New York City and share a passion for medical technology and entrepreneurship. What is MDCalc? MDCalc is the go-to website (and now, iOS app) for clinical decision rules, calculators, equations, and algorithms. We help physicians make clinical decisions at point-of-care, with everything from mortality risk scores to who should be anticoagulated. We have over 175 tools covering 20+ specialties and counting. In the past few years we’ve developed new content for each calculator and have both unbiased experts and the calculator creators themselves (e.g. Philip S. Wells, MD, of the Wells Criteria) contributing to the site. Our iOS app is the most comprehensive free app for physicians, featuring our calculators with expert clinical content, as well as robust new search and filtering that allows clinicians to discover new calculators based on disease or chief complaint. How did you come up with the idea for MDCalc? Back in 2005, I (Graham) was being asked by my chief resident about Ranson’s Criteria, and I thought to myself, “Why am I expected to memorize 10 random criteria? Shouldn’t my energy be spent on patient care?” I realized that there were a number of criteria, scores, and equations that physicians performed on a daily basis, and no site that acted as a repository for them all. Inefficiency always irks me, especially in medicine, where we’re always working as quickly as possible and we’re always so busy, so I wanted to find a way to improve the care of patients while making physicians’ lives a little easier. I combined that need with my web development and programming experience, and MDCalc was born. Joe joined in 2011 to help expand the calculators and content in order to support a wider range of specialties. It’s been incredibly rewarding to see the 44 CardioSource WorldNews vast numbers of physicians we’re helping on a daily basis, literally from around the world. We’ve received emails from a broad range of clinicians, from fellow emergency physicians down the street to surgical intensivists in Thailand, thanking us for creating the site. It’s a great feeling. What are the outcome measurements you are most interested? Evidence-based medicine has really come a long way in the last few decades, and we are now seeing clinical decision research that spans nearly every specialty of medicine. Our aim is to help transform that research into practical tools for every type of practicing clinician. We work closely with a number of academics and score and algorithm creators, and they realize more and more that their work needs another step: implementation and dissemination. And that’s where MDCalc can help. Our MD team spends a lot of time researching, reviewing and validating the latest in clinical decision research. We purposefully don’t include every medical calculator on the site, as there’s a quality threshold based on the robustness of the evidence and validation trials; we also include “Pearls and Pitfalls” content to point out any calculator shortcomings. We know how important it is that our users can trust the tools on MDCalc. We love it when users write to us with suggestions for new additions to the site, as the tools and content we create should fit what is demanded by and beneficial to our user community. Can you discuss what offerings you have for cardiologists or other clinicians/trainees involved in cardiovascular medicine? Cardiology is one of the most used areas of MDCalc. Many of the first great evidence-based researchers and creators of medical calculators are cardiologists. We continue to see cardiologists lead in the development of new, better, more accurate, and more clinically relevant clinical decision rules. The term “risk factor” really came from the Framingham cohort looking at cardiovascular outcomes! It’s been really exciting recently to see the development of some improved risk scores for atrial fibrillation, as well as anticoagulation. The CHADS2-VASC has been a great improvement to CHADS2, and the HAS-BLED (along with the ATRIA and HEMORR2HAGES scores for bleeding risk) has really helped to optimally anticoagulate appropriate patients (and consider lesser anticoagulation in others). Additionally, the HEART Score and EDACS protocols for chest pain evaluations are very useful for objectifying chest pain risk—either high or low— for acute coronary syndrome (ACS). But medical calculators on MDCalc span nearly every disease entity in cardiology, from ACS to arrhythmias and syncope to congestive heart failure to endocarditis. Cardiologists need to make complex medical decisions, and the field has seen many brilliant academics develop powerful tools to help support these decisions. We’re just glad to be a part of it by helping folks get access to these tools. We’re always searching for more scores and criteria to add to the site, as well as experts to help expand our content. We’ve been recently also considering adding user-friendly echocardiogram calculations as well. Where do you see MDCalc in 1 year? 5 years? We’ve been working really hard on a stunning and feature-rich iOS app that was just launched. Our users have been asking for an app for a long time, so we’re incredibly happy to deliver something that exceeds expectations; that is not only true to the MDCalc’s look and feel but is also a platform enabling us to continue to innovate based on feedba ck from our users. In the short-term, we see three main areas for development: expanded tools and content, improved user experience for web and mobile, and better engagement with leaders in clinical decision support. In the longer term, we want to play a larger role in clinical decision support, helping to improve efficiency and patient care, all with the busy practicing clinicians (and ultimately their patients) in mind. It’s really exciting to think about how much digital platforms, like MDCalc, have become an essential part of practicing medicine. And we love daydreaming on how we can continue to support the evolution of clinical decisions tools and calculators one calculation at a time. ■ 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. April 2016