EyeNet Magazine

Practice Perfect: Information Technology
Smartphones in Practice: Dial “M” for Medicine
By Linda Roach, Contributing Editor
Interviewing Ken Lord, MD, Rob Melendez, MD, MBA, and Vinay A. Shah, MD
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The next time you need to consult The Wills Eye Manual, do a quick acuity test on a traumatically injured eye or double-check the dosage on a prescription, your best tool for the job might be in your pocket. That’s because in the last year, a variety of inexpensive ophthalmic applications (“apps”) has transformed the smartphone from a device for personal productivity into a multifunction clinical tool—both in and out of the office.

“Everything is going to the mobile platform,” said Ken Lord, MD, co-developer of Eye Handbook (www.eyehandbook.com), a free app for Apple iPhone and iTouch devices. “Ophthalmology is a very technically oriented and gadget-oriented field, and now you have many of those technical tools in the palm of your hand. This is where ophthalmology is going.” Indeed, physicians seem well equipped for the transition to mobile computing, with a survey last summer by Spyglass Con- sulting Group finding that more than 90 percent of doctors were using smart-phones, up from 59 percent in 2006.

Customizing your phone for practice. When a new smartphone is first turned on, it functions as a phone, camera, pager, PDA and handheld computer with wireless access to the Internet. But adding a few key ophthalmology apps can transform it into a powerful clinical, reference, imaging and educational tool, said Dr. Lord, a vitreoretinal fellow at the University of Missouri-Kansas City. “The computing power in your average smartphone is faster than your desktop computer was less than 10 years ago,” he said.

Mobility in action. Vinay A. Shah, MD, codeveloper of the Eye Handbook and a vitreoretinal fellow at Kresge Eye Institute in Detroit, said he uses his smartphone apps daily, as he moves from place to place. “A database built into the Eye Handbook app contains all the information to answer my billing and coding questions. For chart notes, I write them with a free voice-to-text app, Dragon Dictation,” Dr. Shah said. To avoid drug interations, he can tap a patient’s medication list into the Epocrates app’s Interaction Check tool. This tool for preventing medication errors is included in the free version of Epocrates, an app available for the most common types of U.S. smartphones, but not those that use the Symbian operating system. “And I can access all the little testing tools—like acuity, color vision, Amsler grids—that might be not be available in treatment settings such as the ER,” he added. “Obviously the tools aren’t optimized on a smartphone, but they are pretty good and enable me to handle most situations in an emergency. Now, on call, the only things I carry are my 20-D lens, my indirect ophthalmoscope and my iPhone.”

Imaging on hand. Equipped with other apps, smartphones can be used to take fundus photographs through a slit lamp, and to display images from OCT systems and other high-tech devices. These images are a valuable patient education tool, said Rob Melendez, MD, MBA, a comprehensive ophthalmologist in Albuquerque, N.M. “I can access an OCT on my iPad and toggle between images of a normal eye and the patient’s eye,” Dr. Melendez said. “Then I hand it to the patient. They understand their condition better because they can see the difference immediately.”


Smartphone Basics

Types of operating system. If you already own a smartphone and want to begin exploring medical apps, your phone will only be able to download medical apps specific to its operating system. The U.S. smartphone market is dominated by four software platforms— Apple, BlackBerry, Google Android and Windows Mobile—with another two platforms—Palm and Symbian—playing smaller roles. Most of the smartphones that have been sold outside the United States use the Symbian operating system, which is used on Nokia and Sony devices.

Apple had a head start in the app market, and its operating system is developer-friendly. So far, many developers have initially produced their medical apps for iPhone and iTouch (which differ only in that iTouch cannot make phone calls). Versions for other operating systems have followed in one or two years—if the iPhone app was a hit. This was the pattern followed by Drs. Shah and Lord, along with a third partner, Rohit Krishna, MD, who now is in private practice in Kansas City. They began developing Eye Handbook for their own iPhones when Drs. Shah and Lord were ophthalmology residents at the University of Missouri-Kansas City and established a company—Cloud Nine Development— to launch the Apple-based product. At time of press, Dr. Shah expected a Google Android version to be released in early to mid-2011.

Who pays for your apps? The Eye Handbook app can be downloaded free, with Cloud Nine earning revenue from advertisements. “You can charge users for a resource like this, or you can get some advertising,” said Dr. Shah, who added that the advertisements pop up briefly and don’t interfere with the user experience.

“We decided to keep this free because we knew there were a lot of medical students and others who would use it but do not have much money.”

They also have developed another product, DoctorApp (www.docapp.com), which is free for the patient but subscription-based for the physician. It enables a physician to set up a customized app for connecting patients to his or her office. “Imagine if a LASIK surgeon tells patients to download his app on iTunes and view a video about the surgery. That has a ‘cool’ factor,” said Dr. Shah. Physicians can dynamically add or change content on their app on the fly, using the web interface. “They can change the content of their app by themselves, just by going in and editing. And whenever they change anything, it repopulates the info to all the users of the app.”

Drs. Lord and Shah are partners in Cloud Nine Development. Dr. Melendez developed Ophthalmology Buzzwords, which is available on the Eye Handbook.


Get Smart About Smartphones

WHICH PHONE? SEVEN FACTORS TO CONSIDER. Physicians should go through seven steps when selecting a smartphone, according to mHealth Initiative (www.mobih.org), a group that advocates for greater and better use of smartphones in health care:

  1. Decide whether you want to use your mobile phone as an expanded communication device or if you just want to make and receive telephone calls. If the latter, consider a simple cell phone.
  2. Find out which smartphones will integrate with your local hospital or other providers.
  3. Local connectivity: Which carrier is best in your area?
  4. Do you have mobile phone service with another company, and would that contract be expensive to break? If so, and you don’t mind carrying around a second mobile device, consider an iTouch, which can access the Internet if a WiFi network is present but cannot make phone calls.
  5. If you already use a mobile device in your practice, are the apps that you are accustomed to using compatible with the new smartphone that you are considering?
  6. Which apps might you use and are they available for the smartphone you have in mind?
  7. How important are lifestyle features such as a camera, GPS, listening to music, a calendar and a task manager?

And remember: Mobile computing is changing so quickly that your smartphone will be outdated in a year or two. So you’ll have another chance to get it right.

WHICH APPS? NINE WEBSITES TO GET YOU STARTED. Go online to find out which apps are available for the various types of smartphone.

WHAT ABOUT HIPAA? For information on smartphones and HIPAA-compliance, see www.yale.edu/hipaa/solutions/smartphones.html.


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