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What’s in Your Pocket? Mobile Medical Applications Michelle Kraft, MLS, AHIP November 5, 2008

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Brief History <ul><li>Mobile medical applications not new </li></ul><ul><li>1993 Apple introduced first PDA ( Newton Message Pad )‏ </li></ul><ul><li>In 2001 Ovid created Ovid@Hand </li></ul><ul><li>Computers, Handheld introduced as MeSH Term 2003 </li></ul><ul><li>Original PDAs required direct sync </li></ul><ul><li>Wireless PDAs evolved </li></ul>

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PDA to Smartphone <ul><li>Huge trend shift from PDA to Smartphone </li></ul><ul><ul><li>Traditional PDAs saw 43% drop in sales from 2006-2007. 1 </li></ul></ul><ul><ul><li>Most PDA owners (69%) say their PDAs double as cell phones. This trend is also rapidly increasing; in 2006 only 26% used their PDAs as cell phones. 2 </li></ul></ul>1.PDA Market Continues Steep Decline. Palm InfoCenter. August 8, 2007. http://www.palminfocenter.com/news/8767/pda-market-continues-steep-decline/ 2.Networked Workers. Pew Internet & American Life Project. September 24, 2008. http://www.pewinternet.org/pdfs/PIP_Networked_Workers_FINAL.pdf

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Palm Handheld & Smartphone Growth Figure 1: Palm Analyst Day –Revenue Smartphone/PDA's over the last few financial years. April 10, 2007. http://palmaddict.typepad.com/

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PDA vs Smartphone <ul><li>PDAs had no phone capabilities </li></ul><ul><ul><li>PDAs do not require carrier contracts </li></ul></ul><ul><li>Smartphones now have PDA style programs and functionality </li></ul><ul><ul><li>Smartphone subsidized by carriers </li></ul></ul>

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Growth and Evolution <ul><li>Wide acceptance </li></ul><ul><ul><li>“ Swiss Army Knife” of devices </li></ul></ul><ul><ul><li>iPhone adoption grew by 48% among those earning $25,000 - $50,000 per year 3 </li></ul></ul><ul><li>Perceptions have changed </li></ul><ul><ul><li>People no longer “unplug” </li></ul></ul><ul><ul><ul><li>63% men have smart phone </li></ul></ul></ul><ul><ul><ul><li>69% can’t live without Internet vs. 31% who can’t live without TV 4 </li></ul></ul></ul><ul><li>More functions available </li></ul><ul><ul><li>Internet always available </li></ul></ul><ul><ul><li>No longer need multiple communication devices </li></ul></ul><ul><li>Easy and Fun </li></ul>3. iPhone Appeals to All Buyers. TheStreet.com Oct. 31, 2008 4. Break Media Research Paints Portrait of Men 18-34. Oct.7, 2008

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Evolution and Growth in Applications <ul><li>Previously two primary systems now has grown to seven different systems </li></ul><ul><li>Thick vs. thin client, move towards thin client applications </li></ul><ul><li>Syncing updates and Real time downloads </li></ul>

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US Smartphone Market Looks Like BlackBerry Pie. Just Another Mobile Monday (JAMM). May 31, 2008. http://justanothermobilemonday.com/Wordpress/2008/05/

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Smartphone Platforms <ul><li>Windows Mobile 6.0 </li></ul><ul><ul><li>Not PocketPC </li></ul></ul><ul><ul><li>Relies heavily on Internet connectivity </li></ul></ul><ul><ul><li>Internet surfing not as seamless as other devices </li></ul></ul><ul><ul><li>Limited availability of medical software </li></ul></ul><ul><li>Blackberry </li></ul><ul><ul><li>Relies heavily on Internet connectivity </li></ul></ul><ul><ul><li>Often used standard device for institution/business email </li></ul></ul><ul><ul><li>Lags in medical software availability but improving </li></ul></ul><ul><li>Palm </li></ul><ul><ul><li>Multiple types of phones available </li></ul></ul><ul><ul><li>Very similar to Palm PDA systems </li></ul></ul><ul><ul><li>Many models are NOT wifi capable </li></ul></ul><ul><ul><li>Has the most medical software available </li></ul></ul>

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Smartphone Platforms <ul><li>PocketPC </li></ul><ul><ul><li>Not Window Mobile 6.0 </li></ul></ul><ul><ul><li>Multiple types of phones available </li></ul></ul><ul><ul><li>Has the most medical software available </li></ul></ul><ul><ul><li>Does not play well with MACs and is designed primarily to sync with Outlook </li></ul></ul><ul><li>iPhone </li></ul><ul><ul><li>Two versions 1G and 3G and relies heavily on Internet connectivity </li></ul></ul><ul><ul><li>Very seamless transition with phone, contacts, maps, email, SMS and Internet </li></ul></ul><ul><ul><li>Lots of memory </li></ul></ul><ul><ul><li>Video and audio ready </li></ul></ul><ul><ul><li>Some medical software available, primarily via Internet </li></ul></ul>

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Smartphone Platforms <ul><li>Google G1 Android </li></ul><ul><ul><li>Relies heavily on Internet connectivity </li></ul></ul><ul><ul><li>Open operating system </li></ul></ul><ul><ul><li>Applications limited </li></ul></ul><ul><li>Symbian </li></ul><ul><ul><li>Open source </li></ul></ul><ul><ul><li>Requires unique network capabilities </li></ul></ul><ul><ul><li>Least amount medical software </li></ul></ul>

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Smartphone Comparison Figure 3: Surfing the web: practicing medicine in a technological age: using smartphones in clinical practice. Clin Infect Dis. 2008 Jul 1;47(1):117-22.

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Medical Applications <ul><li>Administrative Tasks </li></ul><ul><ul><li>Most popular </li></ul></ul><ul><ul><ul><li>Billing & coding, calendar & scheduling, email, patient charting </li></ul></ul></ul><ul><ul><li>Other applications </li></ul></ul><ul><ul><ul><li>Word processing, calculator, charge capture, procedure documentation, outpatient tracking, resident hours, dictation, password management </li></ul></ul></ul>

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Medical Applications <ul><li>Patient Care </li></ul><ul><ul><li>Most Popular </li></ul></ul><ul><ul><ul><li>Prescribing, patient record, medical calculator, lab value reference </li></ul></ul></ul><ul><ul><li>Other applications </li></ul></ul><ul><ul><ul><li>Medical References (texts, articles), patient tracking, patient reminders, clinical decision pathways, managed care, diagnostic imaging & radiology </li></ul></ul></ul>

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Where to Look? <ul><li>Fee based services </li></ul><ul><ul><li>UnBound Medicine http://www.unboundmedicine.com/ </li></ul></ul><ul><ul><li>Skyscape http://www.skyscape.com/ </li></ul></ul><ul><ul><li>PDAMD http://www.pdamd.com/ </li></ul></ul>

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Where to Look? <ul><li>Free Resources </li></ul><ul><ul><li>Epocrates Rx http://www.epocrates.com/ </li></ul></ul><ul><ul><li>Diagnosaurus http://books.mcgraw-hill.com/medical/diagnosaurus/index.html </li></ul></ul><ul><ul><li>MedCalc http://med-ia.ch/medcalc/ </li></ul></ul><ul><ul><li>NLM Mobile http://www.nlm.nih.gov/mobile/ </li></ul></ul><ul><ul><ul><li>PubMed for handhelds, WISER, NCBI bookshelf </li></ul></ul></ul><ul><ul><li>Shots 2008 http://www.immunizationed.org/ </li></ul></ul>

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Platform Specific Software Surfing the web: practicing medicine in a technological age: using smartphones in clinical practice. Clin Infect Dis. 2008 Jul 1;47(1):117-22.

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Drawbacks and Concerns <ul><li>Primarily point of care tool </li></ul><ul><li>Formatting </li></ul><ul><ul><li>Images, text, layout design </li></ul></ul><ul><ul><li>Internet sites </li></ul></ul><ul><li>Functional but not always efficient </li></ul><ul><ul><li>Word processing, quick emails, quick research </li></ul></ul>

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Drawbacks and Concerns <ul><li>Institutional buy in </li></ul><ul><ul><li>Email and Outlook sync </li></ul></ul><ul><ul><ul><li>BlackBerry only? </li></ul></ul></ul><ul><ul><ul><li>Intranet / Internet access </li></ul></ul></ul><ul><li>EMR Access and Integration? </li></ul><ul><ul><li>Institutional platform compatibility </li></ul></ul><ul><ul><ul><li>EpicOnHand runs on Windows Mobile or Pocket PC devices </li></ul></ul></ul><ul><ul><ul><li>Other issues regarding HIPAA </li></ul></ul></ul>

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Drawbacks and Concerns <ul><li>Security </li></ul><ul><ul><li>Patient information </li></ul></ul><ul><ul><ul><li>Scheduling and Calendars, tracking software, notes, dictation </li></ul></ul></ul><ul><ul><li>Web security </li></ul></ul><ul><ul><ul><li>Theft of personal information, financial information, scammers </li></ul></ul></ul><ul><ul><ul><li>Encryption varies </li></ul></ul></ul><ul><ul><li>VOIP security </li></ul></ul><ul><ul><ul><li>Spam, Interruptions, Eavesdropping, </li></ul></ul></ul>

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Drawbacks and Concerns <ul><li>Patient’s Health </li></ul><ul><ul><li>Smartphones might cause medical device malfunctions </li></ul></ul><ul><ul><li>Newer phones generate less EMI than older ones but Internet devices cause more than phone </li></ul></ul><ul><ul><ul><li>1 meter debate </li></ul></ul></ul><ul><ul><ul><li>FCC looking to expand usage in “white space” </li></ul></ul></ul>

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Where Do We Go From Here? <ul><li>Library and IT support </li></ul><ul><li>Buying power and synchronization </li></ul><ul><li>Training </li></ul>

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Library and IT Support <ul><li>Be familiar with the technology </li></ul><ul><li>Make library web pages mobile friendly </li></ul><ul><li>Decide amount of library support </li></ul><ul><ul><li>Work with IT to coordinate support </li></ul></ul>

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Buying Power <ul><li>Decide upon purchase plans and licensing </li></ul><ul><ul><li>Site licenses </li></ul></ul><ul><ul><ul><li>Can be very costly, count potential users not actual </li></ul></ul></ul><ul><ul><li>Downloads or concurrent users </li></ul></ul><ul><ul><ul><li>Purchase a set number of downloads </li></ul></ul></ul><ul><ul><ul><li>Concurrent user only works if web based </li></ul></ul></ul><ul><ul><li>Add ons </li></ul></ul><ul><ul><ul><li>Value added option but if no specific license agreement for product, access could change </li></ul></ul></ul>

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Buying Power <ul><li>Discount purchases </li></ul><ul><ul><li>Users purchase with institutional/library discount </li></ul></ul><ul><li>Electronic loaning </li></ul><ul><ul><li>NetLibrary, Overdrive approach </li></ul></ul>

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Synchronization <ul><li>Work with IT </li></ul><ul><li>Get the message out! </li></ul><ul><ul><li>Have product and purchasing information available on website </li></ul></ul><ul><ul><li>Catalog </li></ul></ul><ul><ul><li>Advertise, advertise, advertise </li></ul></ul>

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Training <ul><li>Many are uniformed of possibilities </li></ul><ul><ul><li>Young adopters are usually new to profession </li></ul></ul><ul><ul><li>Older potential users unfamiliar with the technology </li></ul></ul><ul><li>Ensures adopters are aware and select appropriate quality resource </li></ul>

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Training <ul><li>Demonstrate improved patient care </li></ul><ul><ul><li>Better access to point of care resources </li></ul></ul><ul><ul><li>Answer patient questions real time </li></ul></ul><ul><li>Demonstrate time savings </li></ul><ul><ul><li>Scheduling </li></ul></ul><ul><ul><li>Patient care </li></ul></ul>

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Questions? Michelle Kraft http://www.kraftylibrarian.com