The Charlotte Observer
June 6, 2011
Docs add apps to their medical bag
As Dr. John Allbert watched his teenage daughter's spring talent show, his cellphone began vibrating.
He stepped outside to take the call from a fellow obstetrician wanting advice about a pregnant patient whose fetus might be in distress.
To get a better picture of the situation, Allbert walked to his car to grab his iPad. There on the 8- by 10-inch screen, Allbert read the patient's vital signs and saw the squiggly lines that represented the baby's heartbeat and the mother's contractions.
Thanks to a new mobile phone application, Allbert could use his iPad, or his smaller iPhone, to check the same monitoring systems and records the other doctor was seeing by the patient's bedside.
Without having to miss the talent show or rely on the other doctor's explanation, Allbert assessed the patient's vital signs and realized there might not be enough amniotic fluid around the baby. An ultrasound confirmed Allbert's suspicion, and the other doctor delivered the baby immediately, seven weeks prematurely, to avoid complications.
"In five to 10 minutes, I was able to pull it up and figure out what to do," Allbert said. "Any time you can put your eyes on something, instead of having it described to you, it just enhances the communication."
Allbert is one of about 125 physicians at nine Novant Health hospitals, including Presbyterian Hospital, Presbyterian Hospital Matthews and Presbyterian Hospital Huntersville, who are using AirStrip OB software to monitor patients from remote locations.
They're the first in North Carolina to use this iPhone application. About 250 U.S. hospitals, including five in South Carolina, use the AirStrip OB technology, which received clearance from the Food and Drug Administration in 2006.
N.C. doctors in other specialties are also using mobile phone technology to monitor patients. And many predict they're at the beginning of a revolution.
"Health care is really at a transition point," said Dr. Jeff Carr, director of biomedical informatics at Wake Forest Baptist Medical Center in Winston-Salem.
"The interface between patients and their doctors is going to dramatically change, thanks to the mobile technology that we're already using in our personal lives."
More apps than needed
About 75 percent of U.S. physicians own some sort of Apple mobile device, such as an iPad, iPhone or iPod, according to a Manhattan Research study released this month.
Not all of them use the devices for medical monitoring, but that time could be coming.
AirStrip OB has "really started to pick up steam" in the last few months, said Dr. Iltifat Husain, founder of iMedicalapps .com, a website that reviews mobile technology for medical professionals.
More than 6,000 medical apps are available for the iPhone, but Husain said most are not useful for practitioners. His site has reviewed more than 300 apps that he believes are useful for doctors. He is enthusiastic about AirStrip OB and the newer apps that enable physicians to view radiology images.
"It's creating what I call the untethered physician," said Husain, an incoming emergency medicine resident at Wake Forest. "I think it's fantastic."
While Novant adopted AirStrip OB last year, Carolinas Medical Center, part of Carolinas HealthCare System, is still reviewing it.
Meanwhile, cardiologists at CHS's Sanger Heart & Vascular Institute are able to view radiology images on their iPads.
And since January, CMC emergency physicians and cardiologists have been using smartphones and email to see results of electrocardiograms on patients who are being transported by ambulance.
Doctors can review the results, sent by paramedics, "before the patient arrives at the hospital, sometimes up to 20 or 30 minutes in advance," said CMC's Dr. Lee Garvey. It gives medical teams in the emergency room and cardiac catheterization lab time to prepare, and it can also help paramedics with triage.
Doctors at Wake Forest don't use AirStrip OB, but they're among the leaders in using mobile technology to track patients.
Patient records at Wake Forest are available electronically on iPhones or iPads. "You can look at X-rays. You can look at vital signs," Carr said.
Wake Forest doctors are also testing a system that not only allows them to access records and monitors from mobile phones, but also sends alerts if monitors detect a potential problem, such as a developing infection.
"It actively signals the health care team that there's been a change," Carr said. "Rather than the nurse identifying the problem and paging the doctor and waiting for the doctor to call back ... this allows everybody to have the information in near real time. We can move into action much quicker."
Carr said the system is still being tested to make sure it's useful. "There's a challenge that the rate of change of technology outstrips the science base," he said. "Not everything that looks cool helps people."
At Charlotte's three Presbyterian hospitals, obstetricians, midwives and nurses believe AirStrip OB improves communication and enhances patient care and safety.
"Remote monitoring allows us to further protect our tiniest, and one of our most vulnerable, patient populations and their moms," Allbert said.
He admits that some physicians can be condescending to nurses, creating an atmosphere where nurses may be reluctant to bring up a problem or offer an alternative. Also, if nurses call physicians in the middle of the night or when they're seeing office patients, doctors may be curt if they feel the call is unnecessary.
"This technology will hopefully make these interactions more pleasant and give the physician more confidence in giving a plan," Allbert said.
Joanne Thompson, nurse clinical specialist for Presbyterian Women's Center, said it's reassuring for nurses to know that, when they call with a question or a development, the doctor sees the same data they're seeing, in real time.
"Before, we'd call the doctor and give them an overview of what was happening, describe the tracing, read off the vital signs," she said.
"With this, we're both talking about the same piece of information. It's just a great added safety tool. ... It's made us a better team."
Return to In the News