A smarter way to practise

Smartphone use among doctors

Smartphones are a popular choice of phone among doctors. A survey of 175 UK doctors by d4, a non-profit organisation that aims to increase the use of mobile technology by healthcare professionals, found that 82% own a smartphone. When asked how they use their phone at work during a typical shift, 88% of respondents said they use them to communicate with other colleagues, 59% said they access information on the internet or intranet, while 30% use work related software apps. Although the findings may not be truly representative of the profession—most respondents were junior doctors within five years of qualification who responded to email requests and online adverts—they indicate just how important smartphones have already become to many doctors’ working lives. “I use it for work because of the way it synchronises my calendars, appointments, and rotas,” says Paul McGovern, an orthopaedics registrar at Basildon Hospital. “I also use it for looking things up in trauma meetings or on the wards.”

Smartphones for all?

Given that some doctors already find that smartphones improve their efficiency and productivity, could hospitals and health services do the same by supplying medical staff with smartphones for use at work? In many places this is already happening. Physicians at Doylestown Hospital, Pennsylvania, use iPhones to access electronic patient records, medical reference applications, and email.2 In the UK, more than 500 medical students at Leeds University were issued with iPhones last year so that they can access online textbooks. The phones have to be returned when students graduate.

Another initiative, the iDoc project run by the Wales Deanery, has offered smartphones to all foundation year 1 doctors since October 2009. Doctors are given a free smartphone that includes a package of 17 reference tools including the British National Formulary, Clinical Evidence, and five Oxford handbooks. This gives users instant access to information without the need for computer access, internet connection, or books.

“If you ask yourself the question, ‘What do I need to know in order to do the right thing here?’ and look it up, you’ll find an appropriate answer,” says Mark Stacey, associate dean at the School of Postgraduate Medical and Dental Education at Cardiff University, who has been running the project. “The people who have engaged with the project have loved it, using the device on a daily basis to ensure accurate prescribing and appropriate investigations and treatment.”

The findings from this project have not yet been published, but an earlier study by Dr Stacey’s group suggests that junior doctors’ attitudes to the use of smartphones are variable.3 The researchers gave 219 foundation year 1 and 2 trainees a PDA that included 18 electronic textbooks. Looking at use of the devices over 12 months, they found that users fell into three groups: 40% engaged with the project, finding the device a useful learning tool; 25% were unconvinced of the benefits; and 35% disconnected, preferring to seek advice from colleagues instead.

“Those who didn’t engage had a variety of reasons: because they felt they couldn’t use it or they preferred to use other devices or other sources,” Dr Stacey says. However, he says it is important to challenge perceptions about the usefulness and value of such devices. In his latest study some F2 doctors did not take up the offer to participate initially but were enthusiastic once the device was demonstrated face to face. “We have witnessed a snowball effect where it is recommended to peers,” he says.

Top-down initiatives may not be the best way to realise the potential of smartphones within healthcare, according to James Sherwin-Smith, chief executive officer of d4. “Junior doctors are a very mobile workforce. Trusts often struggle to keep up with paperwork such as promptly issuing a P45 form [at the end of employment] or completing Criminal Record Bureau checks, let alone handing out a mobile phone every six months.” However, doctors who wish to take advantage of smartphones in their work can be put off by having to do this at their own expense. d4 aims to build a mobile phone network for health professionals and use the bargaining power of this group to reduce the costs to their members. Another solution may be for schools or employers to subsidise the cost of clinical apps or provide their own.

A smart idea?

Perhaps the biggest concern regarding the use of smartphones in healthcare is that of confidentiality. “People purchasing or handing out smartphone devices need to think very carefully about maintaining the confidentiality of any patient data they store on it,” says Paul Jones, chief technology officer at Connecting for Health. “People need to take personal responsibility for what they are putting on these devices. It is easy to lose a phone, and you should plan for what you are going to do when it is lost. With NHSmail we’ve got the facility to remove NHSmail data from a remote device when it is reported lost or stolen. If you have other patient data on the device you need a plan to deal with that.”

There are other problems that can easily be overlooked. As useful as they may be for clinical work, the distraction value of smartphones is arguably far greater. With instant access to personal email, social networking sites such as Facebook and Twitter, and addictive games such as Angry Birds and Bejeweled (each has been downloaded over 50 million times), there is a great temptation to use smartphones while at work for non-work related activity. Doctors tapping away on their handheld devices can also create a negative impression on the ward, where teamwork is so essential.

Other barriers must also be overcome, such as poor network coverage within hospitals, and the perception that mobile phones are banned in the workplace. For many years mobile phones were banned from hospitals over concerns that their signals interfered with hospital equipment. In 2009, the Department of Health reviewed incidents involving mobile phone interference on medical devices.4 The report advised that patients should be allowed “the widest possible use of mobile phones in hospitals” where that would not pose a threat to safety, privacy, and the operation of medical devices. Wireless networks are thought to be of low risk and need not be restricted.5

Smartphone as a medical device

As smartphones become faster and more flexible, their application within medicine is widening. This has led some people to ask whether smartphones should be classed as a medical device and therefore subject to regulation, for instance by the US Food and Drug Administration.6

Their portability means that they can be used almost anywhere. “Smartphones can make diagnostics personal and accessible— making it true point of care,” says Sailesh Chutani, chief executive officer of Mobisante, whose smartphone ultrasound device will be launched this year. “This could help migrate healthcare delivery from the more expensive settings such as hospitals and specialised personnel, to less expensive settings such as clinics or small practices managed by mid-level healthcare professionals. Such a migration will increase access while improving outcomes and reducing costs.” As such, they may be of particular use in developing countries or rural settings.

Smartphones have already become an everyday part of many doctors’ working lives. As technology and apps improve, they look set to offer even greater benefits in terms of access to information and advice at the point of care and may also become commonly used medical devices in their own right. If security, logistical, and cost issues can be overcome smartphones may one day become essential to every doctor’s job—and then there really will be no getting away from them.