World at your fingertips

Smartphones and their apps are adding a new dimension to medical care, bringing information to doctors’ fingertips and connecting them to the world at the bedside

At the Port Macquarie practice of ophthalmologist Dr Colin Thompson, camera phone technology has become a useful clinical tool in helping to track patients’ eye health.

“We’ve been able to use iPhones in the clinic to assist in documenting patients’ conditions and pre- and postsurgical states, such as pre- and postblepharoplasty”, he explains.

“We have used the phone camera directly and also with an adapter to take photos through our slit lamp microscope for more detailed pictures of the eye. The photos enable us to determine if a condition, such as a pterygium or a corneal abscess, is changing with time.”

Because the camera on the iPhone doesn’t allow a separation of the focus and exposure, Dr Thompson and his colleagues have been using an app called Camera Awesome, which gives him more control over the way the image is taken. They then transfer images to the clinic’s electronic medical record using another app on their iPhones called PhotoSync and a program on their computers called PhotoSync Companion for Windows.

“The main advantage the iPhone has over traditional methods is that it’s cheap, portable and always with me”, Dr Thompson explains. “Its wireless communication enables transfer of images easily without plugging in any cables or transferring memory cards.”

Apps are playing an equally useful role in the Western Sydney practice of occupational physician and e-health consultant, Dr David Allen. Dr Allen uses an app on his smartphone to view and modify his appointments calendar as well as to manage emails.

“This makes it easier to be more flexible in handling my schedule as well as communicating with staff and other professionals at suitable times. Videoconferencing is now possible on smartphones and I often use my phone to take part in international meetings, sometimes spanning three continents, using Microsoft Lync”, he says.

“I also use a PubMed app to do quick literature searches when I am away from my PC. I have several texts on Amazon Kindle which I can access whenever I need to.”

It seems that mobile phone apps, whether they are designed for medical use or not, are becoming an important part of daily life for doctors.

Are there benefits?

Monash University medical lecturer and e-health expert, Juanita Fernando, says there are real, practical advantages in using smartphones.

“The evidence clearly shows there are real gains to be made using the apps and they can empower clinicians and patients alike”, she explains.

“Doctors can not only gain in terms of time management but also by having access to the latest information, journals and, importantly, evidence-based data.”

It seems their capabilities are endless but are they reliable?

What can go wrong?

“The use of these applications is a medicolegal minefield”, Dr Fernando warns.

“There are few standards supporting smartphone devices for medical purposes in Australia and there is no certainty that, should a patient care error occur, doctors using these apps and devices (which are not licensed for medical use) will not be held accountable for their use”, she says.

“This is a shame because there is a plausible benefit of these tools to clinicians and to patients regardless of geography, income level and access to an electrical grid.”

From a privacy perspective, there are also issues to be mindful of, including the type of information you store and share and the potential impact of theft or loss of an unprotected device.

“Many clinicians advise me that physicians sometimes use the mobile devices to photograph patients’ injuries, without consent, for diagnosis and consultation with colleagues — the patient may be unconscious during the process”, Dr Fernando explains.

“In some instances, Freedom of Information requests from patients have resulted in removal of these pictures from clinician-owned devices, but what about those that patients do not know about? It’s a bit of a time bomb really, yet we have the expertise and technology to rectify most privacy concerns.”

Getting technical

With any computer device comes an array of technical issues that can cause grief — data that don’t sync, apps that fail, internet connection issues and applications that don’t perform as expected.

Dr Allen believes that if doctors are going to use smartphones to help carry out medical work, then there needs to be sound information technology support available to them.

“When starting to use these devices — which are relatively cheap, accessible and easy to use — things can come unstuck when it comes to activities such as syncing. For instance, using iTunes to sync an iPhone to a PC is no mean feat for beginners”, he says.

“Care is needed to do regular offsite backups of PCs, servers and devices. I have come across many clinicians who still do not do this. It needs to form part of everyday practice and should be audited regularly and tested to see whether data can be restored. Loss of all your records or calendars can of course be catastrophic.”

Looking ahead

Dr Allen says today’s smartphones and tablets have the processing power of PCs from some years ago but with the obvious advantage of almost always being with the clinician. This has enormous potential when it comes to remote medical record access in the future.

“Over the next few years, many medical record systems will be accessible remotely, particularly as tablets and smartphones become more widespread, useability improves, and wireless internet speeds increase. The advent of 4G wireless will make a dramatic difference to the ease of accessing records when mobile.”