Small opportunities to use mobile technology in medicine

As citizens of the 21st century, we seem to have adapted personal technology for every conceivable use — Siri, the iPhone’s newest darling, can literally remind us to call a proctologist. But as physicians, we may be missing some of the best opportunities to derive “meaningful use” from technology.

I am an emergency physician, and a few nights ago I worked a shift in the ER. It was a typical, busy Saturday night, with nurses and physicians working hard to meet patient needs. Amid the hubbub, I picked up the chart of a 14-year-old girl with syncope — the sudden loss of consciousness. The girl’s concerned father presented me with a typed letter from her pediatric cardiologist at the local children’s hospital. The child likely had a very serious condition called Brugada Syndrome, the letter said, and the condition could affect the rhythm of the heart such that the girl could pass out or even die.

We performed a routine electrocardiogram (EKG) to look for any rhythm disturbances or typical characteristics of Brugada Syndrome. Nothing looked unusual, but I thought it might be wise to contact the specialist on-call at the children’s hospital, anyway. Prior to contacting the cardiologist, though, I needed to refresh the clinical and EKG findings of Brugada. Instead of sifting through volumes of dust-and-fluid-covered textbooks, or even finding a desktop computer and waiting my turn for a search, I quickly reached for my smartphone and pulled up my PEPID medical software app. Within seconds, I was able to learn more about Brugada Syndrome, and was aware of what symptoms to look out for.

Discussing the girl’s symptoms with the on-call at the children’s hospital, I suggested I fax her the recently completed EKG for comparison to their existing EKG on the patient. But an outside EKG was unclear via poor-quality fax machines. Here, we ran up against a fairly common problem: our two hospitals used different information systems, and we were unable to transfer patient files efficiently. For times like these, I thought, a common platform for sharing data would vastly improve patient care. We could reduce the time physicians spend devising creative methods to share information through existing systems. This time, the method of choice was to snap a photo of the EKG on my smartphone, and then e-mail it to her secure hospital domain address from my own. I knew that both our hospitals were on the same secure domain established years ago by the now-defunct Smart Systems for Health in Ontario.

I also told the cardiologist to review and compare the EKG with the previous on file and to call me back directly on my cell phone instead of calling into the central switchboard or hospital ER. Instead of hospital staff having to hunt me down while I finished some medical procedure, I was able to save everyone some time by taking the message directly on my cell phone. And, as planned, the cardiologist called me back a few minutes later to inform me that there were indeed some subtle changes on the EKG that would require observation. The girl was transferred back to the children’s hospital for admission, and her family was very thankful that the two hospitals had found a way to facilitate her care.

That was a series of small opportunities to use technology differently, to find new ways to use the tools we’re given to work with as physicians. But it had the effect of meaningfully improving the way I interacted with a patient and with another care provider. And yes, I’m often able to use the camera on my smartphone to take photos of injuries or x-rays to share for observation — because in medicine, arguably more so than else where, a picture is indeed worth a thousand words — but on a larger scale, health care should be moving toward a standardized and secure platform for sharing patient information between physicians. Despite legitimate privacy concerns by consumers and patients in a largely deregulated online environment, patient care is one realm in which facilitating the flow of data could have significant effect on the profession. Until then, we should continue to work creatively, adapting non-medical technology to improve what we do in small ways.

Karim Jessa is an emergency physician. 

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