Dr. Michael Deitchman carries his laptop with him as he visits up to 30 young patients each day at Cook Children’s Pediatrics clinic in Hurst, Texas. The computer contains each child’s electronic health record, allowing him to chart the exam and order prescriptions or tests as needed. He also brings his smartphone, which has apps like MedCalc to help quickly calculate the right dose of medicine while he is face to face with his patient. Still, he also carries a pocket-sized pharmacy book on him.
Deitchman’s experience reflects how more and more physicians and hospitals are using mobile devices or portable personal computers in the electronic age of medicine. And it highlights how the market for such applications is growing but still has its limitations.
Dr. Elliott Antman, president of the American Heart Association, calls the smartphone “an all-in-one tool, like a modern day Swiss Army knife.”
“They are a digital platform that allows us to do many things,” said Antman, professor of medicine and associate dean for clinical/translational research at Harvard Medical School.
Before government regulations around the Affordable Care Act led Deitchman’s office to transition to electronic health records beginning in 2010, he used medical apps on his smartphone several times a day. Now the office has its EHR software on laptops, so Deitchman uses that as his go-to gadget. Also, many of his favorite applications have online versions as well.
He still uses his smartphone, which now receives the messages he used to get via pager, but it’s in a limited way.
“If I’m on call, and I’m out and about, and someone’s calling and says, ‘Hey, I have a question about this” I can pull up the chart that way and look at things,” Deitchman said.
While the laptops at his office have touchscreens and can be used as a tablet, Deitchman doesn’t find that easier to use. He is not a fan of the way you have to click a box to note, for example, that a child’s ears are red then stop to add a comment about fluid on one.
“It’s hard for me to write with a stylus or to click and then type or click and then type. So I don’t see me using a tablet for that stuff. Maybe if the handwriting recognition gets better,” he said.
His example mirrors the findings of a recent survey of more than 20,000 users of electronic health records by the New York-based firm Black Book Rankings. Of those surveyed, only 11 percent of respondents were mobile EHR application users. Still, that is expected to grow. According to the findings, 91 percent of physicians plan on accessing their EHR software via a mobile device by the end of 2014.
Antman said he is optimistic that the number of physicians who use smartphones or mobile devices as part of their medical practice will increase dramatically.
“Particularly those individuals who are trained more recently, who are more accustomed to digital technology, (they) will be adopting smartphones as part of their tool kit for their medical practice,” said Antman, who is also a senior physician at Brigham and Women’s Hospital in Boston.
Digital technology has come so far that it is now possible for a person to record their heart rate using a smartphone and to record their blood pressure using a digital blood-pressure cuff. Some applications are so sophisticated that the readings go directly into the smartphone, the results can be plotted in a graph, and the results sent to a healthcare provider.
In his cardiology practice, Antman uses smartphone apps that help record an electrocardiogram tracing, that record blood pressure and heart rate, and that allow a person to record the key seven elements to determine his or her overall state of cardiovascular health.
That follows along with a surge in consumers who are downloading health and wellness apps and purchasing wearable devices that track calories, numbers of steps taken and sleep habits.
“We’re thinking we’re going to start seeing all that content that your patients are collecting at their homes or via exercise, you’re going to start seeing that kind of information being interfaced back into the electronic health record where physicians can monitor what their patients are doing,” said Brandon Maenius, a project manager in the Information Services department at Baylor Scott & White Health, the largest not-for-profit health care system in Texas.
Antman agrees and favors using the increased data to “customize the push to the patient’s smartphone.” For example, once a week the electronic health record could automatically generate a text message to the smartphone of a patient with hypertension that says, “Did you take your blood pressure this week?”
“Think of the ability to create a culture of health using that, and the focus will switch from treating disease when it occurs to creating a culture of health to prevent disease from developing,” he said.
Antman envisions the potential for improved care with the “bi-directional flow of information” as well as the possibility of the digital technologies being used as a new research tool.
“We can make physiologic measurements over a broader range of time and much more frequently than we were able to do in the past. And we have the potential to actually decide whether or not a therapy is truly effective by getting more insights into treatment over time,” he said.
Another positive brought about by the digital age is that some patients can see their doctors without the burden of traveling hundreds of miles for a visit.
“We really think that videoconferencing under that tele-health umbrella is going to be the wave of the future,” Maenius said. “Being able to immediately find a doctor … and be able to essentially Skype with them or talk to them face-to-face via your smartphone or via your desktop computer.”
Still this new terrain has brought with it some concerns. For example, 41 percent of physicians in the Black Book Rankings survey remain wary of interoperability and security issues related to mobile EHR and clinical apps.
The worry is something Antman sees among his patients.
“Many patients feel concerned that their personal health data are not adequately protected as they might be and they express concerns about that,” he said.
On the flip side, “Patients do appreciate the opportunity to access medical records, see their lab test results, and not have to wait for a communication from a health provider’s office.”