Despite mHealth's growth, device maturation still needed


Many articles about the current explosion of mobile health apps, including those for healthcare professionals, presume that this is a new phenomenon. But a decade ago, there were so many mobile applications for physicians to select from--roughly 500 or 600 of them--that the sheer volume of choices overwhelmed doctors. Among those programs were drug references, standard clinical texts, electronic prescribers, medical calculators, coding and billing software, patient and procedure trackers, and evidence-based medicine databases. 

Most of those programs were written for personal digital assistants (PDAs), either Palms or Pocket PCs. To give some idea of how widespread the devices were, Epocrates Rx had about 500,000 users in 2002, of whom 220,000 were physicians; that's about a third of the doctors who were in practice a decade ago. 

Today, 80 percent of physicians use some kind of mobile device in their daily work. A big reason is the popularity of such consumer products as smartphones and iPads. Tellingly, a recent HIMSS survey shows that 40 percent of hospitals support personally owned devices that they have enabled to perform work-related functions.

Modern mobile devices also are more capable and less expensive than their predecessors. Smartphones combine cell phones and PDAs, and iPads offer far more functions than did the previous tablet computers such as Table PCs. iPads also are lighter and have a longer battery life, although typing is more difficult than on convertible tablets equipped with keyboards. In fact, the HIMSS study found that most physicians use mobile devices for viewing rather than entering data.

Another factor in the explosion of mobile devices among professionals is the rapid growth in the digitization of clinical data. While there were many valuable databases on the web a decade ago, such as drug checkers and other kinds of reference materials, the amount of electronic clinical data available in hospitals and physician offices was tiny. Now, as electronic health records and other clinical information systems become widespread, physicians increasingly have access to a wide range of patient data they can view on their devices at the point of care.

Tablets and smartphones may now be networked with other systems that can provide up-to-date information on a patient's vital signs, blood glucose levels, test results, medications, and medical history. Physicians can view diagnostic-quality images on these devices wherever they are, if the images are stored in the cloud. All of this presents some daunting security challenges, but healthcare organizations are trying to address those rapidly.

However, the new generation of mobile devices has a way to go before physicians can use them for electronic documentation. iPad screens--unlike those of smartphones--are large enough to view whole sections of an EHR at once, but they're not ideally suited for data entry. Even checking off pick boxes can be a challenge without a stylus.

Perhaps IBM Watson and Nuance Communications will come to the rescue with a breakthrough in natural language processing. If and when that happens, doctors simply could dictate their notes and have them go into the record as discrete data. (The DrChrono.com EHR for the iPad uses voice recognition to transcribe dictation as free text.) With that feature added, mobile devices could achieve their full potential in healthcare. - Ken

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