An Apple a day: A look at how mobile technology is changing medicine

Medicine has gone mobile. From checking reference materials to keeping abreast of the latest research, physicians are transforming smartphones and tablet computers into medical Swiss army knives. Soon, mobile devices could be as omnipresent as stethoscopes.

The numbers are staggering: 81% of physicians are using mobile devices, Manhattan Research reported last year. The figure reflects a near 300% surge in use since 2001, when only 30% of doctors had them. Similarly, Aptilon found that 84% of physicians were likely to be using smartphones at the beginning of 2012.

“Mobile health is creating a digital revolution in health care,” says Cole A. Zanetti, DO, a family medicine resident at Concord (N.H.) Hospital. “This is partly due to the convergence of mobile technology, the digitalization of human beings through big data and artificial intelligence. This convergence is creating a perfect storm for more effective individualized patient care.”

Already, the uses for smartphones and tablet computers are myriad in health care. More than half of physicians say they are using mobile devices to help them make faster clinical decisions and 40% of doctors are using them to cut down on administrative work, a survey from Float Mobile Learning found.

“I think retrieving data on your phone or tablet is the most efficient use of mobile devices in medicine,” says Kelli M. Ward, DO, MPH, who practices family medicine and is the director of medical education at Kingman (Ariz.) Regional Medical Center. “Programs such as Epocrates and UpToDate allow physicians to review the newest information at point-of-care. I use Epocrates everyday to search for medications, calculate dosages for kids or refresh my memory on a rare condition. The technology is inexpensive and fast.”

QuantiaMD dug even deeper into physicians’ mobile habits. It found in a survey last year that 69% of doctors are using mobile devices to look up drug and treatment reference material, 42% are using them to learn about new treatments and clinical research, and 40% are using them to choose treatment paths for patients.

“Health applications are providing seamless data-gathering opportunities for both patients and physicians,” Dr. Zanetti says.

Big Apple

When it comes to choosing mobile devices, physicians have an affinity for Apple products. Three-quarters of doctors have an iPhone, iPad or iPod, Manhattan Research reported. The Aptilon survey predicted that 61% of U.S. physicians would own an iPhone by the end of 2011.

IPads and other tablet computers are on the rise. According to the QuantiaMD survey, 30% of physicians are using tablets and another 35% plan to do so in the next few years. The Float Mobile Learning survey found that physicians are 250% more likely to own a tablet than other consumers.

All those iPads seem to be making medicine more efficient. A study published in the March 12 issue of Archives of Internal Medicine tracked 115 University of Chicago residents using iPads. The medical students used EHRs, ordered tests and viewed the results on iPads. Using the tablet, they were able to reduce their workload by 30 minutes a day. More than three-quarters of the residents said the iPads made them more efficient; 69% said they helped avoid delays in patient care.

Bulletin Healthcare’s analysis of how clinicians garner their medical news further reflects Apple’s health care dominance. “Combined, the iPhone and iPad grabbed more than 90% share of use,” Bill Mulderry, the company’s president said in a March 2011 statement. “Android saw only 6% use, and other platforms like RIM and Palm barely registered.”

Apple’s iTunes store recently rolled out a section called “Apps for Healthcare Professionals” with several anatomy, social networking, pharmacology, education, patient monitoring and imaging apps. There are even a few apps specifically designed for osteopathic physicians.

“Given Apple’s integration of its speech recognition system Siri into its iPhone, there is great potential for the further empowering of patients and medical applications,” Dr. Zanetti says.

Distracted DOs?

For all the good mobile technology can bring to medicine, it can also harm. A recent New York Times article examined “distracted doctoring,” a scenario in which physicians could make harmful mistakes when their attention is split among patients and mobile devices.

“Personally, I think distracted doctoring has existed for a very long time. Any instance where doctors are trying to document patient information and talk to the patient at the same time is distracted doctoring,” says Dr. Zanetti. “This predates mobile devices and computers and reaches back to the paper charts as well. It is the doctor equivalent to texting and driving.”

A 2011 study from the Journal of Medical Internet Research reported that even though they are efficient, smartphones and tablets cause “increased interruptions, a gap in perceived urgency, weakened interprofessional relationships and unprofessional behavior.” The report said physicians are interrupted nearly five times an hour by phone calls, emails and in-person distractions. Adding mobile devices to the mix could pull a doctor’s train of thought right off the rails.

“This is the very reason why artificial intelligence like Apple’s Siri and other mobile video technologies will be so vital in the future,” Dr. Zanetti explains. “The combination of device and voice recognition has great potential to lead into creating AI-driven video recording, documenting, coding and billing systems.”

Until such an intelligent ecosystem exists, DOs would be wise to exercise extreme caution not only for themselves, but for everyone they work with. Take the case of a near-fatal mistake recounted in the Agency for Healthcare Research and Quality (AHRQ) WebM&M. A physician treating a 56-year old man directed the patient’s warfarin to be stopped. As the accompanying resident began to use her smartphone to place the stop order, she was interrupted by a text message from a friend about a party. The stop order wasn’t completed. The patient had to have open-heart surgery to stop the warfarin-caused bleeding around his heart.

Similarly, a Sage Journals survey found that 55% of perfusionists admitted to using a cellphone during cardiopulmonary bypass surgery when they were supposed to be monitoring bypass machines. Another study from the American Society of Anesthesiologists found that residents and nurse anesthetists were distracted 54% of the time, mostly by cellphones.

“I think most doctors will be diligent and professional when using mobile devices for medical care,” says Dr. Ward. “We are learning how to use our devices effectively and efficiently in every area of our lives. Hopefully, we will be able to do this when medical technology catches up with digital music, video and news and we get some great apps to use everyday to care for patients, not just to look up information to use in a traditional chart.”

Nothing is foolproof

And of course, there are the ever-present HIPAA and Internet security concerns. Mobile devices have the potential to be lost or hacked and physicians can be held accountable.

“There is the risk of sensitive information being disclosed—not only by talking on the phone, but also by someone looking over the shoulder to see what is being typed,” Dr. Ward explains. “Also, there is always the dreaded risk of sending an email or text to the wrong recipient. Everyone has done it at one time or another, so being diligent in use is important.”

A survey from CompTIA found that information technology staffs are more worried about mobile security than physicians. Of the doctors surveyed, 44% considered security a mid-level priority. Only 24% said it was top priority.

“What is interesting to me is that the public view of paper security is not being scrutinized to the same level,” says Dr. Zanetti. “The security of patient information is a very important topic but being realistic about our capabilities is just as important.”

“Hackers, such as the Anonymous collective, have been capable of breaking through multimillion-dollar company security systems. Other hackers have been able to get through security at the Pentagon,” he explains. “At some point, we have to give appropriate credence to a well-secured system but acknowledge nothing is foolproof.”

Future mobility

The variety of uses for mobile technology seems limitless. It’s hard to imagine the role the devices will play in medicine’s future. Some DOs are already making wish lists.

“I would love to be able to access information from other physicians or facilities rather than waiting for a staff member to fax me information or for a doctor to call me back,” says Dr. Ward. “Most of the time, the patient has left before the needed information is received. Streamlining the medical process should be in the pipeline.”

Mobile technology is even creeping into medical education. Two California medical schools are teaming with a medical research organization to offer a new preventive medicine residency in wireless health. Residents will study wireless health technology while obtaining their master of public health degrees. Some schools, such as the University of California, Irvine, School of Medicine, bestow iPads on all incoming students.

Perhaps the most ambitious uses of mobile technology are in world health. Dozens of projects are underway across the globe. The Dartmouth Center for Health Care Delivery Sciences, for example, is embarking on a project that will use mobile phones to track tuberculosis in Haiti. The Evangelical Lutheran Church in Tanzania and the international nonprofit IICD are using mobile phones to record case notes and to take photos of patients in remote areas of Tanzania. The information is shared with specialists through the iPath telemedicine platform, where they can help determine a diagnosis.

Says Dr. Ward: “I think the possibilities are endless.”