Dr. Neal Sikka, an Emergency Medicine physician at George Washington University, has a six month study underway examining how accurately Emergency Medicine practitioners at George Washington University Hospital can diagnose wounds from patient generated cell phone images.

Sikka told the Washington Post that it’s currently the largest mHealth (mobile health) study to look at acute wound care.

The study’s methods:

In the new study, researchers recruit people who have arrived at the hospital with cuts, skin infections, rashes and other flesh wounds.  Patients use their own camera phones to document their injuries. After filling out a questionnaire about their medical history and symptoms, they send the images to a secure e-mail account. All images are downloaded and stored on a secure hard drive.

“We’ll look at their picture along with the questionnaire and make a diagnosis,” Sikka said. Researchers use a PC to zoom in and focus on specific parts of the photo. Then the doctor will see the patient to see if the cellphone diagnosis was accurate.

Sikka says that so far the results have been encouraging, with approximately 90% of the diagnoses being accurate. Camera phones that perform particularly well are those with at least three megapixels, autoflash, and autofocus. With advancements in smart phone technology camera phones meeting these requirements should be the standard.

Sikka went on to say the data so far shows a majority are not worried about privacy and security, rather, they believe this type of service saves time, improves access to care, and enhances doctor patient communication.

This type of mHealth, or telemedicine, is a fantastic example of how existing mobile technology – such as better camera phones and data plans – can be utilized in patient care.  We actually gave an example of wound care telemedicine with the iPhone’s Face Time feature previously.

What makes this utilization of mHealth so noteworthy is it’s being incorporated into a legitimate research study.  There are a great number of examples of how mHealth could potentially work – but few good studies that have been performed to see if it actually will work.

The continued interest in the academic world to perform research studies into the utilization and efficacy of mHealth will be the true markers of mHealth’s success in medicine.

Reference: Wall Street Journal
Tip Source: MobiHealthNews

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While there seems to be a never ending stream of medical reference applications for smartphones, it might well be that medical apps for the more mundane parts of a doctor’s life that get the most use. Once outside the examination room, it seems we spend the bulk of our time charting and returning messages. Therefore, it is as much with relief as with pleasure that we welcome two iPhone applications that aim to facilitate medical transcription and handling phone calls: Emdat Mobile and PerfectServe Clinician.

Emdat Mobile

Emdat Mobile (iTunes link) is a simple application that allows dictation directly into the iPhone. It is not connected to a voice recognition engine such as Nuance’s Dragon but rather sends the recorded audio to a medical transcriptionist. Later, the transcribed record is available for viewing on the iPhone. While this may seem mundane, it is actually a very nice advance over using a digital dictaphone and special software to upload dictations.

It is likely that many readers have never heard of Emdat (“Electronic Medical Dictation And Transcription”). The company provides a web based platform for transcribed medical documents and was founded in 1999, early in the internet era . Emdat is not a transcription company but rather provides the infrastructure for independent medical transcription companies to store recorded audio as well as the finished documents. Clinicians and hospitals then use a simple web interface to edit and sign the documents.

While a lot of attention is given of late to computer voice recognition and transcription, many physicians still rely on voice dictation for documenting their patient encounters. The benefits are fairly plain, speaking is faster than typing or clicking and it does not require standing in front of a computer. Of course, many physicians who have converted to template based EHRs will say that, with time, they can document just as fast as with voice dictation. While this is likely correct, the catch is in the product. The dirty secret is that notes generated by clicking and choosing entries from templates are just barely usable as medical documents.

When you’re trying to read the notes of your colleague [in an electronic record], it’s almost impossible to figure out what happened to the patient. You have to read through two pages of all this junk that’s put in to increase billing.

This statement was made by a physician who was quoted in the Wall Street Journal and with whom, no doubt many physicians can sympathize. It was highlighted in EMDATs introduction to their new “DaRT” system which has the ambitious goal of integrating medical transcription with EHRs. The idea is to generate XML tags from within medical transcriptions that will automatically populate EHRs. Emdat feels this “hybrid” system may provide the best of both worlds, faster workflow for doctors and structured data output more friendly to EHRs and more apt to satisfy meaningful use requirements. According to their webpage

Emdat’s DaRT tags transcription content (Eg. Chief Complaint, Medical History, Family History, etc.) and discretely populates your EMR/EHR automatically, as if the clinician had entered it themselves.

While DaRT seems promising, it is not clear how completely it is currently implemented. Meanwhile, Nuance is also pushing aggressively into natural language processing to convert speech into structured text. I have been using the Emdat platform for nearly 3 years and have happily converted to using my iPhone to dictate and upload my office visits over the last few weeks. Now, if there was a seamless way to drive these transcriptions into a powerful EHR, it would be one big blow against the shackles of medical documentation.

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Bradley Merrill Thompson, an attorney with an expertise in the FDA approval process for medical devices, is stating the Food and Drug Administration is actively monitoring app stores on various platforms.

Regulating medical devices and health care related applications falls under the FDA’s jurisdiction.

James Kendrick from JkOnTheRun spoke with Thompson, where he stated the following:

The FDA is actively engaged in surveillance of various app stores to see if apps should trigger their involvement. Applications where a smartphone is connected in any way to imaging are under scrutiny, in particular. Any app that is used to transmit images to a medical facility requires FDA approval.

By “various app stores” Thompson is likely referring to the App store [Apple], Palm App Catalog [Web OS], App World [Blackberry], and the Android Marketplace [Android OS].

Thompson also mentioned that although some medical app developers are attempting to get FDA approval, the specific apps required to do so still remains murky.  Concurrent with Thompson’s above statement, earlier this year Health Canada – a body similar to the FDA – approved an imaging app, Resolution MD Mobile, for diagnostic imaging use by Canadian clinicians.

Another question this type of monitoring raises – Will the FDA ever “force out an app”. We have documented before how there are currently apps taking advantage of consumers, such as the so called “blue light therapy apps“. We were able to show through data how these apps are distorting the truth – but is it enough for the FDA to get involved?

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3. Apple is actively recruiting health care providers at their retail stores

One of the issues we’ve discussed previously is that, when it comes to iPhone and iPad acceptance in healthcare, compatibility with the more traditional enterprise solutions could turn out to be a problem for large scale adoption of iOS 4 devices.

There was a fair amount of concern that the iPhone and iPad, as consumer electronics, would lack the necessary business-oriented features to ever be widely adopted by corporate America, let alone healthcare.

However, a recent article in the Wall Street Journal suggests that Apple may be making major inroads when it comes to adoption as a business-wide mobile solution and this time with the blessing of corporate IT.

The vast majority of electronic medical records run on Microsoft Windows-based and Exchange-based operating systems and servers. Additionally, the traditional stalwarts of mobile enterprise solutions – Blackberry and laptops running Windows – were tried and true products when it came to the ability of IT departments to maintain secure, centrally controlled networks for their companies. However, according to the WSJ,

Businesses are behaving differently with the iPad, in large part because the new device is starting out as more of a known quantity from a technical standpoint. The iPad runs the same operating software as the iPhone, which has been enhanced with a number of business-friendly features.

Some of these enhancements include the ability to internally distribute apps via a corporate network, thus bypassing the App Store, as well as improved techniques for securely connecting to a corporate network. Healthcare is traditionally a late-adopter of non-healthcare technology (i.e. everything but the latest and greatest imaging and procedure modalities).

So the note in the article regarding testing being conducted at Kaiser Permanente’s tech lab in California is particularly exciting. Kaiser is working with the iPad for viewing medical imaging, working with an unspecified EMR, and more. All in all, these developments bode well for the adoption of the iPhone and iPad as a mainstream, IT-blessed mobile healthcare solution.

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Corey Angst, assistant professor of management at the University of Notre Dame, has started a one year pilot study of e-readers, starting with the iPad. One of the goals of the study is to determine how electronic textbooks could potentially replace traditional textbooks.

This has interesting applications for our push towards dynamic electronic medical textbooks.  With the Stanford School of Medicine and UC Irvine School of Medicine recently giving iPads to their incoming medical student classes – data on the usefulness of medical ebooks should be plentiful soon.

For examples of how medical ebooks look on the iPad check out a recent review we did.

Source: SouthBendTribune

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Two deals set to expire:

1) Kaplan is offering it’s USMLE books (Step 1, 2, and 3), and a host of other medical texts for free in the Apple Book store until today. For details refer to our prior full story.

2) Epocrates is giving away a premium version – Epocrates Essentials – for free to medical students until tomorrow. It’s valued at $159. For details refer to our prior full story.

Make sure to get a piece of these deals before they expire and to get the word out to your peers via our Facebook and Twitter share tabs.

Also, we recently started giving away tons of promo codes for medical apps via our Facebook group, so make sure to “Like” our group so you can stay on top of the giveaways: www.facebook.com/imedicalapps

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Two applications, Ear Trumpet and Eye Chart hint at the promise of mobile medical applications to enhance the traditional instruments for hearing and vision testing.

Eye Chart Pro

Eye Chart Pro (iTunes link) is a clever implementation of the classic Snellen eye chart for use on an the iPad. It will also work as a quick “pocket” eye chart on the iPhone. As shown in the screenshot, the implementation is recognizable to anybody who has ever been in the doctor’s office. In practice, the clinician is supposed to hold the screen 10 feet from the patient in order to get an accurate assessment of visual acuity. In contrast to a paper chart, the letters can be randomized so patients cannot memorize the letters. Users can upgrade via an in-app purchase of $3.99 to a premium version which allows for smaller letters, which allows testing from five feet, as well as other features. The non-premium version is free, although the App store currently has it labeled as a “Limited Offer”.

The app has been one of the most popular medical apps on the website, likely in some part due to the fact it was available at the launch of the iPad. The developer (web page) states  the app was the #1 medical app for two months and is being “used all over the country”. The Orange County register recently reported highlighted the app as part of a photo series on the iPad integration into UC Irvine medical school curriculum.  

Ear Trumpet

Ear Trumpet (iTunes link) is an application with even more ambitious goals. It aims to provide hearing enhancement and testing tools using the earphones of an iPhone – in essence a small audiology lab. The app was developed by a medical student in conjunction with the UC Irvine Department of Otolaryngology (developer site) and brings together a suite of tools to test hearing across various frequencies. It allows the user to select the level of testing detail, ranging from one minute to five minutes. According to the developer:

Preliminary studies have demonstrated the high accuracy of the included hearing test and the benefit of the hearing enhancer. We are now confident in releasing the application for public use. The features will continue to be further refined through clinical studies

The hearing enhancement uses the built-in microphone on the supplied iPhone ear buds and allows the user to select which frequencies to boost. One can choose the left or right ear to amplify and even store custom profiles once balance and equalization settings have been selected. The impressive tutorial can be viewed on YouTube (link).

Together with the digital stethoscope, of which several alternatives have been reviewed on this site., Eye Chart Pro and Ear Trumpet are examples of medical applications which enhance the physical exam and hint at a very different physician tool kit in years to come.

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Epocrates latest update for iOS 4 (iPhone, iPod Touch, and iPad operating systems) allows for multi-tasking support, also known as “fast app switching”. If you use Epocrates consistently, this is extremely welcome news.

The app is now significantly easier to use. When you close out of the app it saves the last screen you were on – so if you have to reference that drug you just wrote a script for, you don’t have to waste time searching for it again.

If you haven’t already, make sure to check out our full review of the different premium versions of Epocrates.

The following is a portion of an email Epocrates sent out today with additional features added to the update:

We’ve made substantial improvements to make the Epocrates application on iPhone® OS devices faster and easier to use. The new version will help you:

Multitask with ease. Fast app switching means you don’t have to close Epocrates if you need to perform another function [iPhone 4.0 is required to use this new feature]

Search quicker. The search bar is now more responsive to your taps, so you can start your search right away

Save time. The keyboard is hidden when browsing search results, which means you spend less time scrolling to find the information you want

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There are plenty of apps in the Apple Store and the Android Marketplace that try to help patients quit smoking. Some of them even have integration with social media networks such as Facebook and Twitter. However, these same genre of apps are helping researchers study addition in a new way.

SmartPlanet has a great interview with Dr. David Wetter, who is leading a team of researchers using real-time smart phone data from those trying to quit smoking in order to better understand addiction.

These M.D. Anderson Cancer Center researchers are finding some interesting trends in the data they are collecting.

We use smart phones to collect data during critical events that happen when people try to quit. For example, when they have a craving to smoke or when they actually smoke a cigarette, we’ll collect data. [We'll find out]: Who else is in the environment with them? What else is going on? Are cigarettes available? Are they drinking? Are they eating? Are they at work, at home, in the car?

The smart phone will also beep at random times throughout the day and evening to collect the same kinds of information. We can compare that information across different situations. For example, when someone is craving we may find that they’re in situation characterized by negative emotions, like anxiety and stress, much more so than when you beep them at random times.

From the data collected so far, Dr. Wetter’s group has found that volatility of emotions and intensity of cravings is predictive of relapse. People who have a roller coaster of emotions – volatility – are at a much higher risk of relapse. He credits these findings to the ability of collecting real time data via smart phones.

Source: SmartPlanet

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In the cardiac world, if you want to monitor a patient for a possible arrhythmia in an ambulatory setting, you can consider strapping them with a Holter monitor or other types of more long term cardiac event monitors.

For neurologists, options are limited – but a new group might change this.

Wave Technology Group is working with the University of Chicago Hospital’s Pediatric Epilepsy Center to develop a mobile EEG monitor connected via bluetooth to a patient’s smart phone that can deliver real time brainwave data.

They are calling it the Wave EEG Monitor and expect it to be approved by the Food and Drug Administration in 2011.

Currently, the project is focused on patients with Epilepsy. The team hopes the EEG monitor could be used to warn those with Epilepsy in real time when a seizure could be imminent – making sure they aren’t doing something that could put them at risk if they were to have a sudden seizure. For children with epilepsy the early warning would be of obvious benefit to parents or other caretakers.

The project also has huge implications for research. The large amounts of data collected could be used by researchers to look for trends or this monitoring system could even be used in clinical trials to study the efficacy of anticonvulsants for epileptic treatment.

Continue on for a description of how the device works:

The prototype now in development includes a small 16-channel amplifier – smaller than a credit card — that would be attached by wires to sensors on a patient’s head. In the current design, a hat with a pocket sewn inside would be used to carry the amplifier.

The software would control the gathering of brain wave data by the amplifier and the ability to send it via Bluetooth to a smartphone carried by the patient, and from there to a typical cellular network for transfer to a monitoring center.

One of Wave Technology’s patents is for an SMS (Short Message Service) remote application handler, which can be used on a smartphone to launch an application there. That technology will be valuable for expanding the functions that the amplifier can be used to detect, such as heart rates and data from blood sugar tests for diabetic patients, Cinquegrani said.

The amplifier will be equipped with a chip that can store data in case of an interruption in a wireless connection.

Source: BusinessWeek

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The ability to review patients’ imaging studies on smartphones is a natural progression for mobile physicians. Most hospital PACS (Picture archiving and communication system) now allow viewing not only on any hospital computer but often from home PCs. The ability to view the same images from your iPhone would be a great boon for many physicians and several contenders are already en route to market or have arrived. In addition the extremely dense pixel resolution of the iPhone 4 Retina Display makes it an obvious target for mobile radiology viewers.

In the past, this site has reviewed two applications already available on the iPhone, eFilm (review) and OsiriX (review). One problem that any mobile imaging viewer has to contend with is the vast amount of data (in Mb) of a DICOM image set and the processing power required to perform 2d and 3d transformations. For example, OsiriX stores all the data locally on the iPhone, using WiFi to transmit whole data sets to the phone or performing queries to the PACS server to request data sets to be sent to the phone.

Now ResolutionMD (website) is presenting a different alternative. The DICOM processing and storage stays on the server and transformed image sets are sent to the phone for display and some processing like window and level manipulation. The app (iTunes link) is a free download but, of course, will not work until you hospital installs the server component. The demo (YouTube video) is quite impressive and a great indicator of how creative uses of smartphones will continue to push the envelopes of what was thought possible just a short while ago.