Some doctors find new gadgets, apps, and technology fun; some find them confusing; and others want nothing to do with them. Whichever category you fall into, there’s a good chance that some exciting and important new tools will someday be part of your medical life. Here are some that are changing the practice of medicine.

1) Video Consults on Your Smartphone

Using new technology, some doctors — particularly in rural areas — are doing video office visits. A number of companies have sprung up, such as MDLiveCare, that offer consultations via real-time video.

But mobile video is going even a step further. Faster connections over newer cellular networks — commonly called 3G and 4G, respectively, for third-generation and fourth-generation mobile telecommunications technology (3G and 4G refer to the speed of the network the phone is connected with) — also are enabling wider use of mobile video in healthcare.

Andrew Barbash, MD, head of the neurosciences and stroke program at Holy Cross Hospital in Silver Spring, Maryland, uses the free Google Talk application on his smartphone to conduct video consultations with patients and clinicians in the emergency department when he’s on call but not physically at the hospital. “The mobile phone becomes kind of the enabler,” Barbash says.

Joseph Kim, MD, MPH, curator of MedicalSmartphones.com, believes this is just the beginning. “You will see more patients communicating with doctors via telemedicine,” he says.

2) Tablet Computers

Touch-screen tablet computers are creating a new class of totally cool and incredibly useful gadgets and applications that are helping to make life easier for physicians and their patients.

Let’s face it, Apple’s iPad has taken medicine by storm. Research firm Knowledge Networks reported in March 2011 that 27% of physicians in the United States had a tablet-style computer, or about 5 times the general public’s adoption rate. That study didn’t break down tablet usage by platform or model, but healthcare industry analyst Chilmark Research estimated that 22% of all physicians in the United States were using iPads at the end of 2010 (Sharma C. “mHealth in the Enterprise: Trends, Opportunities and Challenges.” Chilmark Research, November 2010).

Tablets in general and the iPad in particular are more than just oversized smartphones without the phone. They have processing power to rival that of desktop computers. Some of the smaller models — the Samsung Galaxy Tab and the BlackBerry PlayBook — fit into the pocket of a lab coat. And they have touch screens.

“Whenever you’re in a remote environment, it’s much easier to draw things up than to try to explain on the phone,” says Kim.

3) Speech Recognition Programs

Iltifat Husain, MD, Editor-in-Chief and founder of the iMedicalApps.com blog and a new graduate of Wake Forest University School of Medicine, is bullish on speech recognition as a breakthrough technology that makes physicians’ lives easier. “I think that doesn’t get enough play,” he says. It’s already easing the transition to electronic medical records (EMRs) by helping physicians document cases and changing medical transcriptionists into higher-skilled editors. Husain says he is looking forward to the day that Nuance Communications comes out with a version of Dragon Medical speech recognition software that supports real-time voice dictation on mobile phones.

“The beauty of real-time mobile speech recognition is that the physician no longer needs a keyboard,” Husain says. He notes that one company, DrChrono, already makes an EMR specifically for the iPad that includes real-time mobile dictation.

4) Handheld Ultrasound Stethoscope

Goodbye to what has been the symbol of physician care for almost 200 years.

“In 2016, doctors aren’t going to be walking around with stethoscopes,” cardiologist Eric Topol, MD, Director of the Scripps Translational Science Institute, Chief Medical Officer of the West Wireless Health Institute in La Jolla, California, and Chief Academic Officer at Scripps Health in San Diego, said at the Consumer Electronics Show in Las Vegas. “There’s a whole lot better technology coming.”

Topol called the handheld ultrasound the “new stethoscope,” something that will become a must-have device for physicians. In 2009, GE Healthcare introduced the Vscan, an ultrasound visualization device that looks like an oversized cell phone with an attached scanning probe.

The Vscan costs about $8000, but that price is expected to come down as the technology improves. Another company, privately held Mobisante, this year gained US Food and Drug Administration (FDA) 510(k) clearance for a similarly priced ultrasound system that runs on a Windows-based Toshiba smartphone.

5) Smart Bandage

The Holter monitor is also on its way out. Topol has called it, “another obsolete technology, soon to be buried.” It just contains too many wires and is uncomfortable to wear. Instead, Topol said, patients with serious chronic ailments such as congestive heart failure ought to be wearing a “smart bandage,” an adhesive patch containing an array of sensors that measure vital signs.

It’s a technology that patients can even take home with them. Wireless transmitters in the bandage send readings either to a patient’s smartphone or an Internet gateway such as an in-home wireless router, creating what’s known as a “body-area network” that keeps constant tabs on people who might otherwise require hospitalization.

6) Unified Communications

Though cell phones are pretty much ubiquitous in society and smartphones have proliferated in hospitals, far too many clinicians haven’t been able to ditch the old-fashioned pager. But some companies are trying to eliminate the need for multiple devices by promoting what they call unified communications.

For years, Vocera has offered wireless voice-over-Internet protocol (VoIP) phones that send paging, voice, and text messages to portable handsets within a hospital or clinic. So you can get a portable handset that will still page you but also provide other services, including voice and text messages. In the past couple of years, a Sarasota, Florida-based startup called Voalte (pronounced “volt”) has packaged similar technology to run on the user’s own smartphone, with a single phone number for all communications.

7) Remote Medical Devices and Functions via Smartphone

Some software developers have seized the power of the Apple iOS (iPhone) and Google Android operating systems to design apps that effectively turn smartphones into low-cost medical devices, helping to create a new category of mobile diagnostics.

In June 2010, the FDA cleared DiabetesManager from Baltimore-based WellDoc, a blood glucose measuring system that links to a mobile phone app so patients with type 2 diabetes can collect, track, and share readings with health professionals and learn how to better manage their conditions. Three months later, AgaMatrix of Salem, New Hampshire, won premarket approval for its WaveSense Diabetes app for the iPhone that analyzes data from the device maker’s Jazz glucose monitor.

Researchers at the California Institute of Technology have even created a lens-free microscope using a $1.50 digital camera sensor that connects to a smartphone to help remote health workers diagnose malaria in developing countries.

Others have created apps that mimic the functionality of a stethoscope by listening to the heartbeat through a smartphone’s microphone, but that approach doesn’t work for everyone, according to Husain.

“People should be careful when using applications like that,” says Husain. “There is a whole host of variables where you can’t use that.” For example, Husain says it is difficult to get an accurate reading on overweight patients without an external stethoscope attachment.

Technology That’s Changing Medical Care

Some other attention-grabbing technologies include:

Automated Medication Adherence

“Smart” pill bottles can emit light and sound when it’s time to take a pill and send automatic alerts to caregivers if the patient skips a dose. That gives physicians a new way to monitor medication adherence in populations with chronic disease. Automated text messages can serve a similar function. This is such a promising area that biotechnology billionaire Patrick Soon-Shiong, MD, recently purchased Vitality, maker of the GlowCap wireless Internet-connected medication bottlecap.

9) Electronic Reference Tools and Calculators

Mobile medical reference apps, including Medscape’s, have been around for years, but they’re becoming more timely and functional. In April, Canadian mobile software vendor QxMD apparently made history by releasing an update to its Calculate by QxMD app to incorporate new scientific knowledge about the risk for renal failure and the need for dialysis in patients with chronic kidney disease at the same time a Tufts Medical Center researcher publicly presented the evidence.

Husain is a fan of a free medical translator called MediBabble. “This is a terrific app,” he says, noting that it’s particularly useful in international disaster relief. MediBabble is a history-taking and examination application designed to improve the safety and efficiency of care for non-English-speaking patients.

10) Social Networking

Facebook has captured the imagination of the world, claiming 500 million active users, half of whom log in on any given day. You can be sure that plenty of physicians are among those masses. But where do you go when you want to discuss medicine or simply connect with other doctors?

LinkedIn, a business-focused networking site, has at least 100 million users worldwide, but there are several social and professional networking sites just for healthcare professionals, some of which offer secure communications suitable for colleagues who already know each other to discuss specific cases. (Medscape’s discussion boards are popular landing spots for physicians).

For patients, there’s an emerging field called participatory medicine. A group called the Society for Participatory Medicine defines it as “a cooperative model of healthcare that encourages and expects active involvement by all connected parties (patients, caregivers, healthcare professionals, etc.) as integral to the full continuum of care.” Patients facing serious health challenges have been flocking to sites such as Organized Wisdom and PatientsLikeMe.

by: Neil Versel

Mobile Phone Use and Stress, Sleep Disturbances, and Symptoms of Depression among Young Adults – A Prospective Cohort Study

Abstract

Background:
Because of the quick development and widespread use of mobile phones, and their vast effect on communication and interactions, it is important to study possible negative health effects of mobile phone exposure. The overall aim of this study was to investigate whether there are associations between psychosocial aspects of mobile phone use and mental health symptoms in a prospective cohort of young adults.

Methods:
The study group consisted of young adults 20–24 years old (n = 4156), who responded to a questionnaire at baseline and 1-year follow-up. Mobile phone exposure variables included frequency of use, but also more qualitative variables: demands on availability, perceived stressfulness of accessibility, being awakened at night by the mobile phone, and personal overuse of the mobile phone. Mental health outcomes included current stress, sleep disorders, and symptoms of depression. Prevalence ratios (PRs) were calculated for cross-sectional and prospective associations between exposure variables and mental health outcomes for men and women separately.

Results:
There were cross-sectional associations between high compared to low mobile phone use and stress, sleep disturbances, and symptoms of depression for the men and women. When excluding respondents reporting mental health symptoms at baseline, high mobile phone use was associated with sleep disturbances and symptoms of depression for the men and symptoms of depression for the women at 1-year follow-up. All qualitative variables had cross-sectional associations with mental health outcomes. In prospective analysis, overuse was associated with stress and sleep disturbances for women, and high accessibility stress was associated with stress, sleep disturbances, and symptoms of depression for both men and women.

Conclusions:
High frequency of mobile phone use at baseline was a risk factor for mental health outcomes at 1-year follow-up among the young adults. The risk for reporting mental health symptoms at follow-up was greatest among those who had perceived accessibility via mobile phones to be stressful. Public health prevention strategies focusing on attitudes could include information and advice, helping young adults to set limits for their own and others’ accessibility.

by: Sara Thomée; Annika Härenstam; Mats Hagberg
Posted: 04/19/2011; BMC Public Health. 2011

Today’s cell phone technology has advanced to the point that a cell phone can do much more than just place calls. Along with the personal digital assistant (PDA), these devices can now play a major role in making clinical information portable and readily available.

Robert Jones, MD, is a family practice physician with a subspecialty in sports medicine practicing in Charlotte, North Carolina. He serves as the medical director for the student health center of a large public university, he’s the team doctor for the athletic department at that same university, and he’s on the faculty of a family practice residency program. Filling all these roles keeps Dr. Jones constantly on the move, and he relies on handheld technology to keep him connected and informed in several ways.

Smartphones and PDAs can be extremely helpful to physicians caring for patients. Whether in your office, a clinic, or the hospital, the ability to check drugs and dosages instantly at the point of care results in better patient care and can sometimes be lifesaving.

In testimony before the US Senate in 2000 regarding adverse drug events, the President of the Institute for Safe Medication Practices quoted a 1995 study by Leape and colleagues in JAMA that reported that over 40% of adverse drug events can be tied to a lack of critical patient information and drug information at the time of prescribing, dispensing, and administration of medications. Smartphones and PDAs can provide this information to physicians instantly at the point of care.

Smartphone or PDA?
Both smartphones and PDAs allow you to perform many functions that were once reserved for the desktop computer. Simply stated, a smartphone is a cell phone that has the ability to add additional third-party software. In addition to running medical software programs that can help you, smartphones can play videos, take pictures, and play music.

A BlackBerry is a particular brand of smartphone that is very popular. It made its mark providing outstanding corporate email support to business users, yet it is very popular with noncorporate users as well.

In contrast, a PDA is a mini-personal computer without cell phone capability. As a clinical tool, either a PDA or a smartphone will accomplish what you need and will help you throughout your workday. With either type of device, you can access clinical reference programs that give you instant information when you’re with a patient.

If you work a lot in the hospital and plan to access the Internet regularly, you may be better off with a smartphone. One advantage to having a smartphone is that you can access the Internet from wherever you have a good cellular signal. In contrast, a PDA requires a Wi-Fi connection to do this. Even if Wi-Fi is available, you may not be permitted to access the hospital’s Wi-Fi network with a personally owned device; that could prevent you from using the Web-based programs that you want to use. Or you may be able to convince the hospital’s IT department to provide you with a handheld device for this purpose, particularly if you spend a lot of time there.

At your own practice, setting up Wi-Fi access for your device is a fairly simple matter for your IT person to do. Make sure you employ security features such as data encryption and strong passwords to ensure the safety and security of your patient data. Here’s an additional tip for better security: have your IT technician configure your office network’s firewall to only allow wireless traffic to pass to and from your particular device, as opposed to any device that knows the password. Every computing device has a unique code called a “MAC address” assigned that is not changeable. By configuring your firewall to only allow traffic from a device with your MAC address, you add an extra layer of protection should your password ever get compromised. Even if a rogue user attempts to crack your system using your stolen password and their own PDA or laptop, the firewall will refuse access if the MAC address doesn’t match up.

How to Choose?
Several factors will influence the type of device you choose. The first is the operating system (OS) that runs the device. There are 4 major OSs: Palm, Windows Mobile, BlackBerry, and iPhone. While most major medical software is available for any of these platforms, there are a few that may only be available for some of them.

Most Windows Mobile devices available now are smartphones, although some Windows Mobile PDAs still exist. Both Windows Mobile smartphones and Windows Mobile PDAs use the same OS. There are still Palm PDAs in the marketplace, though this once-dominant brand is not nearly as prevalent as it used to be.

The Palm Pre, their newest smartphone, runs on a new OS that is Web-based. Additionally, if you have an older Palm app that you can’t bear to part with, you can buy an application (“Classic”) that allows the Pre to emulate an older Palm OS device and run your legacy app. At this time, the Pre does not have much medical software written for it, though this will likely change in time.

Sources for obtaining applications for your device may be limited as well. Applications for the iPhone are only available at Apple’s iTunes store, and all programs must be approved by Apple before becoming available. Programs for Windows Mobile smartphones, PDAs, and BlackBerries are available from a plethora of online sources. For all these devices, some applications are free and some have a cost. This may be a one-time charge or a recurring subscription fee.

Dr. Jones currently uses 2 handheld devices: a Hewlett-Packard PDA running the Windows Mobile operating system and a BlackBerry smartphone. While he acknowledges that some favor using one device for everything, this particular combination best suits his needs at present. His PDA was issued to him by the hospital system where he teaches family practice residents; it has been set up by their computer department so that he can directly access the hospital’s electronic medical record (EMR). Dr. Jones says, “This is a tremendous help for me because I can access patients’ lab results and chart data in real time.” He uses it a lot when performing inpatient rounding with the residents. His PDA is set up so that whenever he walks into the hospital, the device synchronizes with the hospital’s EMR, allowing him to pull up the latest data for his patients on demand. “Because of this, I no longer have to ask who a patient’s nurse is, find them, and then have them run a printout of, for example, last night’s labs. I can just pull it up on my PDA as soon as I’m in the hospital.” His device allows him to view data but not enter or change it. It is already set up with wireless security features like data encryption and password protection to protect his patients’ data, and the device can be wiped clean remotely if it ever gets lost or stolen.

In the past, accessing an EMR through a PDA or smartphone was not possible. However, more vendors are now making this type of access available. Allscripts, eClinicalworks, and Medent allow you to access their EMRs through a handheld device; you can review medical summaries, check appointments, and perform other patient-related tasks.

Dr. Jones’ other handheld device is a BlackBerry smartphone. He doesn’t use clinical applications on it because they are already loaded on his PDA, but he finds the BlackBerry invaluable for accessing his email and staying in touch via phone when he’s on the go. With all his different roles, Dr. Jones spends a lot of time in transit. With the BlackBerry, he can be reached by phone and can also receive emails from both his hospital and university email accounts no matter where he is. “I find this valuable because I can get my email in real time, which helps me to prioritize which issues need to be addressed first. Often, my email arrives on my BlackBerry before my PC!”

A couple of years ago, only a few medically themed applications were available for the BlackBerry; however, the number of available programs has grown steadily. Now there are a reasonable number of medical applications available for this platform.

While most BlackBerries are similar enough to each other that applications written for that OS work fine on any model BlackBerry, the new BlackBerry Storm uses a touch screen and therefore is a bit different. Some apps written for the BlackBerry may have problems running on the Storm. Be sure to check before you buy.

Andrew E. Craig, MSN, FNP-C