Dr. Shrestha is the Vice President of Medical Information
Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, and
the Medical Director, Interoperability & Imaging Informatics,
Every few years, along comes a technological
wave that can be considered nothing less than revolutionary. In this era
of the always on consumer, mobility has quickly become a “must have.”
Mobility penetrates almost every aspect of our modern life and has
quietly reached a level of cultural acceptance and addiction that is
second to almost no other technological advancement of late.
and tablets have become the technological equivalent of jeans and
t-shirts: easy to slip on, comfortable, functional, and essential to any
wardrobe. According to one report,1 >80% of practicing
physicians actually use mobile devices, such as smartphones and tablets,
along with various types of medical applications in these devices.
Imagers are often earlier adopters of newer technologies, and
radiologists have been quick to adopt mobile devices, for both personal
and professional use.
Imaging vendors have also been busy, and
FDA-approved applications are emerging that even allow for diagnostic
interpretation of imaging studies on some of these mobile devices,
enabling radiologists to deliver results even faster and providing
clinicians increased means to review images via mobile devices during
rounds and discussions with patients.
Newer practice models are being experimented on, and scientific publications2
are emerging that highlight clever ways mobility and imaging are coming
together. One such example is the vastly improved rapid communication
with neurosurgeons resulting from the incorporation of smartphones, and
the reviewing of 30-second videos containing patients’ neuroimages in
the context of clinical information.
Building a fad-resistant mobility strategy
healthcare in general, and in imaging in particular, the strategy
should not just be about embracing the latest fads. It should be
structured to keep imaging relevant at a time when we are seeing an
active conversion of user-driven enthusiasm around mobile devices, and
workflow considerations that could indeed be liberating in many ways.
Embracing mobility for mobility’s sake is futile and short-sighted.When
the enthusiasm dies down, one may just be left with unsupported devices,
a HIPAA breach or two, and a screen full of unused apps.
your healthcare institution have a mobility strategy yet? Any such
strategy needs to focus on 4 key areas: (1) wireless infrastructure, (2)
mobile-device management, (3) mobile-application development and
management, and (4) support. The strategy calls for building a strong
focus on reliability, security, and flexibility. Any such strategy in
healthcare needs to be honed to keep up with the fast pace of technology
change in this area, staying one step ahead of the game (where
A sound policy around device management has to be
simple and clear. The ease of slipping in an Internet-enabled device
that could potentially tap into PHI (protected health information) must
not be taken lightly. The policy should address usability clearly
distinguished between personal and professional devices as well as use
cases, even with the emergence of the Bring Your Own Device (BYOD)
trend.3 The goal is not to be limiting — but accommodating and
safe. Like most successful policies, the aim should be to make it
easier to do the right things, and difficult to do the wrong —while
outlining clear and simple rules, backed by technology that enables the
enforcement of these policies.
Healthcare institutions need to
start dictating expectations and standards to vendor partners as opposed
to the free-for-all, first-come-first served, lets-see-how-it-goes
mobility deployment frenzy we are seeing today.
Workflow = work + flow
promise of mobility in imaging centers is really in being able to
comprehend and intelligently address opportunities to refine and define
the imaging workflow. Dissecting the entire trail of the imaging
workflow reveals specific opportunities to add value in a number of
areas—and these include study ordering, scheduling, study capture,
storage, image distribution, interpretation, report distribution,
clinical image viewing, patient education, charge capture, image
sharing, and many more.
In any of these cases, however, workflow
simply needs to, well, work and flow! The mobile devices, along with the
applications and tools, simply need to work—addressing the key aspects of reliability, performance, and functionality. And they also simply need to flow—ensuring
that these devices and applications actually add value to the imaging
workflow—simplifying and adding convenience to specific tasks.
mobile applications can currently simplify a PACS administrator’s life
by allowing a number of remote monitoring and remote-control
functionalities around quality control, data movement, and information
management. A plethora of applications exists for the clinically
inclined, from clinical workflow enablers for viewing, image sharing and
remote reporting, to training (teaching cases, imaging atlases) and
continuing medical education (CME). Consumer applications are emerging,
too, allowing for controlled access to some imaging studies and reports,
but these apps need to be part of a larger set of workflows, for
example, around personal health records (PHRs).
mobility-enabled workflows mature, users will start to embrace the
convergence of devices and form factors, promoting a fluid workflow
between the computer terminal, the tablet, and the smartphone.
The “always on” generation of clinicians
entire new generation of radiologists and other clinicians is emerging;
a breed that has developed an innate level of comfort with and
acceptance of these mobile devices. With this trend come numerous new
opportunities to improve critical clinical communications among troves
of clinicians who are “always on.” Today’s generation of clinicians
embraces social media and Web 2.0 communication methodologies perhaps
even more readily than more traditional ways of communication in
clinical radiology. This also opens up opportunities to dramatically
decrease clinical miscommunications, for example, during patient
Numerous medical schools and training programs are
integrating iPads and tablet computers into their educational
mandates—StanfordUniversity School of Medicine and University of
California Irvine School of Medicine, presenting delighted incoming
trainees with iPads,being two early examples of this trend.
are literally learning new ways to practice medicine. In addition to
palpation, auscultation, and percussion, tapping and swiping may very
well have arrived as essential “clinical skills.”
Your smartphone will see you now
mobile device is turning out to be man’s new best friend. Imagine the
implications this has for patients. The patient empowerment movement
suddenly has booster rockets. Patients already resort to online search
engines to research health issues, symptoms, and perplexing
terminologies found in radiology reports. I still smile when I recall
the patient who asked me, “Am I worse off now that the report
saysT2-weighted imaging? Is that better than T1?”
diagnosis is becoming well accepted, enabled by a plethora of
customer-focused healthcare applications, including some very good ones
such as iTriage. Newer technologies, such as voice recognition, make
searching that much easier. AT&T recently released aWatson-enabled
application programming interface (API), allowing developers to leverage
applications that could bring the power of strong natural language
processing (NLP) intelligence to everyday applications via smartphone.
is more innovation yet coming on this front. An Israeli company
recently unveiled a first-of-its-kind medical smartphone that renders it
possible to independently measure 7 medical indexes: echocardiogram
(ECG), heart rate, body temperature, blood sugar level, body fat
percentage, blood oxygen saturation, and even stress. Companies such as
Motorola, Nike, and BodyFit have been creating some interesting wearable
health monitors connected to cloud-based applications, portals, and
social media-enabled websites. Imagine how the incorporation of images
would add value to some of these devices. Already, a number of
successful cases have emerged of mobile devices being used for
tele-ophthalmology, wound-image interpretation, and radiology image
access and sharing.
Patient engagement will continue to be
critical. The proposed Meaningful Use Stage 2 rules call for patients to
have the capability to electronically view and download their health
information and require providers to have secure electronic messaging
capabilities to communicate with them. According to the National
Coordinator for Health Information Technology, Farzad Mostashari, MD,
the age of the engaged and empowered patient is upon us, especially with
smartphones and ubiquitous access to information.
The evolution of apps
application stores (app stores) are overflowing with medical apps.
Indeed, there is what one could perceive as an extremely chaotic
proliferation of apps, both for general consumers as well as clinicians.
The rush to create and release apps has unfortunately also resulted in a
lapse in the quality of some of these apps. More purposeful,
intelligent, and well-designed apps are required that are perhaps
connected to a broader set of applications, such as teaching resources,
portals, PACS, etc.—not just standalone apps with limited functionality
and narrow scope.
The Apple app store currently boasts close to 700,000 apps.4 The Google Android app store is not far behind, with close to 500,000 apps.5 Even the Windows marketplace has over 100,000 apps.6 As
of July 2012, the Apple app store carried over 13,600 medical apps. Of
these,almost three-quarters were created for consumers and patients (eg,
wellness and fitness apps, general medical condition management
apps,home monitoring apps), and the rest were targeted to healthcare
professionals (medical reference tools, diagnostic tools, CME apps, and
But one senses an evolution in the quality of these apps.
From what today is often perceived as a chaotic mix of all sorts of
apps, we are perhaps moving to some form of controlled chaos, with an
organized methodological set of purposeful apps that are independently
functional, but also serve as extensions of broader platforms and
clinical or educational workflows.
challenges to wider and faster adoption of mobility in imaging, and
healthcare in general, are rapidly being addressed. Of primary
concernare security and privacy issues. Many organizations are also
lagging behind in instituting clearly defined mobile strategies and
governance policies. According to the HIMSS 2011 Mobile Technology
Survey,7 97% of respondents indicated that clinicians at
their organizations accessed information using a mobile device, yet only
38% noted that their organization has a mobile technology policy in
place that regulates the use of these devices and outlines the
organization’s mobile strategy.
There are also concerns over
wireless bandwidth, but the emergence of 4G bandwidth and better
wireless technologies are addressing these concerns. Some tout business
models around mobility as being a challenge, but perhaps this is more of
an opportunity, both for standalone mobile applications as well as a
value-added extension of broader platforms and tools. Healthcare
institutions are exploring innovative ways to ensure these devices
remain sterile, secure, and charged and ready when needed.
smarter, smartest—that’s the general trajectory of smartphone and
tablet devices today. Healthcare stands to gain tremendously from newer,
high-powered microprocessors with superior operating systems built for
touch and optimized for these devices, ready to embrace cloud computing
and armed with astute sensors, motion detectors, altimeters, gyroscopes,
and voice-recognition capabilities.
The new iPad’s retinal
display features a 2048 x 1536 resolution (Apple), with 4 times the
number of pixels in the iPad 2, and a million more than in
high-definition HDTV. Radiologists have not stopped drooling at the
image quality. Devices are also emerging with state of the art cameras
and video capabilities as standard, opening opportunities for a wide
range of telehealth and teleconsult workflows.
In addition to more
established platforms, such as the iOS and Android operating systems,
Microsoft is making a big bet on mobility, and given the dominance of
the Windows platform in healthcare establishments today, one would be
foolish to ignore the Redmond wave—with Windows 8, Surface PCs, tablets,
and a host of associated technologies and solutions, and opportunities
to evolve user experiences to specific areas of healthcare.
are tremendous opportunities in finding the perfect balance between
mobile devices, and social media — enabling social and peer-level
discussions, coaches and social gamification concepts related directly
to targeted healthcare-outcome improvements, especially in certain
high-cost, high-impact areas, such as adolescent obesity, chronic
disease management, and many others.
Globally, there are 5.3
billion mobile subscribers—equating to 77% of the global population,
including an ever increasing population of users in developing
countries.8 Some are predicting that by 2015, more than a third of U.S. smartphone users will be running m-health apps.
mobility-in-healthcare wave is upon us. There is no doubt that mobility
will continue to have an increasingly profound effect on the practice
of radiology and medicine.
Report: Apps, doctors and digital devices. Jackson & Coker,
Industry Report. vol 4, number 7. Jackson & Coker Research
September 2011. Accessed July 16, 2012.
- Shivapathasundram G,
Heckelmann M, Sheridan M. Using smart phone video to supplement
communication of radiology imaging in a neurosurgical unit: Technical
note. Neurol Res. 2012;34:318-320.
- Visual Networking
Index . Cisco.
Accessed July 14, 2012.
- App Store Metrics. Apple. (n.d.).
148Apps.biz. http://148apps.biz/app-store-metrics/. Posted 2012, July
16. Accessed July 16, 2012, from www.apple.com/ipad/design.
Number of available Android applications. AppBrain.
http://www.appbrain.com/stats/number-of-android-apps. Posted July 19,
2012. Retrieved July 20, 2012.
- Blandford, R. 100,000 apps
published to Windows Phone Marketplace. All about Windows phone.
to_Windo.php. Posted June 5, 2012. Accessed July 20, 2012.
- 2011 HIMSS mobile technology survey. HIMSS.
Revised%20120511%20Cover.pdf. Posted December 5, 2011. Accessed July
- Gray, V. Katherine. Radiology reports in the age of smartphones: Part 1 in a series. Diagnostic Imaging. http://www.diagnosticimaging.com/radblog/display/article/113619/1831603. Posted March 28, 2011. Accessed July 12, 2012.