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