Here at iMedicalApps, we believe that medical mobile technology has the potential to improve modern healthcare. One such developer, who happens to be an orthopedic surgeon as well, Matt Ockendon, has released a number of apps which successfully demonstrate how medical mobile technology can be used within a healthcare environment.

In addition, some of his applications (such as IOS Fixator and Hallux Angles) have hinted at what could be possible for the future of medicine and mobile technology. We were able to catch up with him recently and interviewed him regarding his thoughts on mobile health and developing medical apps.

Please tell us a little bit about your background

I was born and brought up in Worcestershire by schoolteacher parents. Medical school at St. Mary’s Hospital Medical School, Paddington, House Jobs at Mary’s and in Portsmouth. Basic Surgical Training in Bristol, Higher Surgical Training on the Oswestry (West Midlands) Orthpaedic Programme.

What is your current job?

Specialist Registrar in Trauma and Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry.

How many apps have you made?

7 currently on the Apple AppStore. One awaiting regulatory approval, another being independently clinically assessed and another project ongoing.

How many times have they been downloaded (approx.)

In the order of 8,000 downloads per year

When did you first start writing code?

Back in school I started to learn some C programming on Acorn “Archimedes” computers. The Acorn A5000 that my parents bought for my GCSE year lasted until the 4th year of Medical School when I was seduced by the world of Microsoft for a few years before moving steadily to the Intel-Mac Platform.

I had a good friend at school whose programming skills were (and still are; he works for Google now) far beyond exceptional. This was both daunting and inspiring.

My draw to the Mac was chiefly from exposure to the iPhone and its iOS operating system and the potential that I could see therein. Apple have crafted a superb Software Development Kit with copious documentation and numerous code examples to get started on. As luck would have it the iOS programming language (Objective C) is a derivation of the C programming language I had cut my teeth on back in the 1990s.

What apps do you use the most?

I spend most time using Mail and Safari! I use some google WebApps especially their “Reader” service and the BBC news app alongside the Met Office weather app. TomTom is near perfect in its latest App incarnation as a fully functional SatNav and I rely on it heavily.

I use Dropbox across platforms and I imagine that the iCloud service will replace this once it is out of Beta test.

Medical apps I like include MedCalc by Pascal Pfiffner and Mathia Tscopp. The AO Classifcations and AO Surgical References Apps.

What led you to start developing apps for the iPhone?

I was sitting in a clinical teaching session. At the front of the room a colleague was examining a patient’s knee and guessing the knee flexion angle. A row or two in front of me another colleague was playing Labyrinth 3D on his shiny new iPhone Ð using the accelerometers to control a virtual ball bearing rolling around a maze with surprising realism. I thought: “I reckon the guy at the front could use those accelerometers to measure that knee”.

What were the goals of your apps?

I have always enjoyed finding new and interesting ways to leverage existing technology. I like to make gadgets work together in a synergistic way and I feel that I have gotten better value for money out of my shiny toys if I can find a new (and better still novel) use for them. The aim is to harness the power of the hardware in the smartphone, the tech that you already own, for a clinical purpose.

My apps are targeted around my own field of medical and surgical interest; clinical measurement, radiographic measurement, fracture templating and communication.

How have your apps impacted your day to day work as an orthopaedic surgeon?

I regularly use “Knee Goniometer” to measure knee flexion angle (the original inspiration to start writing apps). I always template tibial fractures pre-operatively to assess their suitability for external fixation with the IOS Fixator (Intelligent Orthopaedics) using my IOS Fixator App. In spine clinic “Scoligauge” can be very handy for quantifying Allen’s forward bend test. PainScale is most useful in a Paediatric Setting. Hallux Angles (an application for assessing the severity of Hallux Valgus deformity in the forefoot) can provide a quick and simple way of measuring angles rather that fighting with tools on PACS systems that are often unintuitive.

Have you thought about publishing your ideas in journals?

I have just had a paper on the use of Knee Goniometer accepted (subject to some revisions) in the The Knee Journal looking at the validity and accuracy of a smart phone goniometer in relation to the current bedside gold standard (a Lafayette, long-armed goniometer).

Along with a group at the university of Kent I have been doing work on volunteers to further validate the Knee Goniometer and a paper is currently being prepared.

A consultant hand surgeon at the Pulvertaft Hand Centre in Derby is heading a group working to validate my FingerGoniometer (as yet unreleased) application for making measurements of hand range of movement.

Have other orthopaedic surgeons commented on your apps?

My favourite aspect has been the level of interest from colleagues locally and around the world. Feedback from Australian Orthopaedic surgeons, American Podiatric Surgeons, The Scoliosis Research Society, Physiotherapist at The University of Kent has been tremendously encouraging. Partnerships with a number of commercial companies has allowed me to devote more time to these projects than I would otherwise have been able to do.

Your apps show a lot of potential, are you going to develop them further to be more multifunctional?

Thank you. My main aim for development – other than continuing work to demonstrate clinical validity – is to add database functionality and data handling to existing applications. This has regulatory implications as well and issues of data protection and confidentiality. The use of encryption is very tightly controlled by the US government and, whilst necessary for ensuring patient details are secure, is likely to be something that could consume considerable resources to implement.
A “toolbox” app including a number of different functions with a database is definitely on the cards.


What do you think of mobile technology in medicine?

The exciting thing is the shear power of the devices available and the staggering market penetration that they have achieved. Finding novel applications for fast processors, large storage, internet connectivity, high quality cameras, accelerometers and gyroscopes, ultra high resolution displays, noise canceling audio capture and playback with operating system level cloud integration should not be too hard!

What are your thoughts on mobile technology specifically related to orthopaedic surgery?

We are going to see some exciting applications related to medical imaging and diagnostics. Clinical measurement is in its infancy and so much more is yet to be explored. Augmented reality in a hospital setting has exciting prospects in everything from patient biometrics and pharmacy to intraoperative real time information.

The holy grail would be to integrate all the disparate streams of information in the healthcare setting into a patient specific mobile format that frees the clinician from the desktop computer, from his office or even the ward and makes the flow of information more “natural”.

Orthopaedic surgeons love measurement (clinical and radiographic) and classification systems and mobile tech lends itself very naturally to these things.

What do you think have been the main barriers to technology in the UK?

Internet speed, especially mobile internet. In most of the world streaming high definition video, video calling and large scale data transfer across mobile networks is just routine. In this country we are still pleasantly surprised to see “3G” pop up on our phones (nevermind LTE/4G) and quite used to dial up speed mobile internet in much of the country.

What do you think are the main issues hospitals face when trying to become “paperless”?

Governmental IT projects. There has never been a good one and healthcare exemplifies this. The companies run rings around politicians who neither understand the needs of hospitals and doctors nor the technology itself.
Massive opportunities have already been squandered (along with multi-billion pound budgets).

How do you think healthcare can be improved using technology?

Patients will be better informed; they will measure their own physiological parameters. They will have better ways of communicating with their doctors, each other, and better access to services.

Doctors and healthcare professionals will be more up-to-date and be better able to seek advise. We will have better access to the patient specific information that we need to use our clinical skills to best help our patients.

My wish list for the NHS in the UK is something like this:

  • National PACS system linkage for XRs; I should be able to login and view the XRs of a patient I have been referred without CDs in the post, special image transfers etc.
  • Proper access to hospital networks via mobile devices. Provide a secure API and the developers will come. Don’t buy into one manufacturer, adopt open standards based approach and you won’t find that you have millions of pounds worth of poor quality obsolete kit with no way to move forward in a couple of years.
  • The NHS should subscribe to ALL the major healthcare journals and provide access via a simple alphabetical list. The nonsense systems in place now can waste hours with tantalizing glimpses of the required paper and countless log-ons via Athens et al only to find you’ll have to pay. The access needs to work from home. Scale back on physical library services to pay for it.
  • NHS linux. A major project but imagine the savings on hardware. Lightweight distro that would run on 99% of existing hardware. Inherently secure, scalable, truly multiuser with standardized frontend to access whatever backend servers are already in place.
  • No more “I haven’t been trained, yes I know I’ve been working in the NHS for 10 years”.

Where do you see the future of mobile medical technology in the UK?

Just too rapidly developing to call. The key really is that people are queuing up to buy mobile tech for themselves, we don’t have to buy it for them just make it work in a healthcare context for the patient and for the doctor.