mobile phoneThe widespread use of mobile phones has been one of the greatest breakthroughs in the modern technological era. Over the past few years, the rate of rise of smartphone use has been truly remarkable. The functions of these smartphones are enhanced by apps, small pieces of software that can efficiently carry out specific tasks or roles.

Incredibly there are now one million apps in both Apple’s app store and in the Google equivalent.1 Not surprisingly, there are a large number of health and professional apps aimed at doctors. One interesting article recently published in the Postgraduate Medical Journal2 looked at the use by interns of smartphones in Ireland and an astonishing 94% of the respondents owned one.

Many used it for work and activity included texts, emails and phone calls whilst just over half used it to take a photograph associated with work. The most popular app was perhaps, not surprisingly the BNF. In fact another piece of research3 found that 80% of doctors used smartphones (60% used tablets such as an iPad) in their everyday practice and the most popular smartphone use was for drug information.

This kind of research, whose conclusions do not surprise me, raises a whole host of questions about security of use and quality of apps. For example, if taking an interesting work-related picture, it is stored on the doctor’s phone. This generates questions about patient confidentiality and security of storage. Also there are general issues of using a smartphone in front of patients and staff. For example, some of our elderly patients may consider it rude that the doctor checks their phone during a consultation, even with an explanation that they are looking up something that is relevant. There are also issues about the quality of information found in some medical apps and for that matter websites.

Simple measures such as password protection, restricting access to a smartphone or the ability to remotely wipe a smartphone if stolen or lost will help. Apps are being developed that transfer images to the electronic medical record without storing on the phone4 and so gets round the important privacy and security issues. 

Of course, all this should help to improve staff productivity and hopefully clinical effectiveness. However there may be a price to pay for this, since it is harder to monitor staff use during contracted working time on non work-related activity on their smartphones, such as checking Facebook and browsing Amazon. At least on work-based desktop computers, certain sites can be blocked. A common modern trend is for employees to bring and use their own devices into the workplace for work-related activity (rather than the employer supplying the tablet or smartphone) and this has spawned the expression “Bring Your Own Device (BYOD).5 However this policy of BYOD has its own risks and problems alongside the potential benefits.6,7

Although there are a number of important issues and problems regarding the use of smartphones in daily clinical practice, I am sure they will be overcome. You can’t stop the relentless march of technological advance but we will all need appropriate guidance on the use of smartphones and apps in the medical environment. Hopefully there will be more staff access to wi-fi in the workplace and once national guidance and agreed standards are in place and adhered to, the smartphone could become as common and as widely accepted as the stethoscope, as a clinical tool.

References 
1. http://www.theguardian.com/technology/2013/dec/15/50-best-apps-2013-iphone-android-observer
2. O’Connor P, et al. Interns and their smartphones: use for clinical practice. Postgraduate Medical Journal http://pmj.bmj.com/content/early/2013/11/15/postgradmedj-2013-131930.abstract
3. http://www.wolterskluwerhealth.com/News/Documents/White%20Papers/Wolters%20Kluwer%20Health%20Physician%20Study%20Executive%20Summary.pdf
4. http://www.adamlandman.com/clinicam/contactus.html
5. http://www.deloitte.com/view/en_GB/uk/industries/tmt/technology/bring-your-own-device/index.htm
6. http://www.theguardian.com/media-network/media-network-blog/2013/mar/19/bring-your-own-device-byod-data-risk-security
7. http://www.economist.com/news/technology-quarterly/21590753-mobile-security-when-it-comes-mobile-devices-viruses-are-not-problem-they