Smartphones are quickly gaining the capabilities to make patients’ homes an extension of physicians’ offices, facilitating access to timely medical care. Technological advancements in the phones are enabling them to take higher-resolution photos and deliver better sound quality, suggests Christy Marks-Davis, senior director of marketing for CareCentrix, a company that works with providers and payers to support care of patients in their homes.
Medical device manufacturers and software engineers continue to take advantage of smartphones’ capabilities, adapting them to serve as diagnostic tools that patients and caregivers can use in the home. Clinicians also are beginning to use them in their practices.
Here’s a list of some of the current capabilities used to expand the clinical usefulness of smartphones, building off a blog by Marks-Davis and including other capabilities being tested in the industry.
The stethoscope enables amplification of breath and heart sounds that provides insights into lung and heart function. Smartphones now enhance the power of the stethoscope—patients and many doctors use smartphone-based amplifying devices to replace the earpieces from the traditional stethoscope, enabling patient engagement and a more informed patient-physician dialogue. Beyond that, a new application can interpret breath sounds and coughs in combination with other symptoms that the patient enters, returning results that can indicate the likelihood that a person has various respiratory conditions. The application, ResApp, uses the smartphone’s microphone, and is particularly effective at diagnosing asthma and pneumonia.
Most ECG machines are consoles about the size of a laptop computer, attached to as many as 12 wires that are then attached to a patient’s body. Today, crude ECG recordings can be taken by smart watches; there’s a variety of opinion about the accuracy and clinical effectiveness of these recordings. Even better ECG recordings can be taken with smartphone apps connected to as few as four leads that most anyone can be taught to attach. Other new systems include devices the size of a business card that the users can touch with their fingers to get an ECG reading that connects wirelessly to a smartphone.
Electroencephalogram devices measure the electrical activity of the brain. They are used for a variety of purposes, including diagnosing and monitoring patients with epilepsy. Traditionally, epilepsy patients have had to travel to EEG centers, where they are fitted with several leads that are glued to their scalp. But with smartphone technology, it’s possible for patients to monitor themselves at home and transmit the data to their neurologist. A proof-of-concept study in Nature.com determined that this innovation could soon make EEG technology available to millions of epilepsy sufferers who have limited access to EEG centers.
Every pediatrician has an otoscope for looking in children’s ears, generally to diagnose ear infections. This capability, called pneumatic otoscopy, requires some skill to learn. However, the most significant limitation of the technique is the otoscope itself, which very often provides the practitioner with only the most fleeting glimpse of a child’s tiny eardrum.
The cameras on smartphones now provide such high resolution under limited light conditions that a simple attachment provides high-resolution magnified views, giving doctors—and now parents—the ability to capture images of the ear drum, which can be sent to a doctor.
Specialized attachments and associated applications have turned smartphones into devices that produce images almost as good as those available in eye doctors’ offices. The technology may not become available to the general public, however, because these examinations often require the use of pupil-dilating eye drops, which are used only in office settings. Simpler devices, however, are able to perform visual acuity exams, alerting patients when their eyeglass prescriptions become outdated.
Vendors are beginning to look for ways that smartphones could enable clinicians to quickly and inexpensively gain insight into patients through imaging. For example, Butterfly Network, a rising medical imaging company, is making a pocket-sized ultrasound device that plugs into an iPhone. The medical imaging firm began selling its first product, called the iQ. Priced at $2,000—significantly less than conventional ultrasound imaging machines—it could make the scans vastly more accessible.
In another example, a novel way to locate “regions of interest” in dermoscopy images can improve the detection of skin lesions, through the use of an app on a consumer mobile device, enabling real time identification and diagnosis of cancer and other skin conditions, according to new research reported in arXiv.org, part of the Cornell University Library. The approach uses an attachment to a smartphone that improves its ability to image skin lesions.
Through the use of apps and attachments, smartphones also can better inform patients who need to continually monitor their conditions. For example, in one study, patients with diabetes and uncontrolled hypertension who used a smartphone app were able to significantly reduce their blood pressure within six weeks.
The pilot study was funded by vendor Livongo, the maker of the app that remotely monitors blood pressure, provides recommendations on healthy choices and connects users with a health coach. The study showed that participants’ systolic blood pressure declined by an average of 5.4 mm Hg and diastolic pressure declined by 3.5 mm Hg on average.
Communication aid with device manufacturers
Smartphones also have the capability to monitor the performance of medical devices being used to aid patients. For example, Medtronic is marketing a mobile app for patients with pacemakers that communicates with patients’ smartphones and tablet devices. The MyCareLink Heart app securely sends device data to the Medtronic CareLink network, which can eliminate the need for remote monitoring hardware, according to the vendor, which manufactures biomedical engineering devices and technology.
Some physicians have voiced concerns about diagnostic devices being used in patients’ homes. Expertise and judgment are required when interpreting any medical test. Nevertheless, no one expects smartphone-based devices to completely replace the physician. Only trained cardiologists can read ECGs, and only trained neurologists can read EEGs. For other devices, physicians can and should actively participate in guiding the patient through the diagnostic and therapeutic process. Skilled nurses can help patients use these devices in ways that can greatly increase their accuracy. Still, there’s a risk that patients might take too much medical care into their own hands, increasing the need to offer close provider-patient interaction in their use.
Originally published in Health Data Management by Fred Bazzoli on May 22, 2019