JOURNAL OF MEDICAL INTERNET RESEARCH Ozdalga et al

Review

The Smartphone in Medicine: A Review of Current and Potential

Use Among Physicians and Students

Errol Ozdalga1*, MD; Ark Ozdalga2*, BS; Neera Ahuja1*, MD

1
Stanford University Hospital, Stanford, CA, United States
2
(not affiliated with an institution), San Jose, CA, United States
*
all authors contributed equally

Corresponding Author:
Errol Ozdalga, MD
Stanford University Hospital
MC 5209
300 Pasteur Dr
Stanford, CA, 94305
United States
Phone: 1 4084992117
Fax: 1 8885617051
Email: [email protected]

Related Article:
Letter: http://www.jmir.org/2013/4/e89/

Abstract
Background: Advancements in technology have always had major impacts in medicine. The smartphone is one of the most
ubiquitous and dynamic trends in communication, in which one’s mobile phone can also be used for communicating via email,
performing Internet searches, and using specific applications. The smartphone is one of the fastest growing sectors in the technology
industry, and its impact in medicine has already been significant.
Objective: To provide a comprehensive and up-to-date summary of the role of the smartphone in medicine by highlighting the
ways in which it can enhance continuing medical education, patient care, and communication. We also examine the evidence
base for this technology.
Methods: We conducted a review of all published uses of the smartphone that could be applicable to the field of medicine and
medical education with the exclusion of only surgical-related uses.
Results: In the 60 studies that were identified, we found many uses for the smartphone in medicine; however, we also found
that very few high-quality studies exist to help us understand how best to use this technology.
Conclusions: While the smartphone’s role in medicine and education appears promising and exciting, more high-quality studies
are needed to better understand the role it will have in this field. We recommend popular smartphone applications for physicians
that are lacking in evidence and discuss future studies to support their use.

(J Med Internet Res 2012;14(5):e128) doi: 10.2196/jmir.1994

KEYWORDS
Smartphone; technology; education; medicine; telemedicine; health care; Android; iPhone; BlackBerry; mobile phone

operating systems capable of advanced functions have paved

Introduction the way for applications (commonly referred to as apps) that
On April 3, 1973 the first cellular phone call was placed by a are affecting our personal and work environments. Like other
general manager at Motorola [1]. Ever since, mobile industries, the field of medicine experienced the resounding
communication has drastically changed the way we work and effects of the smartphone. In fact, it may be among those
live our lives. More recently, another technology is again driving industries where the impact has been most profound. One market
such change: the smartphone. Faster processors, improved research firm estimates that 72% of US physicians use a
memory, and smaller batteries in concert with highly efficient smartphone, and the research firm expects this number to rise

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to 81% in 2012 [2]. In another study, 85% of medical providers smartphone in health care or discussed its implications. For the
working in Accreditation Council for Graduate Medical purposes of this article, we defined the smartphone as any
Education training programs reported use of the smartphone cellular device that has additional functions including a camera,
[3]. global positioning system (GPS), and Wi-Fi capabilities and is
running one of the following operating systems: iPhone,
Today, smartphones are being manufactured by numerous
Android, BlackBerry, or Windows Mobile. Our search criteria
companies and are one of the fastest growing sectors in the
included any primary article or review that discussed innovative
technology industry. Operating systems include Google’s
roles of the smartphone in the field of internal medicine. These
Android, Apple’s iOS, Research in Motion’s BlackBerry,
roles included patient care, medical reference, and continuing
Nokia’s Symbian, and the Windows Phone 7 platform. From
education. We also sought uses of the smartphone in medical
patient monitoring and diagnostics to more efficient medical
education, communication, and research. We excluded any
education and communication, smartphones serve a vital role
articles that were limited to mobile phones (considered the
in the practice of medicine today. In this review, we will the
precursor to the smartphone) or personal digital assistants.
available literature to understand how the smartphone has
Additionally, we did not include papers within the field of
changed the field of internal medicine and medical education.
surgery or the surgical subspecialties given the already broad
We also survey the ways in which the smartphone is used to
scope of this topic. Moreover, as internal medicine physicians,
better understand how that impact might be achieved. We
we felt it would be inappropriate to comment on the uses of the
conclude this review with suggested apps for physicians based
smartphone in this setting.
on anecdotal experience and suggest studies that can better
answer these questions. Research on the use of smartphones in medicine and medical
education is limited, which hindered our development of a
Methods systematic article selection process. We did give priority to
primary sources that were controlled, multicentered reports
Database Search providing outcome data.
We searched both Medline via PubMed and Scopus databases
for the literature review. Using PubMed we searched a Results
combination of the Medical Subject Heading cellular phone
with the related key words smartphone*, smart phone*, mobile Search Results
phone, iPhone, android, blackberry, and windows mobile. All From our initial combined database search, we retrieved 2351
terms were combined using the Boolean operator OR. Our articles (Figure 1). A title and abstract review was conducted,
Scopus search used the following keywords: smartphone*, from which we identified 112 articles for detailed review and
smart phone*, iPhone, android, blackberry, and windows added 1 article from the citation review. Of these, 60 articles
mobile, and was combined with medicine to narrow our results. met the eligibility criteria. Given the large sample size, we
We limited our search to journals written in English in both further analyzed these articles to subdivide them into the
databases. Both searches were also limited to the last 5 years. following categories: (1) patient care and monitoring, (2) health
The citations of the search results were then manually queried apps for the layperson, (3) communication, education, and
for eligible articles and reviews. These searches were conducted research, and (4) physician or student reference apps. Of note,
over a period of 10 months, from August 2011 to May 2012. some papers involved both patient care and communication,
but we categorized them based on the smartphone’s primary
Search Criteria purpose. For example, if the smartphone was aiding patient care
Given the broad nature of our review, we attempted to include via telediagnosis, then we placed the article in the category of
all articles that either exemplified particular roles for the communication.

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Figure 1. Flow diagram of the process of article selection and results.

attend traditional hospital-based rehabilitation were monitored

Patient Care and Monitoring in real time through their smartphones while they exercised in
Our literature search found several examples of the use of the their own neighborhoods [6]. This small study followed 6
smartphone’s features for patient monitoring. One such example patients who recently had a coronary event or angioplasty for
involved patients with Alzheimer disease. An attempt to deal 116 exercise sessions. Information obtained from the
with the risk of wandering was proposed with the use of the smartphones allowed researchers to track their patients’ heart
Android app iWander [4]. The app works by using the rates, single-lead rhythms, locations, altitudes, and walking
smartphone’s GPS to track the patient at all times. The patient’s speeds. This information was then used to create custom exercise
age, level of dementia, and home location on the GPS are input regimens, leading to improved postintervention 6-minute walk
into the software. If the GPS detects that the patient is away tests. Patients also reported reduced depression and improved
from his or her home (for example, uncharacteristically late in quality of life on questionnaires.
the day or during inclement weather), the algorithm may predict
that the patient has become confused. The app then requests Other studies demonstrated the smartphone’s potential in patient
that the patient manually confirm his or her status. Not providing monitoring. Shoes fitted with sensors that communicate with
confirmation triggers an alarm that notifies the patient’s family the smartphone were used to follow the activity level of patients
and primary care doctor or contacts emergency personnel. It who have recently had a stroke [7]. The smartphone’s
has also been suggested that identifying Alzheimer patients with accelerometer can be used to interpret gait and balance of
depression might be possible simply by monitoring behaviors patients [8-11]. Another study entailed connecting a single-lead
via the smartphone’s functions, such as their movements using ECG to a smartphone to diagnose and follow treatment with
Bluetooth technology, their communication patterns, and their sleep apnea [12], providing a possible alternative to costly and
level of activity from the GPS. It is important to note that this labor-intensive polysomnography. One study used smartphones
app is limited by factors such as GPS and Internet reliability. to promote physical activity by asking participants to routinely
Also, an older patient with mild dementia may have little ability log their results [13].
to use such modern devices. Recognizing the challenges of a growing elderly population,
The smartphone has also been used in rehabilitation [5]. Using one group worked on the European Union-funded project
smartphones connected via Bluetooth to a single-lead Enhanced Complete Ambient Assisted Living Experiment [14].
electrocardiograph (ECG) device, patients who were unable to This project intended to build a comprehensive remote

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monitoring system targeted at older people with chronic information, such as the type and quantity of food consumed,
diseases. Using sensors attached to garments, continuous these apps calculate the user’s total daily caloric expenditure.
information was monitored and collected. Data from this 3-year
Other apps help track the amount of exercise an individual does.
project (June 2009 to May 2012) intended to show how
Using the GPS and accelerometer, phones can be turned into
smartphone technology provides an environment where older
and navigators and pedometers [28].
people can maintain their independence. At the same time, the
researchers hoped to provide a way to minimize health care Wellness apps that teach yoga are available, as are apps that
costs through early detection of acute illnesses and a decreased focus on other forms of relaxation such as breathing [28].
need for skilled nursing homes. Women can input the dates of their periods and body
temperature to help predict ovulation. Some apps remind a
Patients with type 1 diabetes are also among those who could
patient to take his or her medication. Other apps contain an
benefit from smartphone technology, by using Diabeo [15].
individual’s important medical information such as allergies,
Diabeo is an app that collects information such as self-measured
medications, and contact phone numbers in the event of an
plasma glucose, carbohydrate counts, and planned physical
emergency. There is also an iPhone app that offers free hearing
activity prior to making insulin dosing recommendations.
tests [29].
Researchers in France conducted a 6-month multicenter study
of 180 adult patients with type 1 diabetes with glycated Of the available data concerning the validity of apps to promote
hemoglobin above 8%. They found that patients using Diabeo wellness, a review of obesity-related apps for diet and exercise
together with telephone conversations had lower glycated showed that a vast majority of them rated low on a custom
hemoglobin levels than those with clinic visits. The app was scoring system based on topics covered, accuracy, and other
used safely with no differences in hypoglycemic events. parameters [30]. Similar findings were noted with reviews of
apps for alcohol abuse and smoking cessation [31,32].
The ability to automatically monitor patients with diabetic and
heart conditions from their smartphones is being developed One report described a method of surveying participants to
[16]. This technology extends to other conditions such as create a framework from which to create an app promoting
movement disorders or bipolar disorder [17-19]. Additionally, physical activity [33].
engineers are testing the smartphone to be used as a device for
iTriage (iTriage, LLC, Denver, CO, USA) is an app that
monitoring patients’ balance using the phone’s accelerometer
provides patients with information such as the locations of
[20].
nearby emergency rooms, doctors by specialty, and other
The use of the smartphone as a patient-monitoring device has practical information [34]. It provides emergency room wait
also been described in resource-poor countries. Smartphones times and allows for registration via the app at participating
used by health care workers treating malaria in rural Thailand locations. Another similar app was designed to improve
allowed for better follow-up, medication adherence, and diagnosis and treatment times of stroke patients [35]. ZocDoc
collection of information [21]. A similar study in Kenya allowed (ZocDoc, Inc, New York, NY, USA) allows patients to
workers to collect data during home visits [22]. conveniently make appointments with physicians who choose
to use this system. Patients can view open slots and other
With a hands-free microphone, the smartphone has been used
information about participating doctors.
to record heart sounds for tracking heart rate and heart rate
variability. The phone’s camera along with its light-emitting Communication, Education, and Research
diode light source has been shown to measure heart rate The smartphone has been used for years in hospitals with limited
accurately [23]. Recently, teams have begun working on ECG network capability [36]. It also has been shown to improve
recording devices that work with smartphones [24,25]. communication among doctors and nurses on inpatient wards.
Moreover, the smartphone is being used for echocardiography Timely communication within hospitals remains a fundamental
[26]. MobiSante (MobiSante, Inc, Redmond, WA, USA) became means by which to reduce medical errors [37]. The internal
the first company to design and build a US Food and Drug medicine program at Toronto General Hospital conducted a
Administration (FDA)-approved cell phone-based medical study using dedicated BlackBerrys for each medical team [38].
diagnostic tool with an ultrasound probe in January 2011. A Nurses could call the team or use a Web program to send emails
smartphone connected to a Doppler device has been used for to these phones for less-urgent issues. Overall, surveys from
blood flow measurement [27]. residents reported improvements in communication and
Health Apps for the Layperson decreased disruption of workflow. Nurses reported decreased
time spent attempting to contact physicians; however, there was
In our review we did not find clear data describing usage trends
no change in response time for urgent issues. Another study by
of apps for patients. Additionally, we did not find any evidence
this group also illustrated the efficiency of smartphones over
that these apps lead to wellness. Here we briefly review some
pagers but noted a perceived increase in interruptions and
apps mentioned in our literature search for laypersons.
weakened interprofessional relationships [39]. They also
Weight loss and fitness apps are among the most used. The apps reported value in the ability to receive nonurgent messages via
Lose It! and Calorie Counter provide a way for people to keep email; however, there has been disagreement as to what types
track of how many calories they consume and burn for better of messages are appropriate for various communication methods
control of their weight loss goals [28]. Based on the input [40].

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Communication is also affected by integrating with electronic A study in 2010 claimed that over 60% of physicians surveyed
medical records. One company, Epic Systems (Epic Systems felt that Epocrates (Epocrates, Inc, San Mateo, CA, USA) helped
Corporation, Verona, WI, USA) has partnered with Apple to reduce medical errors [59]. Epocrates claims that their app
(Apple Inc, Cupertino, CA, USA), releasing versions of Epic can help save 20 minutes of time each day for many of their
for both the iPhone and iPad [41]. Another app specifically users [60], but this is not supported by the evidence base.
designed for one particular hospital is being created to provide
doctors with access to patient records from smartphones [42]. Discussion
Interesting and educational patient physical findings are better Here we summarize the database search identifying how the
documented with the use of the phone’s camera. A group smartphone is being used in medicine. We focused on data that
demonstrated that they could accurately diagnose acute stroke would either support or negate the impact of the smartphone
on brain computed tomography scans through the use of iPhones and then surveyed the range of uses to better understand the
with identical accuracy to standard workstations [43]. Another forms in which that impact might occur.
study of stroke patients found comparable examinations of
patients in person and via iPhone [44]. With respect to patient care and monitoring, we found various
ways of using the smartphone to monitor patients. We identified
Several examples demonstrating the smartphone’s role in research attempting to provide evidence that the smartphone
communication can be found in developing countries with scarce has advantages in this area; however, much of this is still in the
resources [45]. In Africa, the amount of network coverage to preliminary phase. Apps such as iWander for people with
send text messages with pictures ranges from 1.5% to 92.2% dementia (see Patient Care and Monitoring above) could
[46], providing an opportunity to send pictures of physical improve quality of life and decrease financial burden.
findings to aid in telediagnosis. Pictures from phone cameras Approximately 5.3 million Americans have Alzheimer disease,
of Gram stains have been sent via text messaged for remote and it has been estimated that this number could quadruple by
diagnosis [47]. Video clips of limited echocardiographic studies the year 2050 [61]. As we enter a new era of rising medical
were taken in remote Honduran villages sent via iPhones to costs exacerbated by a growing elderly population, our health
experts for interpretation [48]. This has been reproduced with care system is looking for ways to meet the rising demand. It
lung ultrasound [49]. Engineers have created various remains to be seen whether the smartphone can help.
microscopes that attach to smartphones, providing a
cost-effective and mobile way to bring more technology to poor We found a wide range of apps for the layperson, from wellness
and rural regions [50-52]. Development of point-of-care apps apps to apps that allow improved communication with health
for human immunodeficiency virus (HIV) infection treatment care providers. The greatest concern is the general lack of
to support physicians with limited HIV training in undeveloped regulation and an evidence base for many of these wellness
regions is expected to minimize errors and improve outcomes apps. Much like the general information available on websites,
[53]. the content of many health-related apps is poorly scrutinized
for accuracy. The FDA does not control the content of most
Outbreaks Near Me (HealthMap, Boston Children’s Hospital, apps; only when apps cross the line of providing direct medical
Boston, MA, USA) provides information on disease outbreaks advice does the FDA make approval mandatory. An example
by geography [28,54]. This project, funded by Google and done of this is the diabetes app WellDoc DiabetesManager System
in collaboration with organizations including the US Centers (WellDoc, Inc, Baltimore, MD, USA), which required FDA
for Disease Control and Prevention, obtains information from approval when it started providing medical advice based on
multiple resources, including online news, eyewitness accounts, input blood glucose levels. Other apps available for free
and official reports. download include symptom checkers, where people can input
In one example of the uses of the smartphone in medical basic symptoms such as abdominal pain and get a whole list of
education, doctors who were trained to use a smartphone app possible causes, prompting inappropriate self-diagnosis and
for teaching advanced life support had significantly improved unneeded anxiety.
scores during cardiac arrest simulation testing [55]. A survey Not surprisingly, we found a larger number of articles that
among medical residents in Botswana showed how a smartphone discussed ways in which the smartphone is improving
preinstalled with medical apps can be an effective way to obtain communication on internal medicine wards. These results
information in a resource-poor region [56]. suggest that there may be a role for better communication
We found two articles describing the use of the smartphone in between doctors and nurses; however, drawbacks such as
medical research. In one example, the smartphone was used to weakened interprofessional relationships may produce new
improve data collection during trials [57]. In another, a study issues. We found it interesting that many people are looking
of falls risk in the elderly, the smartphone’s accelerometer was into using the smartphone for remote diagnosis. It is easy to
used to help detect those at higher risk [58]. imagine the huge benefits that could be reaped in resource-poor
regions of the world, but this may also lead to a change in
Physician and Student Reference Apps insurance companies’ reimbursement methods. In the future,
During our literature review, we found very limited data patients may not need to see their physicians in person as often
regarding the use of reference apps by physicians or medical to get the same quality of care. However, we have not found
students. any evidence specific to the smartphone to support this.

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We also find some examples of the smartphone’s use in but we presume that given the high number physicians with
education, such as a program that teaches cardiopulmonary smartphones and the large availability of apps, many physicians
resuscitation, and the use of smartphones by students in are using these reference apps. A survey of health care providers
resource-poor countries. Medical schools in the United States showed that attitudes toward using smartphones are in general
are also beginning to use technology more in their curriculum. very positive [62].
For example, at Stanford University’s medical school all
students are given an iPad to use in place of text books. Online
Medical Reference Apps
resources are easily accessed. Given the importance of medical reference apps and the paucity
of published data regarding available apps and the evidence for
As the role of the smartphone continues to grow, we can only their use, we present a list of commonly used apps and make
expect that its role in medical education will expand with more suggestions for future research toward better understanding
institutions incorporating it into their curriculums. However, their utility. This list of apps derives from our anecdotal
we need to have better evidence to support both its use and experience, for which we have given preference to apps known
methods of how best to use it. to have a vast database, to have reliable content, to be well
Among our categories, we found that the area most lacking in respected (or contain information adapted from well-respected
evidence is the use of smartphones for physician or student resources), and to have been available for many years. There
reference apps. We found only one older study looking into the are no conflicts of interest. We review some of the most popular
effectiveness of apps to aid in the practice of medicine, with and important apps being used to enhance continuing medical
Epocrates. There is no clear reported data on usage statistics, education, improve patient care, and promote communication
(Table 1).

Table 1. List and description of popular medical applications for physicians.

Smartphone application Description
Epocrates Free up-to-date pharmacologic reference and paid medical
reference.
DynaMed Medical and pharmacologic reference
Johns Hopkins’ Antibiotics Guide Antimicrobial reference
Sanford Guide to Antimicrobial Therapy Antimicrobial reference
Diagnosaurus Differential diagnosis
Taber’s Medical Dictionary, Stedman’s Medical Dictionary, and Dorland’s Medical Dic- Medical dictionaries and reference
tionary
Archimedes (Archimedes 360°) Free medical calculator (Archimedes 360° is available
for a fee)

AHRQ ePSSa Primary care prevention

Medscape Medical reference, news, and education
Massachusetts General Hospital’s Pocket Medicine Medical reference
Washington Manual of Medical Therapeutics Medical reference
QuantiaMD Medical education with interactive cases
MedPage Today Medical news
Doximity Social networking for physicians and physician commu-
nication

a
Agency for Healthcare Research and Quality Electronic Preventive Services Selector.

Epocrates is well known for offering a free, up-to-date focuses on creating mobile phone apps for all health care
pharmacologic reference that is available for all smartphone professions and boasts over 600 apps spanning 35 specialties.
platforms. Strengths of this program include drug dosage They formulate popular textbooks into searchable programs on
guidelines, adverse reactions, mechanism of action, and a drug the smartphone. There are many notable apps, including
interaction checker. Epocrates also offers an upgrade to the full Massachusetts General Hospital’s Pocket Medicine and The
version that includes more comprehensive disease and laboratory Washington Manual of Medical Therapeutics. Unbound
information. Another resource for pharmacologic reference is Medicine (Unbound Medicine, Inc, Charlottesville, VA, USA)
mobilePDR (PDR Network, LLC, Montvale, NJ, USA), produces a similar product offering. Both companies have apps
available for free to doctors after validation of credentials. available for many categories, including pharmacology, medical
references, and medical dictionaries.
Another resource in medical-related apps for doctors is Skyscape
(Skyscape.com, Inc., Marlborough, MA, USA). Skyscape
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DynaMed (Figure 2) is a full medical reference app from The aforementioned programs are just a few of the large number
EBSCO Publishing (EBSCO Publishing Inc, Ipswich, MA, of evolving resources on the mobile phone. Companies such as
USA). DynaMed houses a large repository of disease, syndrome, Medscape (Medscape, LLC, New York, NY, USA) offer a
and drug information. It differs from other resources such as mobile resource for medical and drug information. They also
UpToDate (UpToDate, Inc, Waltham, MA, USA) in that it provide medical news and case studies for continuing education.
optimizes its content for use and display on a mobile platform. QxMD (QxMD Software Inc, Vancouver, BC, Canada)
Once the app is fully downloaded, an Internet connection is no specializes in mobile medical programs such as their popular
longer needed to access this program. 5-Minute Clinical Consult ECG Guide. Information from the International Classification
(Lippincott Williams & Wilkins, Philadelphia, PA, USA) is of Diseases, 9th revision (ICD-9) can be quickly obtained from
another medical reference app organized similarly to DynaMed. QxMD’s ICD-9 app. DynaMed’s app also contains ICD-9
UpToDate offers a mobile Web version of their ubiquitous Web information. QuantiaMD (Quantia Communications, Inc,
platform that is similar in organization but does not offer a Waltham, MA, USA) has a mobile app that specializes in
smartphone app. continuing medical education by providing well-scripted
interactive case studies that can be shared with colleagues
A popular infectious diseases resource is Johns Hopkins’
(Figure 3). Continuing medical education credits can also be
Antibiotic Guide (Unbound Medicine, Inc), providing detailed
earned. MedPage Today (MedPage Today, LLC, Little Falls,
information regarding antibiotics and pathogens. Another
NJ, USA) allows physicians to stay on top of the latest medical
well-known antibiotic resource is the Sanford Guide to
news, organize news by interest, and earn continuing medical
Antimicrobial Therapy (Antimicrobial Therapy, Inc, Sperryville,
education credits.
VA, USA).
Doximity (Doximity Inc, San Mateo, CA, USA) has been
Mobile differential diagnosis programs can help ensure that
likened to a Facebook for doctors. It allows physicians, once
common diagnoses are not overlooked or discovered too late.
registered, to network and even communicate patient-related
One such well-known program is Diagnosaurus (The
information in a Health Insurance Portability and Accountability
McGraw-Hill Companies, Inc; New York, NY, USA).
Act-compliant text messaging environment (Figure 4). A
Other apps, such as medical calculators, are very prevalent in credential check of a potential user’s medical license (which is
app stores and can help quickly calculate risk scores or other already in their database) is required to sign up.
common calculations, such as water deficit in hypernatremia.
While many of these apps have been available for years and are
Skyscape offers a free medical calculator called Archimedes.
very popular, there are still no data to both support their use
Lastly, medical dictionaries such as Taber’s, Stedman’s, and
and help us understand how best to use them. We believe that
Dorland’s are invaluable resources to have readily available in
studies surveying doctors on the perceived impact that specific
one’s pocket.
apps create, as well as examining patient care outcomes, can
An app for primary prevention is offered for free by the US help us understand how powerful these apps can be. The use of
Department of Health and Human Services, Agency for these apps by students while on clinical rotations can also
Healthcare Research and Quality (AHRQ). The AHRQ support education at the bedside. This could translate into an
Electronic Preventive Services Selector is an app designed to improved quality of education that could be a focus of
assist primary care physicians in identifying screening, examination.
counseling, and preventive measures based on their patient’s
age, sex, and other risk factors.

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Figure 2. DynaMed’s medical reference program with organization of topics shown at left.

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Figure 3. QuantiaMD allows for interactive case challenges within multiple specialties, features guest lecturers, and allows physicians to earn continuing
medical education points, all from the smartphone.

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Figure 4. Doximity connects colleagues from around the United States and allows for secure communication.

those who are more technologically savvy. And finally, as we

Drawbacks and Obstacles become more dependent on technology, we become more
Although there are numerous benefits to integrating smartphones dependent on it working flawlessly, with catastrophic
into the practice of medicine and one’s personal life, there are implications when it fails.
noteworthy limitations. We again emphasize the ramifications
mentioned above of patients self-diagnosing using apps that are Doctors and patients are not able to take full advantage of
not regulated. Moreover, the major technological improvements smartphone technology in areas such as teleconferencing,
of both hardware and software are still relatively new and, thus, sending pictures, and emailing, due to health care system
sometimes unreliable. Furthermore, older physicians and others reimbursement processes in the United States. These systems
less inclined to use or intimidated by new technologies may be usually reimburse only the time spent with patients face-to-face.
at a disadvantage if the use of smartphones becomes more As the smartphone integrates its way even more permanently
requisite within medicine. Similarly, elderly patients may find into our medical practices, a greater question arises: will this
it difficult to use and interpret the information provided to them mobile technology improve communication between doctors
by their smartphone, possibly putting them at greater risk than and patients or detract from it by limiting the personalized
interactions that occur best at the bedside or in the office?

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Limitations of This Review to answer many questions about its use and the impact it may
The major limitation of the review stems from the overall have. Apps for pharmacology, medical references, and a myriad
paucity of high-quality studies such as multicentered or of other categories are providing physicians with quick and
controlled trials using the smartphone in medicine. While we practical medical information that will aid in education and
did find some studies of patient monitoring and communication, patient care. Communication within hospitals and between
even these categories leave many questions to be answered, and patients is improving. Additionally, developing countries now
future studies are either planned or underway. have the potential to access better diagnostic tools in
resource-poor regions. However, many obstacles still stand in
Additionally, we again note that this review did not include the way of this progress. The question regarding whether
papers that demonstrated novel uses of the smartphone in the smartphones in medicine will lead to a healthier population with
field of surgery and its surgical subspecialties. As internal better patient–doctor relationships remains to be answered.
medicine physicians, we felt that our analysis on this subject Nevertheless, the smartphone has a very bright future in the
may be inaccurate and thus chose not to include this. world of medicine, while doctors, engineers, and others alike
Another limitation of this study is the rapid and evolving nature continue to contribute more ingenuity to this dynamic field. It
of this technology. We intended to make this review as is our hope that by informing the medical community of the
up-to-date as possible, including the addition of new reports numerous ways in which the smartphone can be used to benefit
just prior to publication of this paper; however, this topic is health care providers, patients, and their families, the smartphone
evolving as rapidly as advancements in the industry are made, may one day be recognized as a diagnostic and therapeutic tool
outpacing our ability to provide the most current study possible. that is as irreplaceable as the stethoscope has been in the practice
of medicine.
Conclusion
The amount of research in the use of the smartphone in medicine
is rapidly growing, but there are very few good-quality studies

Acknowledgments
We would like to thank Lauren Maggio, MS (LIS), MA, Director of Research and Instruction at Stanford University’s Lane
Library, for her invaluable support with this review. We would also like to thank Kelley Skeff, MD, for his advice. We finally
thank the editor, reviewers, and our colleagues for their useful comments, which greatly helped to improve this paper.

Conflicts of Interest
None declared.

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Abbreviations
AHRQ: Agency for Healthcare Research and Quality
ECG: electrocardiograph
FDA: Food and Drug Administration
GPS: global positioning system
ICD-9: International Classification of Diseases, 9th revision

Edited by G Eysenbach; submitted 11.11.11; peer-reviewed by R Wu, F Wodajo; comments to author 15.01.12; revised version received
06.02.12; accepted 01.08.12; published 27.09.12
Please cite as:
Ozdalga E, Ozdalga A, Ahuja N
The Smartphone in Medicine: A Review of Current and Potential Use Among Physicians and Students
J Med Internet Res 2012;14(5):e128
URL: http://www.jmir.org/2012/5/e128/
doi: 10.2196/jmir.1994
PMID: 23017375

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