Smartphone Apps in Medicine: Review

In a previous post, I examined a research survey of smartphone app use by medical students and junior physicians in the United Kingdom.  I would like to follow up on this topic by summarizing a recent review of  the smartphone in medicine.

Ozdalga and colleagues from Stanford University Hospital recently published results of literature review on this topic in the Journal of Medical Internet Research.

Their study examined all published research studies with the search term smartphone and similar terms, i.e. iPhone through May 2012.

I will summarize key findings from their review by the four categories outlined in their manuscript.  I will highlight some of the noteworthy apps and the author's assessment of the current status and future of smartphone apps in medicine.

Patient Care and Monitoring

• iWander: This app is designed for patients with early Alzheimer's.  It employs GPS technology to track the patient 24/7.  When GPS indicates location outside a specific range, the patient is triggered by smartphone to respond and confirm status.  Failure to confirm status by the patient results in emergency notification of the patient's family and primary care physician.
• Diabeo: This diabetes app collects self-measured plasma glucose levels, dietary carbohydrate levels and physical activity via accelerometer data.  The data is then analyzed with individualized insulin dose recommendations.  A controlled study in France found use of the Diabeo app by patients with type 1 diabetes resulted in better diabetes control compared to patients using only standard office visit monitoring.
• Smartphone apps are in use and in development to provide mobile tech monitoring for ECG, ultrasonography and blood flow measurement.

Health Apps for the Layperson

• Lose It! and Calorie Counter: These two apps and others provide a system for monitoring and recording daily calorie consumption as part of a weight loss program.  However, the authors note that many wellness apps fail to incorporate current medical research and guidelines in their programs.
• iTriage: This app provides patients emergency medical information including location of nearest emergency rooms and current waiting times.  Additionally, patients can provide basic information through the app prior to arrival at the emergency room.

Communication, Education, and Research

• Electronic medical record providers are beginning to incorporate smartphone apps into medical records systems.  An app by Epic Systems allows physicians access to patient medical records via their smartphones
• Outbreak Near Me:  The authors note this app is a collaborative project between Googe and the U.S. Centers of Disease Control.  It locates users and provides information about infectious disease outbreaks geographically close to the user.

Physician and Student Reference Apps

• Popular medical references used by physicians have smartphone apps for on-the-go access to important clinical information.  These apps include drug reference resources such as Epocrates and antibiotic selection references including Johns Hopkins Antibiotic Guide and the Sanford Guide to Antimicrobial Therapy reference.  One advantage of smartphone reference apps is the ability for the apps to be instantly updated providing more current information that found in hard copy references that may be only updated every year or more.  These types of reference apps also are easy for physicians to adopt as often have experience with the hard copy reference before using the smartphone app.
• Diagnosaurus:  This app provides lists of diagnoses to use in differential diagnosis for a variety of symptom and sign categories.  The app may prompt physicians to consider diagnoses that may have been initially overlooked in clinical practice.
• Doximity: Physicians with a medical license can access this app that the authors note is like a "Facebook for doctors".

The authors note a significant problem in smartphone apps is the variability in quality of health information.  This opens the door for errors by patients in self diagnosis.  

Additionally, the authors also note many physicians and patients may not adopt smartphones limiting the implementation of current and future apps.

In summary, this review documents the emerging development and use of a variety of smartphone apps in medicine.  The question of whether smartphone apps will improve population health is unknown and needs to be an important research focus in the future.   However, the authors conclude "the smartphone may one day be recognized as a diagnostic and therapeutic tool that is as irreplaceable as the stethoscope has been in the practice of medicine".

I would agree with this assessment of the potential of smartphone apps in medicine.  Having the capability of a portable computer in your smartphone should be used to contribute to the evolution of high-tech patient care.

Readers with interest in this topic can find the full access article by clicking on the DOI link in the reference below.

Diagnosaurus app screen shot from an iPod Touch is from the author's files. 

Ozdalga, E., Ozdalga, A., & Ahuja, N. (2012). The Smartphone in Medicine: A Review of Current and Potential Use Among Physicians and Students Journal of Medical Internet Research, 14 (5) DOI: 10.2196/jmir.1994

Are Physicians Using Medical Smartphone Apps?

The number and types of medical apps for physicians and other medical providers is rapidly increasing.  Smart phone apps (i.e. iPhone and Android apps) have the potential to allow physicians real time access to medical records, treatment guidelines and medical reference information. 

As these apps increase in number and type, it will be important to understand the facilitators and barriers to implementation in the medical setting.  Additionally, research will be needed to document whether physician apps actually improve the quality of care.  What seems in theory to be important, may fall short in actual clinical practice settings.

A recent survey of medical student and junior physician use of smartphone apps in the UK has recently been published in the journal BioMed Central.  Karl Frederick Braekken Payne and colleagues surveyed 257 medical students and 131 junior physicians about their ownership and use of smartphones and smartphone apps.

Seventy nine percent of the UK medical students surveyed owned a smartphone with the iPhone being the most common type (3:1 over the an Android smartphone).  Among junior physicians surveyed, 75% owned a smart phone again with the iPhone owning a significant 4:1 advantage.  The following key findings were documented in the study:
Medical students used their smartphones for both medical school education and clinical rotation functions

• The majority of users had relatively few medical related apps (1-5 apps) on their smartphones
• The majority of junior resident physicians used their medical related smartphone apps 20 minutes per day or less
• Medical students were more likely to use their smartphone apps more than 20 minutes per day in clinical rotations

The attached chart shows they types of medical related smartphone apps that were used often, very often or constantly in the medical student and junior physician groups.

The medical student group tended to more frequently use drug reference, disease management and procedure/case documentation apps compared to the junior physician group.

The junior physician group tended to use medical calculator/clinical score apps more frequently.  It is unclear whether these trends represent true cohort differences between medical students and junior physicians or a tendency with increased skill level to become less reliant on smartphone app use.

One of the barriers to smartphone and smartphone app use in the study was cost.  Medical students and junior physician noted device cost and app cost were barriers to medical related smartphone app implementation.

The survey also showed that medical students and junior physicians at times did not use available apps in the presence of patients or medical supervisors.  One concern was that smartphone app use could be misinterpreted as just checking personal email or web-surfing.

There would seem to be an important opportunity to grow the use of smartphones for documentation of educational experiences.  Medical students and junior physicians are increasingly required to document the number and type of procedure experiences during training.  The smartphone (with central backup) would seem to be an important tool for this process.

The research study authors conclude that their survey showed "junior doctors and medical students are overwhelmingly enthusiastic and endorse organisational associated apps that help their learning activities".  Clearly there are also barriers that need to be overcome.

It will be important that medical related app development be paired with research studies of their implementation and value of such devices in the medical care setting.

Readers with more interest in the details of this survey can access the free article by clicking on the PMID link below.

Top figure is an iPod screen shot of the medical related drug reference app Epocrates from the author's files.

The figure is an original figure for this post produced from data provided in the manuscript.

Payne KF, Wharrad H, & Watts K (2012). Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): a regional survey. BMC medical informatics and decision making, 12 PMID: 23110712