Smartphones, apps and tablets are changing the way doctors diagnose and interact with patients.
The use of mobile electronic devices and applications is creating new and innovative ways for technology to improve health and health care. As doctors and hospitals swap file folders for computer files and X-ray films for digital images, both patients and physicians stand to benefit.
Dr. Thomas Lee is an orthopedic surgeon who relies on traditional health-care technology and mobile devices. "In my daily practice, I use an iPad that interfaces with our office's electronic medical records system. I can take the entire medical record for all of my patients with me wherever I go. Images, labs and notes are all available to me," says Lee, a partner at Orthopedic Foot and Ankle Center on OhioHealth's Westerville Medical Campus. He also practices at Dublin Methodist Hospital.
Lee is hardly the only doctor to adopt mobile technology. A June 2011 study by online learning collaborative QuantiaMD found that 83 percent of physicians use some sort of mobile device capable of downloading applications from the Internet. Seventy-nine percent said they owned either an Android smartphone or iPhone, while 32 percent owned an iPad or Android tablet.
"Traditionally, health-care systems and doctors have required patients to come to us. That's changing. There's no doubt that technology, and specifically mobile technology, will play an increasing role in how medicine is delivered in the future," says Dr. Clay Marsh, vice dean for research of the Ohio State University College of Medicine.
"Mobile technology is changing the dynamic of the doctor-patient relationship. In days past, physicians were all-knowing and patients were all-trusting. Those days are gone. Today's patients are more informed and proactive. A 15-minute appointment isn't enough. Leveraging technology enhances the doctor-patient interactions," says family physician Dr. Mrunal Shah, who's also system vice president of physician technology services at OhioHealth.
Driving the growth of mobile devices, in part, are federal incentives to convert from paper charts to electronic medical records, or EMRs. The American Recovery and Reinvestment Act (ARRA) of 2009 allocated $19.2 billion for accelerated adoption of EMR systems by doctors and hospitals. Providers who adopt EMRs by 2014 will receive a carrot: increased Medicare payments for five years and a bonus. Those that don't get a stick: lower Medicare payments starting in 2015. Medicaid providers also have financial incentives to go electronic.
In Franklin County, the four biggest players--Mount Carmel Health System, Nationwide Children's Hospital, OhioHealth and the Ohio State University Medical Center--all have implemented EMR technology to make patient data accessible via desktop, laptop and, most recently, mobile devices.
Physicians say such tools streamline workflow, keep medical professionals up-to-date in an ever-changing environment, improve access to patient information and encourage patients' involvement in their treatment. The technology is being incorporated into office visits and even at the hospital bedside.
Physicians who have embraced mobile technology say the devices and apps allow them to accomplish more each day.
"My BlackBerry accesses the hospital's email. I can page other physicians or email them directly. As I go floor-to-floor and room-to-room, they page, email or call my phone. There's no desktop computer and no operator. It's much faster," says Dr. Dennis Cunningham, medical director of epidemiology at Nationwide Children's Hospital. The pediatric infectious disease specialist also is an associate professor of clinical pediatrics at the OSU College of Medicine.
"The advantage is getting real-time information faster. That's huge, no matter what technology you use," says Dr. David Rich, chief medical information officer at Nationwide Children's Hospital and associate clinical professor of pediatrics at OSUMC.
As doctors travel between the offices and hospitals where they practice, mobile devices keep them connected to their staff and their patients' needs.
"No matter where they are--in their office, in the hospital, at home--they can see the EMR just as if they were sitting in the nursing unit. Patient information is at their fingertips," says John Lawson, divisional director at Mount Carmel Health System.
OhioHealth developed a mobile platform that gives physicians access not only to the EMR, but also to its entire desktop. "We use virtualization software, so they can virtually queue up a desktop that configures to our environment. It enables them to do their work, regardless of what device they use or where they are," Shah says.
Doctors in training are learning to incorporate technology into the practice of medicine right from the start. The OSU College of Medicine requires its students to have, at minimum, an iPod Touch (iTouch), though some opt for an iPhone or iPad for more functionality.
"We help our students understand point-of-care technology and the ability to access information at the bedside or in a clinical environment. We want them to have the informational resources to educate themselves and patients at the point of care," says Dr. Daniel Clinchot, associate dean for medical education at the OSU College of Medicine.
Historically, doctors would chat with the patient, jot down any questions, research them and respond later. "Now, questions and concerns are addressed and answered as soon as they're asked. Because of iTouch, learning is not detached from the patient," Clinchot says.
This gives students a multidimensional learning experience. "Everyone learns differently, and today there are a sundry of ways to teach the material. It's a lot more than a professor and a book. We can even show the increased performance on our licensing exams," Clinchot says.
Twitter has been part of the dental anatomy curriculum at the OSU College of Medicine since 2010. After anatomy lectures, sample exam questions are tweeted. The answers are tweeted the next day.
"We're using mobile technology and social media to make the most of the time we have with students. It's increasing professor-student interactions and keeps the material top-of-mind. The more they think about it and work with the material, the more they'll remember," says Douglas Gould, Ph.D., anatomy division vice chair at the OSU College of Medicine.
"We shouldn't be telling students to turn off their phones. That's how they communicate today. We'd be missing a big opportunity if we didn't use this technology for educational purposes," Gould says.
Resource apps are popular with medical students and doctors alike. They provide instant access to information that used to be found only in thick medical books. "It's a peripheral brain. Smartphones and tablets have a lot of apps, software and databases. Anytime you have access to more resources, medical student or not, it makes all of us better doctors," Rich says.
Dr. Robert Stone, an internal medicine physician with Central Ohio Primary Care, doesn't think twice about using apps on his iPhone. "Some doctors are hesitant to look something up in front of patients for fear they'll look like they don't know everything. That's crazy. I check for updates all the time. Patients are impressed that I'm current on the technology and that I use the latest information in their care," he says.
Stone also manages his continuing medical education (CME) requirements on his iPhone. "I use an app to catalog what CME credits I've earned. I used to go to conferences, but now I do a lot of the CME sessions on my iPad," he says.
Proponents say mobile devices can lead to not only improved doctor-patient interactions, but also better patient outcomes.
"No matter where I go, I have access to patients' progress notes. My iPad connects to the hospital's EMR system and I round with it. I can see lab results and their medical chart. If they were admitted six months ago, I can open up their old records. That's really helpful," Cunningham says.
"Mobile technology gives our clinicians better information faster," Lawson says. "The immediate access prompts better dialogue between doctors and patients."
Gone are the days of doctors scrutinizing X-rays on light boards. "Now I bring up a digital image on my iPad," Lee says. "About 85 percent of my patients have smartphones themselves. I encourage them to take a picture of that image and to audio record our conversation. For surgery, informed consent is critical and it helps them to better understand the procedure."
Lee accesses an extensive video library of surgical procedures on his iPad to show to his patients. "Arthroscopy and highly technical operations such as ankle replacement lend themselves well to video. When patients visualize the problem and see how it'll be repaired, it helps with their healing," he says.
The OhioHealth Results Browser Mobile is a smartphone platform that gives doctors two-way documentation. "They can send information back into our EMR system though their smartphone anytime, anywhere. The capability increases the likelihood that physicians will actively communicate, so patient care is based on active and good communications among providers. It's especially beneficial when multiple physicians are involved," Shah says.
Patients are embracing mobile technology for their health, too. "Some of them take photos of the problem with their smartphone at the time it occurs. I can see what the swelling looked like or watch their video of how bad the limp was before they came in," Lee says.
Despite all of the administrative, educational and patient treatment benefits, mobile devices aren't a panacea. "They don't replace other technology. They add to how we use technology in health care. And they're definitely not a substitute for patient dialogue and interaction," Rich says.
Oversight of such devices and apps may soon increase. The U.S. Food and Drug Administration has approved some mobile medical apps used by health-care professionals, such as a smartphone-based ultrasound and an iPhone/iPad app that lets doctors view digital medical images and X-rays. Now the agency is mulling oversight of apps that present the greatest risk to patients when they don't work as intended.
"The FDA focus is on mobile apps that make the mobile device into a medical device. That could be through using the mobile device in place of a medical device or by installing an app that turns it into a regulated medical device to monitor a health condition or make a diagnosis," says attorney Jeff Porter, a director at the law firm of Kegler, Brown, Hill & Ritter.
Porter cites apps that take blood pressure readings or monitor heart activity as examples of those that could be regulated by the FDA in the future. The agency was accepting public comments through Oct. 19, but hasn't indicated when it will make a decision.
With such easy access to personal health information, patients naturally worry about their privacy. What if an iPad is stolen, or a smartphone is left on a lunch tray? Disclosure of sensitive health information is embarrassing at best, but could lead to even worse problems including identity theft or insurance fraud.
Mount Carmel, Nationwide Children's, OhioHealth and OSUMC each encrypt the EMR data that's accessed via mobile devices. ARRA provisions tightened Health Insurance Portability and Accountability Act (HIPAA) notification and enforcement regulations, and have made violations more costly. Encryption not only makes it more difficult for bad guys to decipher patient data, it also relieves health-care systems of HIPAA obligations to notify patients of a lost mobile device.
"Certainly the privacy issues are concerning. However, the networks we use are very protected and secure. We take that issue very seriously, and know how important it is to our patients," Marsh says.
"Our patient data is encrypted and password protected. We can remotely wipe out the data on the mobile device, too," Lawson says.
"For good patient care, we need access to information, but it's all protected for their privacy. We have multiple levels of security, including requiring username and password. It's monitored to make sure the information is being used properly, so I can't look up random patients. My BlackBerry and iPad are just as secure as a desktop computer," Cunningham says.
Lisa Hooker is a freelance writer.
Reprinted from the November 2011 issue of Columbus C.E.O. Copyright © Columbus C.E.O.