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Volume 4- NUMBER 7  2011

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Special Report: Apps, Doctors, and Digital Devices

By Jackson & Coker Research Associates


Smartphones and tablets: turns out they're not just for checking your Facebook wall or sneaking in a quick Angry Birds session. In fact, these digital devices are increasingly in use within the medical world. Doctors throughout the medical industry are finding that they can use these devices for a wide array of medical, technical, and administrative tasks. But could these handset helpers prove more of a burden than a blessing?

 

All the Cool Docs Are Doing It

The popularity of handheld digital devices among the physician set is well established. Look into an examination room or a doctor's office, and you're likely to find a doctor tapping and swiping away at an iPhone or iPad or any of the assorted similar devices available. This popularity makes sense, really: digital devices are faster, more portable, and generally more convenient than other tools. Additionally, physicians have more disposable income than do others, and thus are more likely to be early adopters of technology offerings like smartphones and tablets. Add to these factors the interactivity and connectivity of these devices–which allow for a wider range of uses than many non-digital tools–as well as the growing move to digitize as much of the health care delivery process as possible, and their increasing popularity makes all the more sense.

A number of different outlets have made pronouncements on the prevalence of digital device use among physicians. Most of them have found that a preponderance of physicians have readily adopted these devices for use in their daily practice. As far back as 2007, The Diffusion Group–a connected home and broadband media analyst firm–estimated that, by 2011, 70 percent of physicians would be using Internet-enabled smartphones. [1] Their estimate, according to recent studies, turned out to be conservative. One study by Manhattan Research found that 75 percent of American physicians have purchased an iPad, iPhone, or iPod. That is: three out of four physicians have adopted mobile devices made by one manufacturer. [2] Overall, the study found that 81 percent of physicians used some sort of smartphone, up from 72 percent in the previous year's study. [3] Yet another survey, this one by pharmaceutical sales and marketing company Aptilon, put the total percentage of physicians with smartphones–or planning to have a smartphone before the end of the year–at 84 percent. [4]

Physicians aren’t rushing to adopt only smartphones, though: physicians are embracing tablet computers as well. Echoing findings in the aforementioned Aptilon survey, Chilmark Research estimates that 22 percent of U.S. physicians had iPads at the end of 2010. [5] Another survey by market research firm Knowledge Networks puts the figure even higher, estimating that 27 percent of primary care and specialty physicians own a tablet computing device. [6] As the functionality of these devices increases, and as the price points decrease, it appears that we can only expect their use in the everyday practice of medicine will increase. But what exactly are physicians using them for?

There’s an App for That... and That... and That

The answer to that question is: whatever they can be used for. Mobile computing devices operate on the "App Model," in which third-party players develop software solutions to cater to a particular niche. The importance of the medical niche becomes apparent upon even a cursory examination of either of the two largest "App Stores." Both Apple's App Store and Google's Android Market have “Medical” sections, ostensibly devoted to apps that will prove useful for physicians and health care professionals. The most popular apps across both platforms include medical reference tools, drug information repositories, anatomical maps, educational assistants, and an array of other tools for patients, physicians, and medical students. Other offerings include apps like AirStrip Cardiology, which provides physicians with access to patient heart readings, and Epocrates, which functions as a medical dictionary, diagnostic lab test tool, disease-treatment guide, and drug-interaction checker. There are also apps such as VisualDX, a mobile dermatology atlas, and Calculate, a medical calculator and decision support tool.

The aforementioned Knowledge Networks survey also found that, in addition to using them as informational tools, physicians are using mobile devices largely to perform tasks such as email, research, and taking surveys. [7] Physicians throughout the medical industry, though, are continually finding new ways to use mobile digital devices in everyday practice. Last year, one Japanese surgical team used an iPad–of course, wrapped in cling-film to preserve sterility within the operating room–to provide a manipulable image of the surgical procedure in process. In real-time, the surgeons were able to zoom into and out of images being fed to the device from their imaging tools. [8] Others have opined on the potential for tablet computers to be used as a means of displaying patient imaging studies during surgery. [9] Other doctors have hailed the potential for tablet computers to be used in daily interactions with patients: one pediatrician says she uses her iPad to contact patients with referral information, digitally sketch out concepts for patients, display symptom guides, conduct developmental tests on children, and just plain distract child patients while she talks to their parents. [10]

Apps’ Applicability

Mobile devices have proved particularly useful in the field of radiological imaging, where physicians and technicians are continually looking to implement technological offerings to improve their access to imagery and their ability to diagnose based on that imagery. Researchers at the University of Calgary, for example, last year proved the efficacy of the app ResolutionMD as a diagnostic aid during a stroke trial. [11] Previous studies have also demonstrated the effectiveness of app offerings such as OsiriX in diagnosing acute appendicitis. [12] With results like those, one would expect radiologists to be near the top in mobile device use as compared to other specialties, no? Not quite. A study by Bulleting Healthcare found mobile device usage among specialties to be as follows: [13]

  • Emergency Room Physicians – 40 percent
  • Cardiologists – 33 percent
  • Urologists – 31 percent
  • Nephrologists – 31 percent
  • Dermatologists – 30 percent
  • Gastroenterologists – 30 percent
  • Psychiatrists – 28 percent
  • Optometrists – 28 percent
  • Radiologists – 24 percent
  • Rheumatologists – 22 percent
  • Endocrinologists – 21 percent
  • Oncologists – 20 percent
  • Clinical Pathologists – 16 percent.

All that isn’t to say that apps aren’t useful in radiology and other specialties. Rather, these results demonstrate the current state of usefulness of medical apps. As aforesaid, the most popular apps available are largely reference tools: they list conditions, medications, drug interactions, etc. Reference is typically the task for which emergency physicians–the most device-savvy specialty according to the Bulleting Healthcare study–use their tablets and smartphones. As information technology increasingly becomes integrated into health care delivery, though–for instance, through the adoption of electronic health records and e-prescribing–we are likely to see smartphone tools take the next step toward full utility. Experts in the field foresee physicians using apps to connect to patient data in order to check schedules, e-prescribe, review results, and communicate with patients.

iSecurity

Of course, the rapid adoption of smartphones and tablets by physicians doesn’t come without its risks. Physicians and health care professionals face more security responsibilities than do others buying consumer electronics. With physicians and health care professionals eager to integrate these digital tools into their workflows, hospital administrators and information technology professionals are scrambling to make sure that the devices can integrate in a manner consistent with the security protocols to which the hospitals and practices are beholden. HIPAA and HITECH privacy concerns represent an ongoing issue when it comes to these devices, as it can be difficult to know whether or not the app one has just downloaded is fully compliant with regulatory standards regarding health information technology. To mitigate this issue, some facilities create locations where clinicians can securely and cleanly drop their iPads and smartphones, removing sensitive data from the devices before the clinician takes the device with her out into the world.[14] Other facilities are using software solutions that only allow the mobile device to access patient health data, not to store it. As such, they are able to use these devices without risking HIPAA compliance. [15]

The Future Is Digital

So what is the future of health care delivery with regard to these digital devices? If current trends are any indication, you can expect to see mobile computers popping up more and more often. Already, a number of medical schools are integrating iPads and tablet computers into their educational plans: the University of California Irvine School of Medicine, as well as Stanford University’s School of Medicine, will be presenting incoming students with iPads from here forward. [16] Administrators have plans to sync students’ iPads with their stethoscopes, with ultrasound machines, and with a range of technologies across the medical education experience. As the upcoming generation of physicians is undeniably more tech savvy than their forebears, we can expect to see them bringing mobile digital devices into practice in ways that may be currently unimaginable.

As to what is within the realm of the imaginable, the physician’s office of the future will almost undoubtedly feature greater integration of mobile digital technology. Physicians can expect to use tablets and smartphones to interact with their electronic medical record systems, prescribe medications, and even assist them in conducting check-ups. These devices put information directly into the hands of physicians, and the potential applications are virtually limitless. For example: imagine a primary care physician carrying a networked tablet as she makes the rounds in a family care clinic. She enters one examination room, where a patient waits. After tapping in a few letters of the patient’s last name, the physician sees a list of options, and chooses the correct patient name. Instantly, the patient’s medical history, medications, allergies, and other relevant information are displayed on the screen, drawn up from the networked electronic medical record system. Over the course of the examination, networked medical tools automatically record the patient’s vital signs; and at the end of the examination, the physician schedules a follow-up, schedules lab tests, enters billing codes, and prescribes a medication for the patient... all within minutes from the same tablet. Sound like science fiction? It’s science fact: most of these things are already possible, but the future of medical apps and mobile devices will integrate all of these tasks seamlessly.

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1. Zieger, Anne. "Physician Mobile Device Use: It's Your Move," Fierce Health IT, October 1, 2007. http://www.fiercehealthit.com/story/physician-mobile-device-use-its-your-move/2007-10-01
2. "75% of Physicians Use iPad or iPhone, Survey Shows," Sandlot Solutions. http://www.sandlotsolutions.com/knowledge-resources/industry-news-items/2011/05/09/75-physicians-use-ipad-or-iphone-survey-shows
3. Horowitz, Brian. "75 Percent of Physicians Prefer Apple iPad, iPhone: Survey," eWeek, May 6, 2011. http://mobile.eweek.com/c/a/Health-Care-IT/75-Percent-of-Physicians-Prefer-Apple-iPad-iPhone-Survey-494578/
4. Dolan, Brian. "Survey: 61 Percent of Physicians to Use iPhones," MobiHealthNews, April 27, 2011. http://mobihealthnews.com/10809/survey-61-percent-of-physicians-to-use-iphones/
5. ibid.
6. Dolan, Pamela. "Doctors Cite Ease of Use in Rapid Adoption of Tablet Computers," American Medical News, April 18, 2011. http://www.ama-assn.org/amednews/2011/04/18/bisc0418.htm
7. ibid.
8. Geere, Duncan. "Japanese Doctor Uses iPad to Assist Surgery," Wired, June 3, 2010. http://www.wired.co.uk/news/archive/2010-06/3/japanese-doctor-uses-ipad-to-assist-surgery
9. Wodajo, Felasfa. "How to Use an iPad in the OR During Surgery," KevinMD.com, May 2011. http://www.kevinmd.com/blog/2011/05/ipad-surgery.html#more-52963
10. Burgert, Natasha. "5 Ways I Use My iPad at Pediatric Point of Care," KevinMD.com, March 2011. http://www.kevinmd.com/blog/2011/03/5-ways-ipad-pediatric-point-care.html
11. Husain, Iltifat. "Health Canada Approves iPhone Medical App for Diagnostic Imaging Use–FDA to Follow Suit?" iMedicalApps.com, April 22, 2010. http://www.imedicalapps.com/2010/04/health-canada-approves-iphone-medical-app-for-diagnostic-imaging-use-fda-to-follow-suit-resolution-md-mobile/
12. Husain, Iltifat. "OsiriX Used in Research to Show Accurate Mobile Diagnosis of Acute Appendicitis, but Many Questions Still Left Unanswered," iMedicalApps.com, December 3, 2009. http://www.imedicalapps.com/2009/12/osirix-used-in-research-to-show-accurate-mobile-diagnosis-of-acute-appendicitis-but-many-questions-still-left-unanswered/
13. "Physician Mobile Use Grows 45 percent," HealthcareITNews.com, April 7, 2011. http://www.healthcareitnews.com/news/physician-mobile-use-grows-45-percent
14. Atoji, Cindy. "Top iPhone & iPad Devices for Physicians," The Progressive Physician, May 16, 2011. http://www.theprogressivephysician.com/practice-management/top-iphone-ipad-devices-for-physicians.html
15. "Jefferson County Department of Health Using CareRevolution on Apple's iPad," SuccessEHS, June 16, 2010. http://www.ehsmed.com/display_press.cfm?id=378
16. Husain, Iltifat. "UC Irvine School o Medicine Joins the Party–Giving Incoming Med Students iPads with Their White Coats," iMedicalApps.com, August 3, 2010. http://www.imedicalapps.com/2010/08/uc-irvine-school-of-medicine-ipad/

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