Vol. 18 • Issue 1 • Page S2
The old adage "An apple a day keeps the doctor away" implies that an apple can keep a person healthy. As more clinicians reach for their iPhones, a new type of "Apple" is taking the lead in health care.
The iPhone has rocketed to the forefront of personal digital assistants (PDAs). For several years, the goal of some technology companies had been adding features such as music players and calendars to a phone. But Apple took a different tack, taking their wildly popular iPod and making it into a phone. But the iPhone is much more than a simple telephone, and in fact, it has redefined the PDA.
Gone are the grainy screens of the original Apple Newton, with its lackluster performance, limited capability and icons that looked like cave paintings compared with the sexy gloss and crystal-clear display of the iPhone. Sales of the iPhone have soared: In the first quarter of 2009, iPhone sales were 3.89 million, an astonishing 123% increase over the same quarter a year earlier.1
A great many clinicians use a PDA in daily clinical practice,2-5 and as many as 70% of medical students use PDAs.6 Physicians' PDA use has grown to an estimated 45% to 85% in clinical practice.5 Not only are physicians utilizing PDAs, but also 73% of the participants in one study utilized their PDA multiple times a day.5 Usage patterns show that the most frequently used medical apps are equations (85%), followed by medical reference software (74%) and medical dictionaries (19%).5
PDAs in medicine can assist with lifelong learning, provide rapid access to evidence-based information and provide portability.7 They offer clinicians advantages such as time savings, error reduction, education, cost savings and improved patient care by providing information with which to make better medical decisions.8 One physician aptly summarizes this way: "Handheld computers are quickly becoming a ubiquitous device in the white coats of all physicians. Some say that it will not be long before the handheld computer is as common in the laboratory coat of a physician as is the stethoscope."9
Integrating iPhones Into Practice
The iTunes stores now offers more than 60,000 applications, with nearly 300 added each day, by some estimates.10 As more consumers purchase iPhones for personal use, they are asking their information technology departments how to integrate the device with corporate backend systems.11 Apple appears to be taking a page from the Microsoft playbook by attracting home consumers who then push for corporate acceptance. This is true for medical institutions, as well.12,13
Medical students are moving quickly to utilization of the iPhone and its cousin, the iPod Touch. For example, a survey of the Yale medical school class of 2011 showed that more than 75% of students owned an iPhone or iPod Touch.14 Several schools now are incorporating iTunes and QuickTime video into their course curriculum. Not only is iPhone technology being added to the curriculum, but schools such as Stanford see huge potential for the iPhone: "At Stanford, we envision the iPhone as having a profound potential to break barriers in the way we provide information and services to students-in how they converse with the institution, their curriculum, the faculty, and each other."13
Supporting the iPhone's push into medicine is an incredible repository of content. Simply by going to a single portal, Apple's iTunes, users can select from millions of items of content that can be seamlessly transferred to their iPhones. Clinically relevant information on the Apps Store includes iTunes U, which is the iTunes medical application repository, and the iTunes medical podcast library, both of which are easily downloaded from the site.
iTunes U is a mobile virtual learning environment that can be carried on an iPhone. The site features classes in anatomy and physiology, behavioral sciences, dentistry, diet and nutrition, pharmacology and more. Simply go to iTunes U in the App Store and download a topic.
Interested in taking an introduction to psychology class from MIT? No problem. Thanks to MIT's OpenCourseWare project, you can download the entire class, along with many other MIT courses, for free to your iPhone and listen at your convenience. Or maybe you're interested in a quick refresher on Lyme disease before your vacation. Download the Yale University Medical School's Health and Medicine iTunes U podcast on the topic and listen as you walk the Appalachian Trail.
iPhone Medical Apps
Many medical apps exist for the iPhone. The challenge for consumers is how to find, select and use the software that is most appropriate. The challenge for developers is how to not get lost in a huge and ever-growing pool of apps.
A few apps truly showcase the power of the iPhone platform. For example, the full version of Epocrates, called Epocrates Essentials, contains a huge range of features, including drug information, drug interactions, disease information, infectious disease lists, diagnostic and lab tests, alternative medicine and a number of medical tables and calculators. Specific to the iPhone platform is a pill identification and picture database that is very handy when talking with patients. (Notably missing from the iPhone version of Epocrates Essentials is the symptom checker that is available on the Palm and Microsoft platforms.) Although several inexpensive or even free apps feature parts of the Epocrates database, Essentials is the only one that integrates all of the components in one easy-to-use app.
In Epocrates Essentials, a clinician can look up a disease, click a link to appropriate therapies, select a drug, check the dosing, look for interactions and provide patient information all in one seamless stream. Some might be intimidated by the $199 a year price tag, but this software is well worth the expense. Disease information content is developed in conjunction with the BMJ Group, publishers of the British Medical Journal. The drug information contains more than 3,300 prescription medications, plus hundreds of over-the-counter and alternative medications. The interaction checker checks up to 30 drugs for potential interactions. Formulary information is included so clinicians can check and compare medication prices for patients.
To put this in perspective, having to purchase a different textbook for each of these functions, and trying to keep all of them continuously updated, would certainly cost more than $199 a year. Plus, many universities and other institutions offer discounts for Epocrates software.
Several free medical apps are worth downloading. Epocrates Rx offers a tremendous amount of drug-related information. It also is a good way to try Epocrates before considering an upgrade to the Essentials version of the software.
Eponyms (student version), another free software tool, is a wonderful source of eponyms frequently used in medicine, along with brief definitions. A few other free apps worth downloading are BlackBag, Heme Calc and Cardio Calc. For clinicians willing to spend 99 cents, Medical Calculator by MarketWall is an excellent tool that contains about 50 easy-to-use formulas commonly used in medicine.
For those willing to spend $2.99 for an application, consider The ECG Guide by QxMD Software. This easy-to-use application is packed with information on ECGs-numerous diagrams, interpretation guides, ECG wave and segment explanations, sample rhythm strips, an ECG quiz to test your knowledge and even cardiac tables with details for pediatric patients. iMurmur by Phalanx Development, also $2.99, is a clever application that allows users to hear various heart sounds, see a pictogram of an ECG tracing and get background information on various heart sounds. This is especially useful for new clinicians learning the complex and varied sounds of the heart.
Students may find handy the Mental Case Flashcards by MacCoreMac Software. For $2.99, users can create their own flashcards to quickly study medical topics or download prepackaged ones, including those for the PANCE.
iPhone Medical Books
Research has shown that most students today prefer to use printed texts when learning new material, but then prefer using electronic texts as a reference once the material is learned.15 Therefore, it may be better for students to use traditional, printed textbooks in the classroom. When looking for a few references in a clinical setting, consider iPhone reference texts, but be cautious. The texts are generally expensive, and customer ratings are poor for most PDA versions of medical texts.
Most users, at least for now, probably should stick with free or low-cost versions of PDA medical texts. Some publishers still struggle with taking a very comprehensive text and converting it to an efficient and effective electronic format. If you are interested in an electronic medical text, consider products by Unbound Medicine and Skyscape, who are working to convert their paper content to effective electronic formats. Another company to consider is Modality, which has developed a number of innovative iPhone medical apps.
iPhone Medical Podcasts
A podcast is a series of downloadable electronic episodes of information on a wide range of topics. Podcasts can be audio or video and can contain supplemental information such as PDF text files that are easily downloaded to an iPhone. A few are worth special recognition. The Johns Hopkins Weekly Health News is timely, relevant, entertaining and extremely informative. Each week, hosts Elizabeth Tracy and Rick Lange, MD, recap key medical topics in a 10-minute podcast that is an excellent summary of current medical issues.
For medical students and those with a sense of humor, try MedPod 101. Dr. Jacob presents topics with a range of humorous accents and very odd patient scenarios that will make you laugh as you learn medical topics. An entertaining podcast for anyone who enjoys a good medical mystery is Discover magazine's Vital Signs Podcast. The medical sleuth in you will enjoy solving medical cases and honing your medical skills.
Challenges of iTunes
Among the challenges related to software on iTunes is that no real quality control exists for the apps on the site. Apps range from free to about $150, with no guarantee that they will work and no refund policy. Some software development companies offer "lite" versions that users can try for free at no risk. Others offer no "lite" version, nor do they provide demo versions of the software. For example, one product that may have potential in a clinical setting is iChart EMR by Caretools. The software costs $139.99, but the company offers no demo and suggests users watch a Web video for more information about the product. Although the software might be excellent, it's hard to know how well it works without taking out a credit card. Consequently, iPhone software developers need to consider offering "lite" versions to allow users to try software before buying.
Caveat emptor is the bottom line when purchasing iPhone software. Fortunately, most software is inexpensive enough that you can try it for little or no risk. For more expensive software, talk with colleagues, or wait for software companies to offer demo or "lite" versions.
iPhones & the Future
Apple has now turned some attention to wooing manufacturers to connect various medical devices to the iPhone. Examples include a blood pressure cuff connected to an iPhone via a small cable;16 another prototype, not yet commercially available, is a blood glucose monitoring device utilizing Johnson & Johnson's LifeScan products.17
Also on the horizon are augmented reality applications for the iPhone. Augmented reality is, essentially, pointing your iPhone camera at an object, after which a virtual display overlays the live picture. For example, an iPhone camera could be pointed at a restaurant, and a display would show ratings in real time. It is conceivable that this application could be used in a medical setting. General Electric has developed a demo application of a 3-D augmented reality that users can try at home with their personal computer and webcam.18 Scott Stein at CNET writes, "If augmented-reality navigation apps can progress at the same feverish development pace as the rest of the App Store, the new iPhone could soon be capable of location-based feats that approach (Star Trek) tricorder capabilities, scanning the environment in real-time for data."19
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10. Ahlund A. The 35 best iPhone apps of the year (so far). TechCrunch Web site. http://www.techcrunch.com/2009/08/15/the-35-best-iphone-apps-of-the-year-so-far/. Published August 15, 2009. Accessed January 19, 2010.
11. Subbloie A. Should you support your employees' iPhones? Forbes Web site. http://www.forbes.com/2009/09/22/iphone-support-corporate-leadership-managing-ceonetwork.html. Published September 22, 2009. Accessed January 19, 2010.
12. Doylestown Hospital. always on call: iPhone 3G. Apple Web site. http://www.apple.com/iphone/business/profiles/Doylestown. Published June 4, 2009. Accessed January 19, 2010.
13. iApps Project. Stanford University Web site. http://www.stanford.edu/dept/registrar/studentapps/iapps.html. Accessed January 19, 2010.
14. The medical iPhone and iPod Touch. Yale University Cushing/Whitney Medical Library Web site. http://www.med.yale.edu/library/services/computing/iphoneitouch.html. Accessed January 19, 2010.
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http://medicalconnectivity.com/2009/03/19/apple-targets-health-care-with-iphone-30-os/. Published March 19, 2009. Accessed January 19, 2010.
17. Dolan B. Interview: Lifescan on iPhone 3.0. Mobile Health News Web site. http://mobihealthnews.com/973/interview-lifescan-on-iphone-30. Updated March 18, 2009. Accessed January 19, 2010.
18. Smart Grid Augmented Reality. General Electric Web site. http://ge.ecomagination.com/smartgrid/#/augmented_reality. Accessed January 19, 2010.
19. Stein S. Augmented Reality: iPhone 3G S killer app? CNET Web site. http://news.cnet.com/8301-17938105-10266380-1.html. Published June 17, 2009. Accessed January 19, 2010.
Joseph G. Weber is a PA in Concord, Ohio. Before becoming a PA, he was a computer engineer for 20 years, including at Microsoft. He indicates no relationships to disclose related to the contents of this article.