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The first mobile device that incorporated both communication and computing features was the Blackberry, which was introduced in 2002.5 After the Blackberry was brought to market, other handheld mobile devices were introduced. Perhaps most notably, in January 2007, Apple launched the first-generation iPhone.5 Subsequently, smartphones that run the Google Android operating system were introduced in October 2008.5 Because of the intuitive touch-screen user interfaces and advanced features and capabilities that the iPhone and Android smartphones offer, ownership of mobile devices has increased rapidly.12 In April 2010, Apple introduced a new innovation, the iPad tablet computer, which because of ease of use, portability, and a comparatively large screen was yet another transformative computing tool.5 The iPad ignited the tablet computer market.9 Tablets that run the Google Android operating system (Samsung Galaxy and others) were launched later that year, making the use of these mobile devices even more widespread.5
Without a doubt, medicine is one of the disciplines that has been profoundly affected by the availability of mobile devices.4 This is evident in many surveys of HCPs that reveal a high ownership rate of these tools, which HCPs use in both clinical practice and education.2 Smartphones and tablets have even replaced desktop systems as the preferred computing devices for HCPs who need fast access to information at the point of care.9
Prior to the development of mobile devices, these resources were mainly provided by stationary computers, which do not support the need for mobility in health care settings.7 In an attempt to address this need, some health care environments set up portable, wireless mobile information stations such as Computers on Wheels (COWs) or Workstations on Wheels (WOWs).7 With the availability of mobile devices, however, clinicians now have access to a wellspring of information at their fingertips, through their smartphones and tablets.10
The ability to download medical apps on mobile devices has made a wealth of mobile clinical resources available to HCPs.15 Medical apps for many purposes are available, including ones for electronic prescribing, diagnosis and treatment, practice management, coding and billing, and CME or e-learning.9,10 A broad choice of apps that assist with answering clinical practice and other questions at the point of care exist, such as: drug reference guides, medical calculators, clinical guidelines and other decision support aids, textbooks, and literature search portals.7,13,15 There are even mobile apps that simulate surgical procedures or that can conduct simple medical exams, such as hearing or vision tests.6,7 Many mobile apps are not intended to replace desktop applications, but are meant to complement them in order to provide a resource that has the potential to improve outcomes at the point of care.7 The use of medical apps has become frequent and widespread; 70% of medical school HCPs and students reported using at least one medical app regularly, with 50% using their favorite app daily.1,9
Cloud-based storage and file-sharing services that can be accessed using a mobile device are also useful for information management, since they allow users to store, update, and share documents or photographs with others without exchanging a flash drive or CD.2,5,6 Most cloud-based storage systems provide users with a few gigabytes of memory for free; additional space often requires payment of an annual subscription.2 Cloud-based information storage provides the additional advantage of permitting information to be accessed instantaneously from multiple devices, which allows people who are collaborating together to share materials quickly.2,5,6
One health care software company, Epic Systems, has partnered with Apple and released versions of the Epic scheduling, billing, and clinical support app for the iPhone and iPad.4 PatientKeeper Mobile Clinical Results provides physicians with access to patient clinical data via either Apple or Android mobile devices.7 Teamviewer is a general-purpose record maintenance and access app that can be installed on mobile devices, allowing remote access to desktop PCs.5 In the absence of such apps, a virtual private network (VPN) log-in can often be obtained from the hospital to allow remote secure access into the in-house network through the Internet to view records for emergency consultations.5
Mobile devices have been proven to improve contact between HCPs and their colleagues.1,4 In one study, mobile devices were shown to improve communication between doctors and nurses on inpatient wards.4 In a survey of medical school HCPs and students, more than 80% of respondents described using mobile devices to communicate with colleagues about patient care via e-mail, telephone, and text messages.1 They described texting as a more efficient means of communication than telephone conversations or in-person meetings.1 Mobile devices also allow rapid response to e-mail, allowing users to keep up with communication.1 Texting or calling colleagues directly on their mobile devices, rather than paging them, has also been shown to save critical time in emergency cases.3,7 Mobile devices can also be used by HCPs to aid long-distance patients by allowing them to text or send pictures regarding problems or questions.3
Many evidence-based software apps serve as useful bedside clinical decision-making tools.7 Printed medical references often used in disease diagnosis are now available as mobile device apps that provide information on diagnosis, treatment, differential diagnosis, infectious diseases, pathogens, and other topics.7 Such apps include: Johns Hopkins Antibiotic Guide (JHABx), Dynamed, UpToDate, 5-Minute Clinical Consult (5MCC), 5-Minute Infectious Diseases Consult (5MIDC), Sanford Guide to Antimicrobial Therapy (SG), ePocrates ID, Infectious Disease Notes (ID Notes), Pocket Medicine Infectious Diseases (PMID), and IDdx.2,7
Diagnosaurus, a popular, low-cost mobile differential diagnosis app for the iPhone, iPad, and iTouch, can help ensure that alternative diagnoses are not overlooked.4 Flowcharts to help physicians identify diagnostic possibilities are included in the apps 5MCC and Pocket Guide to Diagnostic Tests.7 Other diagnostic mobile apps apply clinical algorithms to aid physicians in determining a disease diagnosis.7 Mobile devices can also be used to access CDSSs installed on desktop computers in clinical settings to aid in diagnosis and treatment decisions.8
Current treatment guidelines available at the point of care via mobile apps also provide a valuable resource for HCPs.6 Several guidelines are accessible on mobile platforms, including the National Comprehensive Cancer Network guidelines for cancer care available through the Epocrates app, and the American College of Chest Physicians antithrombotic therapy guidelines available via the CHEST app.6 The Johns Hopkins ABX Guide app provides an impressive compilation of antimicrobial recommendations and guidelines, including some for surgical prophylaxis and surgical site infection treatment.6
Other mobile apps, such as medical calculators, use standard formulas to make calculations to determine risk scores and other measures, such as body mass index (BMI), body surface area (BSA), and proper drug doses.4,7 Calculation of clinical scores or indices typically involves utilizing complex formulas that require several input parameters.7 Even if a HCP knows the formula, performing even simple clinical score calculations manually can be surprisingly time consuming and error prone in a fast-paced clinical environment.7 In contrast, HCPs who use medical calculators do not necessarily need to know the formula for calculating a clinical score or index; they only need to enter the parameters to quickly produce a reliable result.7 153554b96e