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Research Letters |

Smartphones in Clinical Practice, Medical Education, and Research FREE

Daniel C. Baumgart, MD, PhD
[+] Author Affiliations

Author Affiliations: Division of Gastroenterology and Hepatology, Department of Medicine, Virchow Hospital, and Charité Medical School, Humboldt-University of Berlin, Berlin, Germany.


Arch Intern Med. 2011;171(14):1294-1296. doi:10.1001/archinternmed.2011.320.
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Published online

Cellular phone technology and additional hardware were integrated into personal digital assistants1 and they evolved into smartphones. The installation of high-speed cellular networks with near-universal coverage has allowed these devices to show their full potential, which also benefits users in the medical community. Long-term Evolution technology (LTE), the high end of the fourth generation (4G) of mobile networks, offers speeds up to a hundred times faster than 3G. Currently, 64% of US physicians own smartphones, but this is predicted to increase to 81% penetration by 2012.2

Hardware

Today's high-end smartphones feature capacitive (finger gesture enabled) or noncapacitive (stylus enabled) high-resolution touch screens, discrete or screen keypads, communication ports such as mini-USB, infrared, Bluetooth, wireless local area network radios, assisted global positioning technology, electronic compasses, accelerometers, gyroscopes, proximity and ambient light sensors, microphones and cameras for videoconferencing, and inductive, cable-free battery charge technology.

Software

The most critical aspect of any computer is the software it is running, since it ultimately determines usability, usefulness, and user adoption (see eTables 1 and 2 and eFigures 1-3). Other important aspects include multitasking, adherence to industry standards, and availability of native software applications (Figure and eFigure 2) vs simple mobile Web pages (Web apps) (Figure and eTable 1).

Place holder to copy figure label and caption
Graphic Jump Location

Figure. Comparison of smartphone operating systems (platforms). To quickly access the Web links from a smartphone, QR codes (quick response matrix [2D] barcodes) were included. Please install one of the free barcode readers, ie, i-nigma (http://ht.ly/1Vkt8), available for virtually all smartphones, and scan the QR code with the built-in camera and it will direct you to the Web page. In the row “Availability of medical and scientific software,” the asterisks represent the scale of availability (*least available; ****, most available). NA indicates not available.

Clinical Practice

Most health care professionals desire current clinical information and decision support at the point of care. Smartphones can provide both by accessing traditional medical textbooks, professional society guidelines, drug references, and institution-specific therapy standards. Medical calculators simplify the bedside use of medical equations, scores, stratification, and risk prediction and prevention models. Smartphones can assist with physical examinations using applications to check hearing, eyesight, and color recognition; evaluate mental status; or photograph or video document physical findings.

Taking full advantage of current technology means wireless retrieving of the most up-to-date information anywhere anytime. The National Library of Medicine's “PubMed for handhelds” engine and third-party applications offer searches structured by diseases and conditions, medical specialties, differential diagnosis, drugs and medications, and journals and medical news or use a latent semantic analysis framework.

Our patients expect information about their conditions, the treatments, and procedures we offer them. Illustrations and videos formatted for mobile display can assist obtaining informed consent at the office or bedside.

Health care is affected by globalization and migration of people, resulting in the need to interact with them (and their relatives) in languages we may not speak or understand. Text-to-speech, speech-to-text, and speech-to-speech translation have become a reality. They could be particularly useful for deployment in disaster relief teams.

Smartphone solutions to fully access and edit electronic medical records including coding and billing have been deployed. They are no longer restricted to numeric or text data and allow viewing of “digital information and communication in medicine” (DICOM) formatted 3-dimensional imaging data from “radiology information” or “picture archiving and communication systems” (RIS/PACS) in conventional radiology, ultrasonography, computed tomography and magnetic resonance imaging, or endoscopy. Sensors for both, radiofrequency device identification devices (RFID)—best known from electronic passports—and biometric data (user's skin [fingerprint, handprint, palm print, knuckle print, blood vessel pattern], eye movement and face recognition, ear canal sensory, individual voice pitch recognition, odor, and DNA detection) are being considered for smartphone integration.3,4 RFIDs can also be injected5 or implanted (skin or molar teeth) to allow emergency responders identify and assist victims faster.

Smartphones can also be used to monitor patients outside the medical enterprise. Wearable real-time cardiovascular disease detectors are already available6 and electrocardiographic and arrhythmia monitoring may soon be fully integrated into smartphones.7

Education

Software repositories are replete with multimedia rich educational applications covering virtually every biomedical subject. Board-certified health care providers who periodically need to revalidate their credentials can now earn Continuing Medical Education (CME) credits on the go. Smartphones can serve highly customized educational and scientific content through RSS feeds, podcasts (eTable 2 and eFigure 3), social media (eFigure 1), and other Web 2.0 technologies (CMS [content management system], LMS [library management system], or VLE [virtual learning environment]) (eFigure 2).

Research

There are applications to emulate scientific graphing calculators; render chemical compounds and proteins in 3 dimensions; help prepare standard laboratory solutions; view restriction enzyme information, tutorials, and protocols; and watch laboratory video tutorials (Figure and eFigure 2).

Smartphone-attached “laboratory on chip” (LOC) devices with modular microfluidic chips based on optoelectrowetting technology can perform sample preparation and detection steps in a simple and automated manner; LOC devices to run capillary electrophoresis, real-time polymerase chain reaction, flow cytometry, enzymatic assays, biomarker screening, and immunoassays have been developed.8,9

Real-time medical and scientific communication and information is already at our fingertips, literally. A breakthrough will be “biocommunicators” incorporating a whole new dimension of information. Feasible potential applications include population-based cancer screening; prediction of drug response for biological or targeted therapies using genetic polymorphisms; environmental monitoring; on-site and bedside detection of critical laboratory and drug values on house calls by emergency responders; as well as clinical research with home-based collection of real-life biomedical data and FDA (Food and Drug Administration)-demanded patient-reported outcomes.

Correspondence: Dr Baumgart, Charité Medical Center–Virchow Hospital, Medical School of the Humboldt-University, Department of Medicine Division of Gastroenterology and Hepatology, 13344 Berlin, Germany (daniel.baumgart@charite.de).

Financial Disclosure: None reported.

Online-Only Material:eTables 1 and 2 and eFigures 1, 2, and 3 are available. They provide categorized exemplary software applications and other Internet-based resources for the various use scenarios in clinical practice, research, and biomedical education discussed. They include a brief marketing description (drawn from the app vendor's site) and clickable hyperlinks for easy access. No endorsement is made or implied. Trademarks, logos, and ad copy are the property of the respective owners.

Baumgart DC. Personal digital assistants in health care: experienced clinicians in the palm of your hand?  Lancet. 2005;366(9492):1210-1222
PubMed   |  Link to Article
Manhattan Research.  Physician smartphone adoption rate to reach 81% in 2012. http://manhattanresearch.com/News-and-Events/Press-Releases/physician-smartphones-2012. Accessed March 19, 2011
Troyk PR. Injectable electronic identification, monitoring, and stimulation systems.  Annu Rev Biomed Eng. 1999;1:177-209
PubMed   |  Link to Article
Oresko JJ, Duschl H, Cheng AC. A wearable smartphone-based platform for real-time cardiovascular disease detection via electrocardiogram processing.  IEEE Trans Inf Technol Biomed. 2010;14(3):734-740
PubMed   |  Link to Article
Li J.National Aeronautics and Space Agency Ames Research Center.  NASA Ames Scientist Develops Cell Phone Chemical Sensor. http://www.nasa.gov/centers/ames/news/features/2009/cell_phone_sensors.html. Accessed March 19, 2011
Malic L, Brassard D, Veres T, Tabrizian M. Integration and detection of biochemical assays in digital microfluidic LOC devices.  Lab Chip. 2010;10(4):418-431
PubMed   |  Link to Article

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure. Comparison of smartphone operating systems (platforms). To quickly access the Web links from a smartphone, QR codes (quick response matrix [2D] barcodes) were included. Please install one of the free barcode readers, ie, i-nigma (http://ht.ly/1Vkt8), available for virtually all smartphones, and scan the QR code with the built-in camera and it will direct you to the Web page. In the row “Availability of medical and scientific software,” the asterisks represent the scale of availability (*least available; ****, most available). NA indicates not available.

Tables

References

Baumgart DC. Personal digital assistants in health care: experienced clinicians in the palm of your hand?  Lancet. 2005;366(9492):1210-1222
PubMed   |  Link to Article
Manhattan Research.  Physician smartphone adoption rate to reach 81% in 2012. http://manhattanresearch.com/News-and-Events/Press-Releases/physician-smartphones-2012. Accessed March 19, 2011
Troyk PR. Injectable electronic identification, monitoring, and stimulation systems.  Annu Rev Biomed Eng. 1999;1:177-209
PubMed   |  Link to Article
Oresko JJ, Duschl H, Cheng AC. A wearable smartphone-based platform for real-time cardiovascular disease detection via electrocardiogram processing.  IEEE Trans Inf Technol Biomed. 2010;14(3):734-740
PubMed   |  Link to Article
Li J.National Aeronautics and Space Agency Ames Research Center.  NASA Ames Scientist Develops Cell Phone Chemical Sensor. http://www.nasa.gov/centers/ames/news/features/2009/cell_phone_sensors.html. Accessed March 19, 2011
Malic L, Brassard D, Veres T, Tabrizian M. Integration and detection of biochemical assays in digital microfluidic LOC devices.  Lab Chip. 2010;10(4):418-431
PubMed   |  Link to Article

Correspondence

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Multimedia

Smartphones in Clinical Practice, Medical Education, and Research
Arch Intern Med.2011;171(14):1294-1296.eTables and eFigures

eTables and eFigures-Download Excel file (2274 KB). This file requires Microsoft Excel software to view.

eTable 1. Online smartphone applications (mobile Web pages or Web apps)

eTable 2. Selected smartphone RSS podcast feeds

eFigure 1. Selected smartphone Twitter feeds

eFigure 2. Selected smartphone applications for the iPhone

eFigure 3. Selected smartphone podcasts and iTunes University content for the iPhone
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