YOU IMAGINE: Doctors connect to patients in an mHealth world

Written by on October 31, 2012 in Research & Technology - No comments

Part 1 of 2

It’s a time to imagine. As a medical illustrator beginning to develop medical apps and e-books, that’s what I am doing. It’s what I am doing with my clients as I begin to create mobile health “mHealth” ideas for smartphone and iPad apps and e-book tools. I want to know what my clients need most and what they envision would be useful in their clinical settings. The mobile device has great potential as a highly interactive, sophisticated, visual, portable, and social communication tool. Apps are not yet fully embracing that potential, but they are constantly improving. Can mobile devices like the iPad truly change medicine? Are they making health and health care any better for people? In speaking with my clients, there are certain questions I encounter. I will explore those questions in this two-part series on doctors and the mHealth era. Perhaps these are your questions, too.

How are mobile devices changing the medical scene?

According to a recent Manhattan Research study, 38 percent of people regularly use smartphones for health. Of those who use smartphones, 38 percent use health apps and 32 percent use their smartphone with their doctor, medical institution, or pharmacy. As for tablets, 15 percent of people use one for health related issues. And of those who own tablets, 41 percent regularly use health apps. 51 percent of people use their smartphones or tablets to handle health-related issues[1]. In another study, 95 percent of patients thought the iPad was helpful for coming to understanding of their condition[2].

As for doctors specifically, the rate is much higher. Nine out of ten doctors carry a smartphone[3]. According to Manhattan Research, 62 percent of U.S. doctors reporting using one for professional purposes, and are adapting more rapidly to iPads than anticipated in past years. Half of iPad-owning doctors also reported using their tablet with patients. Manhattan Reseach expects this to increase so that two third’s of U.S. doctors will be using iPad’s professionally in 2013[4]. Brian Dolan, editor of MobiHealthNews, notes that the demand for good medical apps from physicians is even higher[5]. According to Surround Health, while 15 percent of health care workers in their study used tablets during patient interactions, 59 percent of respondents said they would have preferred to use tablets[6].

How can it change the doctor-patient relationship?

Not every doctor uses a smartphone or iPad on the job, and not everyone is adapting at the same rate. But several medical schools have now dropped their use of textbooks in favor of iPads for learning medicine. Stanford and Yale Medical Schools both have paperless, iPad-based curriculums. They’ve specifically designed the student and resident labcoats to hold iPads, so the devices are accessible at all times.

Among the many hospitals embracing iPads is Duke University. A study of the Duke Oncology Medical division found that iPads decrease physicians’ documentation time by 17 percent[7]. University of Chicago’s internal-medicine program runs a very successful iPad program, launched in part by Dr. Bhakti Patel. This program offered so many improvements to the daily routines of doctors and patients that it was considered a success early on. Now all internal-medicine residents at the university receive iPads when they begin the program. A study in the Archives of Internal Medicine, evaluating this Chicago initiative, found that patients got tests and treatments faster if they were cared for by iPad-equipped residents[8]. Patients said that as a result of exposure to the iPads, they gained a better understanding of the ailments that landed them in the hospital in the first place.

Johns Hopkins internal-medicine program created a similar initiative, implementing iPads for medical students and residents. In the Johns Hopkins program, residents using iPads placed 8 percent more orders before end of afternoon shift. Almost 90 percent of residents said they routinely used the iPad for clinical interactions. 78 percent said the iPad made them more efficient. And 68 percent said the iPad resulted in fewer delays in patient care. An analysis of the order submission rates for these residents confirmed that orders were submitted more readily and at the time of patient’s admission, than for patients admitted without iPads. According to the Advisory Board Company, iPads can save doctors one hour a day[9].

Because every resident has their own device for test results, rather than sharing with other health professionals, there is greater efficiency. Because patient records and test results are available now on the iPad, residents check test results at the patient’s bedside during conversation. Residents speak and interact more readily with patients, sharing relevant details as decisions are made.

In the Texas Health iPad initiative, Ferdinand Velasco, M.D., chief medical information officer, noticed that physicians without iPads spend a great deal more time in the nursing stations sitting at computer terminals. But physicians with iPads are freer to be at the point-of-care. He said it’s striking how iPads have changed the hospital scene[10]. The continued adaption rate seems inevitable, and generally for the best.

Apps that doctors use for teaching (medical apps)

But smartphones and iPads offer more potential than simply as a conduit for medical records and for test results. The research is not yet out on the effectiveness of these tools on the iPad, because the field is so new. Developers work with physicians to fulfill and enhance their vision for education and health communication on the iPad. There is potential to use illustrations, and dynamic video content to teach complex medical concepts about anatomy, pathology, embryology and pediatric growth, and progressive health changes. This information can be personalized, specific, and quickly accessible as a tool for physicians to speak with patient. It can offer comparisons of conditions, before and after sequences, projections, 3D capabilities, and scaling to and from any magnitude.

Such tools put physicians in a situation where they are better able to direct and narrate for the patient: making simple drawings of their own which can then be offered to patients. And while apps are being developed for this, and there are more than 10,000 apps in the iTunes Medical section of iTunes, it is not impossible for physicians to work with developers to tailor and design their own apps for mobile devices. And with app development more affordable on the iPad, from just a few thousand to about $15,000, depending on the app, some clinics are developing apps specifically suited to their own needs.

What’s already available in my specialty?

Back in September of 2011, iTunes began offering a new category, Medical, specifically to separate from consumer apps the apps a professional might use in the clinical setting. Asking physicians and searching reviews, I have compiled a list of some of the most popular medical apps available.

A particular series that stands out is a series of free apps developed by DrawMD[11]. It is a vision made, “by doctors for doctors”. And these apps allow physicians to quickly pull up background anatomy illustrations relevant to their own specialty, upon which they can draw and make diagrams for a patient’s unique needs. DrawMD apps include a stamp library, the ability to draw freehand in many colors, undo and erase, email or save any sketch, print sketch by AirPrint (accessible on AirPrint printers). The apps also allow physicians to import their own backgrounds or to draw on a blank slate. As of September 2012, DrawMd offers apps in General Surgery, Female Pelvic Surgery, Otolaryngology, Cardiology, Anesthesia & Critical Care, Pediatrics, Vascular, Urology, as well as a Sampler app.

Orca Health[12] is another developer offering a suite of apps for various specialties. Their apps are not all free, but they cost less than $4.99 for the initial purchase. And they offer very in-depth 3D illustrations with a 360-degree accessible view. The apps offer some common conditions and treatment recommendations. But beware that these conditions are an added in-app purchase on top of the purchase price of the app. The Orca Health Decide series offers AirPlay support, which will let you display the app on an Apple TV. The series includes these apps: AgingSpine, HeartDecide, BreastDecide, ENTDecide, EyeDecide, FaceDecide, FootDecide, KneeDecide, HandDecide, ShoulderDecide, and KidsDental. These apps do not offer sketching and diagramming capabilities, for physician users, but the graphics are more dynamic, and even the anatomical labels are offered in 3D.

For more complex anatomy, the Netter’s Anatomy Atlas has become a standard iTunes medical purchase. It is useful for both professional education and patient education. It offers quizzes and the ability to make notes as well. It costs $89.99.

CardioTeach is an app developed by Boston Scientific. It offers a beautiful interface to explore cardiovascular and peripheral diseases, including specifically atrial and ventricular arrhythmias, coronary artery disease, heart failure, and heart rhythm disorders. The illustrations are dynamic, but do not allow sketching as the DrawMD series does. This app is free at the iTunes store.

A South Florida physician, Dr. Ariel Soffer, developed MedXCom. The app is not visual, but so useful to patient communication that is worth mentioning. It protects both doctors and patients from misinformation arising from cell phone conversations. The app records every call between doctor and patient. The recording also allows patients to replay the call and review instructions. When a patient makes or receives a call, a recording first announces, “This call may be recorded for quality purposes.” And the patient is offered immediate access to the recorded call and can auto-request a transcript. The app also allows physicians to prescribe medications. This app is available in the iTunes Medical category for physicians, and in the iTunes Health & Fitness category for patients.

Many medical apps on iTunes are simply not useful for education. There are several “plastic surgery” apps, for example, which allow users to experiment with and manipulate faces. These are apps that allow the user to drag facial features into various contortions. But the apps are more fun than educational or useful for demonstrating before and after illustrations of plastic surgery.

For a complete list of the apps I explored, please see my full article in Med Monthly.

Further exploration to come

Exploring the use of mobile devices by physicians led me to questions about what patients need and want from health apps. I will be talking about this in Part 2 of this exploration of mobile devices in clinical settings. I will also explore the question of security, which looms large in the mind of many doctors I speak to.

[1] These figures are outlined in the Manhattan Research, Cybercitizen U.S. Health Study 2012, in which 8,639 U.S. adults were surveyed.
“Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education”. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.
Manhattan Research Physician Specialist Survey. “2012 Taking the Pulse” polling 3,015 U.S. practicing physicians in over 25 specialties.
[5] is a technology tracking Website.
Surround Health.
Study reported here:
Impact of Mobile Tablet Computers on Internal Medicine Resident Efficiency Bhakti K. Patel, MD; Christopher G. Chapman, MD; Nancy Luo, MD; James N. Woodruff, MD; Vineet M. Arora, MD, MAPP Arch Intern Med. 2012;172(5):436-438. doi:10.1001/archinternmed.2012.45.
Draw MD.
Orca Health App Developer.

By Laura Maaske

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