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July 24, 2013

ONLINE ONLY: Could a smartphone physical be in your future?

(Continued)

Smartphone EKG

How can doctors wielding smartphones make a physical exam more effective? Technologies such as CellScope are often smaller and less unwieldy than otoscopes, stethoscopes and ultrasounds. "The Smartphone Physical" included a smartphone case that doubles as an EKG machine. Participants could get readings of their heart rhythms just by placing their fingertips on sensors located on the back of the smartphone case. By contrast, a standard single-lead EKG usually requires a technician to attach sensors to a patient's body in a clinic, doctor's office or, often, ambulance.

A study of the smartphone EKG presented at the 2012 American Heart Association annual meeting showed that its results were as accurate as a single-lead EKG at detecting atrial fibrillation and other arrhythmias. (Hospitals and emergency rooms use 12-lead EKGs to detect heart attacks and other conditions.)

Furthermore, the new device allows patients to participate in their own exam: The EKG readings can be transferred directly from iPhone to the Web, enabling a doctor to remotely look for specific heart wave abnormalities in real time - as opposed to having the patient go to an ER or doctor's office to be evaluated.

One doctor has used the app on two occasions to diagnose life-threatening heart conditions on airplane passengers in distress.

These devices also can increase patients' ability to understand their own care. Smartphone technologies provide user-friendly visual and audio output that patients can have literally at their fingertips and, with help from their doctor, can be shown how to use and understand at home as well.

Imagine, for example, that you didn't have to wait days to get your blood pressure checked at the doctor's office (where blood pressure readings are often artificially high due to "white coat syndrome". but could instead measure it whenever you wished using a smartphone blood pressure cuff attachment whose results would be transferred instantly to your doctor. This would not only be easier for patients but could provide more accurate results for the physician.

As Shiv Gaglani, a Johns Hopkins medical student and the curator of the "Smartphone Physical" exhibit, notes: "Some of the smartphone devices are already being used by patients to collect and store their data, so when they see their clinicians they can have productive and informed conversations."

Smartphone medical applications are also, on average, less expensive for physicians and clinics than traditional diagnostic tools. Some insurers charge $50 per EKG to insured patients; uninsured ones, though, can pay over $1,000 for one. By contrast, the mobile EKG attachment has a one-time cost of $199, which means doctors will be able to charge their patients less.

As difficult as I find them, the otoscope and other traditional tools will remain a large part of medical practice for the near future. And to be fair, doctors grew up training with these tools; learning the smartphone physical would come with time and opportunity costs. But doctors should also realize the deficiencies in some of these older technologies and how smartphones can address them. Hopefully, the "no cellphone" policies will then also turn into a relic of the past.

Parikh, a student at Harvard Medical School and the John F. Kennedy School of Government, is an editor of MedGadget, the blog that co-organized the "Smartphone Physical" exhibit at TEDMED 2013.

 

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