Many chief information officers have smartphones on the top of their 2009 wish list. The compact mobile devices combine online access to information with PDA (personal digital assistant) functionality, making them perfect for on-the-go clinicians.
According to a report by market-research firm Manhattan Research, the number of physicians who own smartphones will increase from 64% to 81% by 2012. The October 2009 report states that the ability to complete tasks remotely will become even more indispensible to physicians in the future.
The devices are becoming the desktop of the future as hardware improves and applications become more sophisticated and robust. Programs that were formerly only available on desktops, such as PACS (picture archiving and communication system), can now easily fit in a physician's hand.
"We're no longer using it as a reference device, we're using it as a computer replacement," says Henry J. Feldman, MD, chief information architect at Beth Israel Deaconess Medical Center in Boston.
Whether your facility provided you with a smartphone or you purchased one as a gift to yourself, the experts say that you can expect to see some innovative trends in mobile health applications making their way to handheld screens next year.
1. Augmented reality
"Augmented reality" is the latest buzzword for smartphones. It describes the ability of users to view real-world structures using the GPS, camera, compass, and other hardware contained in a smartphone. WIKITUDE World Browser is one example of augmented reality.
The browser presents smartphone users with information about their surroundings, such as nearby points of interest. It works by overlaying information on the real-time camera view of a smartphone.
In healthcare, this may mean that one day patients may be able to point a smartphone at a facility and view detailed information, such as a staff directory, phone numbers, and building maps. They may even be able to take virtual tours. Think of it like a high-tech online information desk.
"It would tell you any information you want to have about a building just by where the phone is pointing," says Mark Laytar, a Web production manager at Baltimore-based University of Maryland Medical Center (UMMC). "It's really interesting."
2. EMR integration
Electronic medical records (EMR) aren't going to stop making headlines. If smartphones have anything to do with the matter, we'll begin seeing applications that integrate a patient's EMR with a physician's smartphone.
PatientKeeper is one such product. The Newton, MA-based company of the same name has developed an application that lets physicians access their EMR systems from a smartphone. Physicians can view a list of patients, a patient summary, lab and test results, medication lists, clinical notes, allergies, and much more.
Naturally, accessing clinical data on a mobile phone will likely raise data security and privacy concerns. Feldman says this problem can be easily solved using encryption technology.
"People have to remember that a smartphone isn't any different than a laptop," he says.
Given the popularity of the application, one can expect EMR companies to develop their own tools in response to this mounting need, especially given the growing number of physicians who are using mobile devices.
3. Image viewing
OsiriX Imaging Software has an open source PACS application available on the iPhone. The company offers free and sophisticated paid versions of the application. Physicians can use the application for PACS tasks they would have ordinarily completed using the OsiriX desktop application.
"It's not a weird sort of hybrid application," says Feldman. "This is a genuine PACS system for your iPhone."
Feldman says he can walk down the hall, run into a colleague, and conduct a consult on the fly by displaying patient CAT scans and animations. It even allows him to annotate images that will sync back to the PACS system.
"It's not diagnostic quality," he admits. "But it's good enough for 90% of what we do."
Feldman says the mobile hospital desktop, a.k.a. "the computer on wheels," is no match for his smartphone, which is always by his side and linked to the hospital network. If he were to use a desktop to conduct a consult, he would need to locate it and wheel the heavy, awkward device where he needs to use it.
"I can do all the things that I normally do on a desktop during my walk down the hall with another physician," says Feldman. "That's a fundamental shift."
The Blausen Human Atlas is another fine example of an imaging application. It provides point-of-care access to animations of medical treatments and conditions, along with accompanying narration. Users can manipulate illustrations and animations. The added zoom capability lets them explore different parts of the body systems.
"If you're a clinician, you can use the atlases as an educational tool with your patients," says Michelle Snyder, senior vice president of subscriptions at San Mateo, CA-based Epocrates, which markets a popular drug and disease reference application.
4. Mobile health monitoring
Gartner, Inc., an information technology research and advisory company, recently ranked mobile health monitoring—the use of mobile communications to monitor patients remotely—number five in its top 10 consumer mobile applications for 2012. The company's report states that mobile health monitoring has the potential to help governments, care delivery organizations, and healthcare payers reduce costs related to chronic diseases. It also has the potential to improve quality of life in patients.
According to Feldman, Apple has already made it possible to turn an iPhone into a glucometer. Instead of going to their physicians with their diabetes logs, patients may only have to bring a smartphone with them in the future. (You can view a demonstration of this technology at www.youtube.com/watch?v=0lwp2vgxF3I.)
"It frees you from the computer," says Feldman. "Right now, people show up with a glucometer and sometimes I can figure it out, sometimes I can't. All of the sudden, I now have a device that I understand and it's standardized."
Snyder says it is in the best interests of pharmaceutical companies to enter the mobile health monitoring space. If their patients become more compliant, then they will use more of their medications.
She predicts that patients may not be the prime audience for mobile health monitoring applications, since most patients with chronic diseases are older and not as likely to use mobile devices. However, she states that these applications would be helpful to an individual who may be caring for an aging parent.
5. Disease mapping
News outlets are typically the timeliest source of information on the spread of diseases. However, one smartphone application has set out to change that. HealthMap integrates disease outbreak data from news sources, personal accounts, and official alerts and displays them on a Web site.
The project, which is based out of the Massachusetts Institute of Technology (MIT) Media Lab in Cambridge, MA, is funded through a grant by Google.org, the philanthropic arm of Google.
HealthMap, which launched as a Web site over two years ago, has released an application called OutbreaksNearMe, which is available on both the iPhone and Android smartphone platforms. The application provides users with location-based information about diseases using the global positioning system (GPS) available in smartphones.
"We can deliver HealthMap alerts directly to your phone that are particularly relevant to your current location," says project co-founder Carl Freifeld, a PhD student at the MIT Media Lab. "I think having the smartphone application makes it easy for physicians to keep up to date on what outbreaks of diseases are happening in their area so they know what to look for when their patients come in."
While federal, state, and local health departments collect data about diseases, they often conduct a lengthy approval process. By the time information reaches physicians, it may be too late for them to react. By comparison, the information on OutbreaksNearMe gathers real-time data.
"Official announcements are obviously still very important, but in order to be official, it has to go through a vetting process," says Freifeld. "That introduces a time lag."
6. Interactivity
In 2010, look for interactive smartphone applications that allow users to contribute data in addition to accessing it. OutbreaksNearMe has already started incorporating interactivity into its application. Users can contribute knowledge about disease outbreaks in their area using the application. The concept is similar to the iReporter feature that CNN.com uses to gather news tips from the public.
"It's exciting for us, because it's a way to improve our system to get access to even more information. It also allows users to be participants in the HealthMap community rather than be passive recipients of the data we're collecting," says Freifeld.
Another example of this trend comes from UMMC. The hospital garnered much attention when they released Medical Encyclopedia, an application containing approximately 50,000 pages of medical content from A.D.A.M., a creator of health-related information. (For more information on this application, visit www.umm.edu/iphone/.)
"We really didn't know what to expect, but we certainly weren't expecting 1,500 to 2,000 downloads a day, which we've gotten consistently from day one," says UMMC Web site editor Chris Lindsley. "We became one of the most popular medical applications right out of the gate."
The reference application lets users ask experts at the medical center questions about health concerns. While the experts do not diagnose patients online, they do provide them with explanations of diseases and conditions and direct them to sources of additional information.
7. Mobile testing
On-the-go physicians need tools they can take with them as they travel from one patient's room to the next. Expect to find companies releasing more mobile testing applications in 2010. Some applications that have been extremely popular include eye charts, color blindness tests, hearing tests, stress checks, and many others.
Many applications are beginning to leverage the smartphone accelerometer—a device that detects motion. When you turn your phone left or right, the display of a phone with a built-in accelerometer will change from portrait to landscape. For gamers, that means that they can simulate driving a vehicle by simply tilting their phone.
Healthcare is developing slick applications using this feature. The CobbMeter is one such example. It allows physicians to measure spine curvature angles with surprising accuracy. Instead of using a protractor, physicians can align the side of an iPhone to standard tracings that they use and the position sensor in the phone will display the curvature angle. The precision of the device is 1/10th of a degree.
There are also CPR applications that let users practice CPR motions by pushing their smartphone down to deliver compressions. The applications provide users with feedback on the appropriate amount of force they should use during compressions.
8. Videos
Snyder predicts that 2010 will bring with it a lot more video, particularly for instructional purposes. One company to watch is Durham, NC-based Modality, Inc. They create learning and reference applications for the Apple iPhone and iPod touch.
One of their more popular applications is called Procedures Consult. It helps users prepare for, perform, and test their knowledge of common medical procedures encountered in a clinical setting. It uses videos, animations, illustrations, and text.
According to Snyder, many hospitals are using Modality tools to train student nurses, nurses, and other healthcare professionals.
For more information about Procedures Consult, and other Modality tools, visit www.modalitylearning.com.
9. Guidelines
Although admittedly less exciting, smartphones will soon be able to access clinical guidelines. Organizations don't need to invest a lot of time making guidelines suitable for smartphones, since they typically already have the content developed and on their Web sites.
"Associations are realizing that it's not that hard to get your guidelines into an app for the iPhone," says Snyder. "I think you're going to see more associations, societies, and other organizations developing their guidelines for the iPhone, because that's usually when the clinician wants to look at it—at the point of care. It's the same reason they use ePocrates."
10. Revamped reference apps
In addition to the top nine trends listed in Medicine on the ‘Net this month, you can expect to find enhancements to popular applications like ePocrates and UpToDate (an evidence-based, peer-reviewed information source).
"The reference apps have grown up," says Feldman. "They have connectivity to the Internet. So ePocrates, which used to be a simple textbook, now has intelligence."
For example, if a patient brings a mysterious blue pill to an appointment, the physician can look up the pill in ePocrates and determine what medication it is based on its visual characteristics. The tool can also look up drug formularies based on a patient's health plan.
"A lot of people are taking what they already have and then adding additional features and functionality," says Snyder.
Beyond 2010
In the future, you can expect to find more individuals entering the health informatics industry. According to Feldman, many developers who are releasing smartphone applications don't have a clinical background—and it sometimes shows.
"When I'm on the ward, I work 100 hours a week seeing patients, but at the same time I write a lot of code," he says. "I understand software and system design, but at the same time I understand the clinical care. It's easy to make apps now; it's hard to make them good. If you design these incorrectly, you can kill people."
Smartphones, along with their applications, will continue to evolve in response to the persistent demand for mobile information and tools that solve real-life problems for the growing number of clinicians who will adopt these devices.
The experts predict that the next advance in smartphones may occur when 4G (fourth generation) wireless devices come on the market.
"It basically means that you're going to be walking around with Ethernet speed everywhere," predicts Feldman.
Cynthia Johnson is the editor of Medicine On The 'Net, a monthly newsletter from HealthLeaders Media.