Smartphones in Healthcare

Smartphones represent a truly revolutionary form of health information technology (HIT), according to a report published in April 2010 by the California HealthCare Foundation. The first generation of smartphone applications is being adopted because the apps are “agile, easy-to-use, hand-held and mobile,” attributes which have not been the hallmarks of traditional HIT. Cell phones are the nearly universally-available platform, but it’s only a matter of years, not decades, before cell phones among healthcare professionals will be supplanted by smartphones. Indeed, the market penetration is already significant and it’s soaring. The number of mobile Internet users increased 74% between 2007 and 2009. About 42% of all Americans owned smartphones by December 2009. At that same time, two-thirds of physicians used smartphones.

Manhattan Research projects the number of physicians who own smartphones will increase from 64% in 2009 to 81% in 2012. Epocrates, a leading provider of clinical content and medical reference material on mobile platforms, surveyed its users 10 days after Apple announced the iPad in February 2010 and reported that 20% of the respondents said they were likely to purchase an iPad.

Epocrates offers its service on multiple platforms, including Android, BlackBerry, iPhone, Palm and Windows Mobile. It’s now 10 years old and claims more than one-third of U.S.-based physicians use at least one of their products. More than 125,000 physicians use their products on iPhone and iPod touch devices alone. Further, Epocrates reports that the average clinician uses one of its applications six times a day.

As of February 2010, there were 5,805 health, medical and fitness apps at the Apple App Store, 27% of which were aimed at healthcare professionals. Gartner named mobile health as one of its top 10 consumer mobile applications for 2012. In the medical category, 32% of apps are physician-oriented, while 17% are for medical students, 4% for allied health students, and 2% for nurses.

Despite the large installed base, experts characterize the market in the earliest phase of providing health information to mobile devices. As with most media and platforms, the “payment system and health stakeholder financing” are driving the early activity. Some of the best populated categories for apps are for conditions – like diabetes – which are associated with pharmaceutical and medical device products.

Even in this early phase, it can be overwhelming to enter an app store and begin a search for health information.

Within medical reference apps, the largest categories are:

• Medical student study guides – 19%
• Clinical consult – 9%
• Anatomy – 7%
• Drug reference – 7%
• Literature updates – 6%

Here are the leading examples of apps being used by healthcare professionals:

• Alerts and Awareness –FDA Recalls, a free app also available on iTunes, offers information about recalled products
• Medical Reference – Epocrates’ drug reference is the most popular free medical download in the iTunes store. Skyscape is the other large medical reference content supplier to mobile devices. Like Epocrates, its content is available for every smartphone operating system. Skyscape licenses content form more than 50 health sciences publishers
• Diagnostic tools
  • General Diagnosis — Popular apps: Diagnosaurus, written by Dr. Roni Zeiger (now with Google Health); IDdx; STAR Analytical Services, which has developed an app to analyze coughs, one of the most common symptoms when a patient presents.
  • Lab apps: delivering lab results as soon as they are completed. Popular apps: ARUP Consult and Care360.
  • Digital imaging: OsiriX – a mobile picture archiving communication system. eRoentgen Radiology DX is an app identifying the most appropriate radiology exam for a patient.
  • ECG: Many apps provide images of common ECG results. Instant ECG was one of the top 10 paid iPhone apps in December 2009.
  • CME — Numerous companies offer services providing CME apps for the smartphone, including Epocrates, Skyscape, MedPage Today, UpToDate, and XtraCredit.

And, of course, the gigantic emerging potential application centers around the electronic health record for providers and caregivers and the personal health record for consumers.

Manhattan Research predicts the next growing category for physicians’ smartphones are “transaction-oriented, point-of-care apps, such as electronic prescribing and evidence-based decision support.”

Dr. Joseph Kim, the physician technology blogger for Medical Smart Phones, wonders how smartphones and intermediate mobile devices like the iPad will be “integrated into the workflow of physician practices.” For new doctors, the transition is likely to be more natural. Some medical schools — notably Georgetown, University of Louisville, and The Ohio State University — issue smartphones to their students.

A couple of factors make smartphones naturally attractive in the medical environment:

• Health apps are cheap and simple to adopt. They are also easy to deactivate or jettison if they are no longer useful.
• A smartphone is about the same size as a prescription pad.

Do you have a smartphone? Have you downloaded any medically-related apps? Which ones?