SMARTPHONES AND BEYOND: Mobile Applications in Medicine

Brian Keeffe, MD

Today we are on the cusp of a revolution. In the very near future, doctors will find that mobile technology, including mobile apps and wireless sensors for monitoring our patients, will transform how we practice medicine.

The cell phone was invented in 1973. For the first 34 years of its existence, it served doctors mostly as a means of being able to answer pages without having to pull over their cars to find a phone booth. The invention of the smartphone in the late 1990s improved the functionality of cell phones. Doctors were now able to store notes and access limited medical information while in the office or hospital. In 2007, however, everything changed with the introduction of the iPhone, which had significant capabilities. Five years later, medical innovation with smartphones is starting to show exponential growth.

When I began practicing medicine in the late 1990s, the first mobile device I used was the Palm Pilot. I and many of my residency colleagues created and shared medical notes on these devices. Later, Epocrates became available on Palm Pilots and proved invaluable in medication prescribing.

I have used an iPhone daily for medical applications ever since its inception. The applications I use most frequently include a mobile version of the Allscripts electronic medical record; Epocrates for pharmacy help; Doximity for locating other physicians’ addresses and phone numbers; Qx Calculate for quick medical calculations; and Syntranet for charge capture of hospitalized patients. I also use the iPhone’s camera and movie functions to send anonymous images to colleagues for curbside consults.

I am not embarrassed to Google medical questions that may come up over the course of a patient visit. I do, however, continue to use a desktop computer for the bulk of my EMR viewing and documentation, as the mobile apps have not yet developed the full functionality of the desktop versions. Although tablets such as the iPad are becoming more popular, their EMRs still don’t have full functionality, so I’m sticking with the iPhone-desktop combination for now.

Using a smartphone in my practice does make me more efficient and reduces the time needed to find information that aids in patient care. The smartphone is also a remarkably efficient way to communicate with other doctors. I religiously gather cell phone numbers of any doctor I can in our community. Calling or texting a doctor (must be HIPAA compliant) on their mobile device can save me valuable minutes relative to trying to reach them at the office.

I use social networks sparingly, but some are handy. Sermo and Doximity, for example, allow doctors to share cases with each other and even transmit pictures or movies to get second opinions.

Much more is possible in the world of mobile devices. There are many health-related applications that our patients can use, although few do as of yet. These include applications for monitoring blood pressure, diet, nutrition and sleep, among other functions. On the physician and hospital side, there are mobile telemedicine applications for emergency rooms and ICUs; mobile imaging apps for reading x-rays, CTs and MRIs; and mobile applications for inpatient cardiac telemetry and fetal monitoring.

The FCC recently announced that wireless monitoring devices will be allowed to transmit data by spectrum bands previously reserved for use by the aerospace industry. This new capability will eventually allow physicians to monitor patients anytime, from anywhere--and the number of applications for this purpose will continue to grow.

I can envision a future where much of our patients’ health information can be stored in mobile software. All types of data--including blood pressure, weight and heart rate, blood glucose, detailed exercise data, diet and caloric expenditure, oxygen saturation and sleep information, heart rhythm assessment, laboratory data and medication adherence--will be acquired and assessed on a mobile device. Furthermore, EMRs will continue to develop mobile versions of their software, making desktop or laptop computers less and less required. The frequency of face-to-face visits with patients will go down as the ability to view patient data on mobile devices increases. Information technology, however, will never be able to replace the power of seeing a patient in person, talking to them, and performing a physical examination.

An obvious and major limitation of mobile devices is that they can distract from the doctor-patient relationship. For physicians, our mobile devices serve not only as a source of medical information, but also as our personal and professional communication devices. Phone calls, text messages and emails can be distracting and difficult to ignore. I personally leave my smartphone on silent when I am in the exam room with a patient and only take it out to check medical information. I always let my patient know why I am using the smartphone. I do not answer calls or respond to text messages or emails while I am with a patient.

Moving forward into the future of medical practice, I am excited about what the world of mobile devices and digital advancement will bring. I hope that patients having more access to their own health data will empower them to improve their health, and that mobile access to more data will make physicians better and more efficient providers of healthcare.

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Dr. Keeffe, a veteran user of mobile devices and applications, is a Larkspur cardiologist.

Email: keeffeb@marinhealthcare.org