[This is a preview of some of the exciting mHealth research being presented at the upcoming Medicine 2.0 Congress this week September 15-16. This abstract and others are candidates for the iMedicalApps-Medicine 2.0 mHealth Research Award]

By: Douglas Elwood, MD/MBA & Jeff Heckman, MDiMedicalApps-Medicine 2.0 Research Award finalist

The tremendous surge in mobile devices is permeating the healthcare industry at a staggering pace, with over 80% of physicians already using smartphones and over 60% owning tablets.

Likewise, apps are flooding the market with capabilities that are increasingly poised to revolutionize how healthcare professionals (HCPs) and patients interact, educate, and communicate. As the mobile health landscape evolves, it is essential to understand the use and impact of apps, and the mobile devices on which they are offered, in real-time clinical settings.

In October, 2010 over 20 residents and attendings at Rusk Rehabilitation, NYU Langone Medical Center were provided with iPads (Apple, Cupertino) to initiate a study that was one of the first and largest to examine these devices in a clinical setting.

The research team examined a multitude of variables surrounding the use of iPads and smartphones, and the impact these devices had on daily clinical care and physician education. They aimed to understand which apps physicians used and for which purposes including for individual education, information sharing with healthcare professionals, and patient interactions, among others.

That research has since expanded in both sample size and scope to become a multi-faceted assessment of how HCPs are using mobile devices and apps. It has been extended to explore fundamental elements of social media, gaming, physician/patient interactions, and patient satisfaction all in an effort to promote the better delivery of care and ultimately, to improve outcomes.

This article discusses a specific component of that research which was designed to understand two distinct elements of the mobile health movement as it relates to physicians and patients:

  1. General use of apps and specific drivers of app selection and usage.
  2. Use and impact of mobile technology in the clinical setting. Most importantly, it was designed to evaluate these metrics over time, as participants became more knowledgeable about relevant apps and increasingly savvy in their application to daily care. While many surveys currently exist on use of mobile devices by HCPs as a snapshot, few explore real clinical applications, and importantly, how they are evolving over time. Data discussed here represent only a slice of the overall project.

Baseline assessment of participants at the outset of the study in October 2010 revealed widespread enthusiasm for using mobile health devices, but little understanding at that time of their capabilities. This understanding quickly developed, however, and became quite sophisticated as physicians independently transformed the iPad from a personal tool into one that is essential for their professional work (14% reported very good understanding in 2010, increased to 89% within weeks).


Attending Dr. Jeffrey Heckman with a multidisciplinary team at Rusk Rehabilitation on patient rounds (consent provided)

Furthermore, despite having nine self-selected, preloaded websites available for use at all times, participants uniformly preferred apps (increased from 6% to 96% over the time period reported here), not all of which were specifically made for healthcare purposes but did add to their ability to organize and share information. Interestingly, participants reported very high satisfaction with apps, but as the study progressed, simultaneously expressed dissatisfaction with many elements of the apps themselves (48% to 32% satisfaction rate over time).

Most specifically, physicians recognized incompatibility and irrelevance as patient care needs become more complex and desired that the apps become even better. This dichotomy is interesting and points to both the heightened expectations and potential of these devices and apps in clinical care. The satisfaction drop was not, according to results, indicative of the low quality of apps or a switch back to the Internet, but rather secondary to the realization of what was possible.

This fact in many ways underscores the power of mobile devices and apps in the discussion of the future of health delivery.

This study is one of the first initiated and largest in the country to examine physician use of apps and mobile devices in the clinical setting. While Internet capabilities continue to expand, the results of this study point to a clear preference for apps based on their ease of use, streamlined and interactive content, and superior graphics and navigation. Within weeks, physicians became connoisseurs of apps, integrating both the apps and mobile devices into daily care and continuously seeking apps with more relevant information for education and communication.

Still, there is a gap between the current capabilities of apps and the complexity of patient care/physician workflow. As the mobile health field continues to form, it is essential that app developers and healthcare providers work together to ensure maximization of this technology for patient care, especially as it expands into areas such as remote monitoring, gaming, social media, personalized medicine, telehealth, and many other rapidly emerging subsections.


The authors would like to thank all the physicians and staff at Rusk, and of course the patients, for being involved in these studies.

Doug Elwood is a physician and an entrepreneur. He is an MD/MBA who is board-certified and currently practices part-time. He has spearheaded a number of studies examining the use of mobile devices in real-time clinical settings in a variety of areas including gaming, social media, patient satisfaction, and shared decision making.

Dr. Jeff Heckman founded and grew one of the largest support group networks for his specific patient population of amputees in the country. He has dedicated his career to improving the lives of patients both inside and out of the clinic. He practices at the Rusk Institute of Rehabilitation Medicine in New York.

[update, 9/11/12: this article was initially erroneously published without recognition of co-authorship by Dr. Heckman]