Review Article

The scope of mobile devices in health care and medical

education
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Devi Prasad Mohapatra, Madhusmita M. Mohapatra1, Ravi Kumar Chittoria, Meethale Thiruvoth Friji,
Shivakumar Dinesh Kumar

Departments of Plastic Surgery and 1Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
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Pondicherry, India

ABSTRACT

The use of mobile Internet devices (MIDs), smartphones, and proprietary software applications (also
known as “apps” in short) can improve communication among medical caregivers. The utilization of these
mobile technologies has further transformed health care, communications, commerce, education, and
entertainment, among other fields. Newer technologies have the potential to be adapted for improvement
in health care and medical education in general. Mobile technology is one of the latest strings of
technological innovations that can be integrated into medical education. M-learning (the use of mobile
technologies in teaching/training) has been used as a complimentary resource for interaction between
students and instructors for motivation and learning. The main uses described for mobile devices in
medical education can be divided into (a) information management (IM), (b) communication, and (c) time
management. The field of mobile technology in health-care services and medical education is quite new
and throws open ample opportunities for researchers to conduct further studies. Educators in medicine,
dermatology, and public health as well as practicing physicians and surgeons need to embrace this new
technology, study its further adoption, and assist in the responsible integration of these devices into the
art and practice of medicine.

Key words: Applications, medical education, mobile education, smartphones

INTRODUCTION of usage of these MIDs in improving health care as well

as medical education.
The use of mobile internet devices (MIDs), smartphones,
and proprietary software applications (also known as There has been an accumulative growth in information
technology in the last few decades. The utilization of
“apps” in short) can improve communication among
these mobile technologies has further transformed
medical caregivers.[1,2] Wani et al. have highlighted the health care, communications, commerce, education, and
efficacy of communication using WhatsApp in plastic entertainment, among other fields. Newer technologies
surgery. We would like to elaborate upon a wider scope have the potential to be adapted for improvement
in health care and medical education for medical
Access this article online sciences in general. Due to this reason, mobile devices
Quick Response Code: are increasingly being used since the past few years,
Website: reflecting the growth in technology that has enhanced
www.ijamhrjournal.org
access to information. Thus, the future of health care,
medicine, and medical education depends upon
DOI: technological innovations as well as the capability of
10.4103/2349-4220.159113 future generations of physicians, medical teachers, and
even medical students to adapt to newer technologies.

Address for correspondence: Dr. Devi Prasad Mohapatra, Department of Plastic Surgery, Superspeciality Block, Jawaharlal Institute of Postgraduate
Medical Education and Research (JIPMER), Pondicherry - 605 006, India. E-mail: [email protected]

International Journal of Advanced Medical and Health Research | Volume 2 • Issue 1 • Jan-Jun 2015 3
 Mohapatra, et al.: Mobile devices in health care and medical education

TERMINOLOGY data access is provided by either Wi-Fi or mobile

broadband.
Terminologies like smartphones, MIDs, personal digital
assistants (PDAs), apps, tablets, mobile operating Tablet
systems (mobile OSs), cloud computing, etc. have A tablet computer, also known as a tablet, is a one-piece
become fairly common parlance among the new mobile computer. These devices have a touchscreen,
generations of technology-driven health caregivers. which can be controlled with finger (or stylus) and
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A brief introduction to the terminology in the context supported by the use of one or more physical context-
of mobile technology is essential in improving the sensitive buttons and are guided by the input from
understanding. one or more accelerometers. Accelerometers refer to a
mobile component that can measure the tilting motion
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Mobile device and orientation of the mobile device. These also come
Mobile device is also known as a handheld device, equipped with touch-sensitive hideable onscreen
handheld computer, or simply handheld. It is a small, keyboards. They are available in a variety of sizes like
handheld computing device, having a display screen 7 in and 10 in, which refer to the diagonal screen size.
with touch input and sometimes a miniature keyboard.
The emergence of technological sophistication has Mobile OS
brought about extremely lightweight devices. Mobile OS, also known as mobile operating system, is
an OS software that operates a smartphone, tablet, PDA,
MID or other digital mobile devices. Modern mobile OSs are
A MID is a multimedia-capable mobile device responsible for the multifaceted performance capabilities
providing wireless Internet access. It allows two-way of smartphones. At present, multiple OSs for mobile and
communication with real-time sharing of data and handheld devices are available [Table 1].
location-based services.
Apps
PDA These are application software, used in handheld
A PDA is also known as a palmtop computer or a computing devices having an OS. They are programs
personal data assistant. It is a mobile device that developed to run on the device for a specific purpose.[3]
functions mainly as a personal information manager. These can be either native apps or web apps. The native
With the growing sophistication of mobile devices, these apps depend on the OS and can be used offline. The web
are becoming obsolete. apps are those applications that are present on the web
and can be accessed through the mobile Internet browser
Mobile phone (e.g., mobile website versions of a standard website).
Mobile phone is also known as a cellular phone, cell The web apps need network access and work only when
phone, hand phone, or simply a mobile. It is a device that one is online. With the improvement in mobile software
can be used to make and receive telephone calls over a technology, “hybrid apps” are becoming more common.
radio link while moving around a wide geographical The hybrid apps are advanced versions of web apps that
area. In addition to telephony, modern mobile phones are installed on the MID and have the capabilities to use
support services such as text messaging/short the native apps of the device.
message service (SMS), multimedia messaging service
(MMS), e-mail, Internet access, short-range wireless G
communications (e.g., infrared, Bluetooth) apart from G stands for generations of wireless telecom connectivity.
business applications, gaming, and photography. Accordingly, there are 1G, 2G, 3G, and 4G technologies,
4G being the most advanced technology in general
Smartphone usage at present. Research for the development of 5G
Smartphones are mobile phones built on a mobile OS, technology is being carried out worldwide.
with more advanced computational capability and
connectivity. The first smartphones combined the Cloud computing
functions of a PDA with a mobile phone. Newer models Cloud computing is the use of hardware and software
perform as portable media players, low-end compact resources, which are available in a remote location and
digital cameras, pocket video cameras, and Global accessible over the Internet.
Positioning System (GPS) navigation units combined
to form one multi-use device. Further, modern USE OF MOBILE DEVICES IN HEALTH CARE
smartphones include high-resolution touchscreens
and web browsers that display standard web pages as Recent review studies have highlighted the scope and the
well as mobile-optimized sites. High-speed Internet future prospects of mobile devices in health management
4 International Journal of Advanced Medical and Health Research | Volume 2 • Issue 1 • Jan-Jun 2015
 Mohapatra, et al.: Mobile devices in health care and medical education

Table 1: Comparison of most common mobile OSs in use

OSs iOS Android Windows phone BlackBerry OS
Company Apple Inc. Open Handset Alliance/ Microsoft BlackBerry
Google
Latest version (as 8.1.3 5.0.2 8.1 10.3.1.1565
of February 2015)
Licence Proprietary except for Free except proprietary Proprietary Proprietary
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open source components components

OS family Darwin Linux Windows NT8+ QNX
Applications store apple.com/itunes play.google.com/apps windows.microsoft.com/en-IN/ appworld.blackberry.com
windows-8/apps
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Common devices iPhone, iPad Samsung Galaxy Note, Nokia Lumia, BlackBerry Z10
Google Nexus Microsoft Surface tab
Medical Type A √√√√ √√√√ √√ √√
applications Type B* √√√√ √√√√ √ √√
[Table 2]
Approximate number 24,970 apps 15,965 apps Data not available Data not available
of medical applications
available
*
Android and iOS have dedicated medical apps. BlackBerry has limited medical apps

and health care.[3] Usage of mobile technology in health d. Can transform the mobile phone into a medical
care can be broadly grouped into two categories, device with the addition of an attachment [e.g.,
the first being communication and the second, care. AliveCor’s AliveECG app, which can convert the
Communication could be between physicians and mobile phone into an electrocardiogram (ECG)
patients, physicians and health-care workers, or among monitor].
physicians themselves. Communication between
physicians and patients would be typically related to Few studies have been carried out for assessing the
appointment scheduling, advice regarding procedures/ diagnostic ability of these software and devices. [4]
medications, or adverse effects of the same. Inter- They have shown excellent correlation between the
physician communication is related to the analysis of smartphone ECG software recording versus the standard
patient care or difficult case scenarios or discussion of 12-lead ECG recordings.
a treatment plan. The communication could be voice-
based or text-based. Voice-based communication is made Utilization of mobile devices for health care in
either through the standard phone calling feature of the specialties like plastic surgery and dermatology could
mobile device that is facilitated by the use of a subscriber be for teleconsultations for burns, treatment planning of
identity module (SIM) card provided by the cellular congenital facial deformities [Figures 1a-c], acute wounds
service provider, or through conversation over the [Figures 1d-f], chronic wounds, lymphedema, limb
Internet using a software application with (e.g., Skype) anomalies, cutaneous lesions, and malformations. Recent
or without video calling. Text-based communication is studies have shown the use of Internet-based instant
done through SMS and typically consists of appointment messaging applications in communication between
schedule reminders or medication and health-care advice physicians.[1] Plastic surgery simulator applications are
as well as reminders. Internet-based text communications available for mobile platforms, which are basically photo
can be done using software applications like WhatsApp[1] morphing software apps and can help in counseling the
that also has the advantage of the ability to send pictures patients about the possible outcomes of a procedure.
for discussion and treatment planning among physicians. Studies have demonstrated the use of apps (e.g., OsiriX)
These advanced communication capabilities of MIDs to intraoperatively analyze the Digital Imaging and
have the potential to be utilized for telemedicine services Communications in Medicine (DICOM) images, over
involving patient data transmission from remote areas to a tablet during surgery.[5] Novel uses of smartphones
a telemedicine center, which could usually be a tertiary having these apps and hardware attachments have been
hospital. Care of the patient could be provided through described in ophthalmology. These apps are being used
newer mobile devices by software applications that: for visual acuity testing, color blindness testing, and also
a. Can provide diagnosis and treatment for fundus photography using a photo adapter device
recommendations through a patient-specific analysis, over the smartphone (e.g., iEXAMINER).[6]
b. Maintain patient health records (e.g., MediTouch),
c. Provide access to evidence-based patient-care Websites (for example, www.theappbuilder.com) for
guidelines (e.g, UpToDate), and the creation of web apps are available where patient-
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 Mohapatra, et al.: Mobile devices in health care and medical education

specific applications can be produced for guidance of Few studies have highlighted the use of smartphones in
treatment schedules, physiotherapy regimens following improving clinical skills in medical education.[11] Mobile
reconstructive surgery, or speech therapy regimens for devices-based medical education can help students,
cleft palate patients. These applications can be designed primarily in various aspects of the cognitive domain of
by the physicians themselves, based on their practice knowledge:
and requirements. a. IM: IM is the collection and management
of information from one or more sources and
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USE OF MOBILE DEVICES IN MEDICAL the distribution of that information to relevant

audiences. IM consists of organizing, retrieving,
EDUCATION
acquiring, securing, and maintaining information.
Present day mobile devices perform these activities
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Mobile technology is one of the latest strings of

technological innovations that can be integrated into extremely well.
medical education. M-learning (the use of mobile 1. Storage and organization: MIDs come equipped
technologies in teaching/training) has been used as a with an inbuilt or expandable memory, which
complementary resource for interaction between students is essential for the storage of information.
and instructors for motivation and learning.[7] Students Consequently, medical textbooks can be stored
view m-learning as having an important supplementary in the form of e-books and portable document
role to e-learning. [8] Studies show that mobile formats (PDFs). A large number of books can
technology creates content generated by the community be stored virtually, depending on the storage
and a community of learners, and so creates a more capacity of the device and can be retrieved
communicative or interactive setting rather than a later. The availability of cloud computing and
traditional content-based setting.[9] Mobile technologies
have been found to be convenient, flexible, and cost- Table 2: Classification of apps that could be used
efficient when compared to paper-based technologies.[10] for medical education
Type A Type B
The main uses described for mobile devices in medical (Apps with additional medical/ (Medical apps (apps with specific
education can be divided into: educational uses) medical uses))
a. Information management (IM), Note taking Medication guides
b. Communication, and Evernote Epocrates
c. Time management.[10] Skitch Omnio
S Note Clinical handbooks and textbooks
We have suggested a classification of medical apps useful File organising Washington Manual Handbook
in medical education according to their utility [Table 2]. AndroZip Harrison’s Textbook of Medicine
Imaging Speciality-specific reference
Camera Neurology reference app
Voice recording iRadiology
Voice recorder Discipline-specific reference

a b c Video player Netter’s Anatomy Atlas

YouTube CME apps and question banks
Cloud storage Medscape CME
Dropbox USMLE question bank
OneDrive Clinical examination apps
SkyDrive Visual acuity test
Web browser Color blindness test
Opera Medical calculators
Google Chrome MedCalc
Schedule organisers and Apps with diagnostic capabilities
d e f “Tasks To do” App
Figure 1: (a-c) Figure demonstrating the use of mobile software S Planner AliveECG
application to show the markings of cleft lip repair and postoperative Group communication iStethoscope
result. (Device: Samsung Galaxy Note 2 (Samsung Electronics, South
WhatsApp Simulation apps
Korea), apps used: Camera, Photo Editor) (d-f) Figure demonstrating
the use of mobile software application to provide intraoperative ChatOn Plastic Surgery Simulator
planning in reconstructive surgery and postoperative result (Device: Google+ Hangout Touch Surgery
Samsung Galaxy Note 2 (Samsung Electronics, South Korea) with The list in this table is indicative. A large number of apps are available in each of the categories
Stylus, apps used: Camera, Photo Editor, WhatsApp) across various OSs

6 International Journal of Advanced Medical and Health Research | Volume 2 • Issue 1 • Jan-Jun 2015
 Mohapatra, et al.: Mobile devices in health care and medical education

storage applications (e.g., Dropbox) has further mobile devices-based medical education were identified
facilitated information storage and retrieval. as portability, flexibility, access to multimedia, and the
Internet-based resources like online repository ability to look up information quickly.
of video clips (e.g., YouTube) provide a platform b. Communication: True to their primary purpose,
for information storage and instructional these devices help in communication between
resources. These can complement traditional peers, teachers, and other members of the medical
teaching and also act as sources of reliable online education team about patient care using telephone,
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medical information for patients. text messages, e-mail, multimedia messages, and
2. Retrieval of information: Other means of teleconferencing. SMS-based schedule reminders
retrieval and access of information is in the have been found to be useful in increasing student
form of online textbooks, apps-based text participation in educational activities. Text-to-speech,
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[Figure 2a] and reference books, medical speech-to-text, and speech-to-speech translations
podcasts, medical calculators, and online have become a reality. How these could be optimally
lectures. In addition, these can be used to used for improving cognitive learning among
access online journals and get medical news medical students remains to be seen.
online. [9] Software archives are packed with c. Time management: These can be based on the use
multimedia-rich educational applications, of calendar-based apps and can help students and
covering virtually every biomedical subject. teachers by providing access to schedules of the
Certified health care providers can have access medical curriculum.
to online continuing medical education (CME)
to revalidate their credentials through these A few disadvantages have been identified with the use of
mobile devices. Mobile devices, including mobile-based devices in medical education.[9,11,12] Studies
smartphones, can serve highly customized have shown that initially the m-learning applications can
educational and scientific content through cause inhibition and anxiety due to the phone keypad
Rich Site Summary (RSS) feeds and social and the screen.[9,13,14] These anxieties seem to be addressed
media. by newer generations of smartphones, which have larger
screens and improvised input devices like the stylus
Studies have showed that smartphones facilitate student that can enable data entry by free hand too [Figure 2b]:
learning by providing immediate access to key facts, a. Superficial learning: Some researchers have
allowing learning in the context (e.g., learning clinical demonstrated apprehension that these devices might
diagnosis and treatment protocols in the wards by enable learners to access information very rapidly.
using applications like Medscape) and by repetition, This may inhibit the “internalization of knowledge,”
supplementing other ways of learning, and making which is a traditional part of medical education,
optimal use of the available time.[8] The advantages of leading to a potential for “superficial learning.”
b. Trusting information sources: Concerns have been
shown about how learners should navigate the
swarm of information available from the devices,
how they should find “good applications,” and how
they would know if the information provided was
of high quality and validated.
c. Distraction: Mobile computing devices have been
accounted for causing distraction from the normal
activities of learners in classrooms and clinical
settings. This could be in the form of receiving a call
or text message, e-mail, or access to social networking
sites on the Internet.
d. Concerns about information privacy: Concerns have
been expressed about the possible implications for
privacy and confidentiality when material related to
patients is stored in one’s personal device.
e. Expenses: The cost of mobile devices, paid apps,
Internet usage charges, mobile data, and talktime
a b charges all add up to the overall expenses of the
Figure 2: (a and b) Figure showing screenshots of a typical reference
learner. In addition, the creation of apps and Internet-
app and a note-taking app (Device: Samsung Galaxy Note 2 (Samsung based training modules seem to be expensive at
Electronics, South Korea), apps shown: Medscape, S Note) present. At the same time, every student cannot
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 Mohapatra, et al.: Mobile devices in health care and medical education

possess devices of similar sophistication due to CONCLUSION

differences in their affordability.
f. Blurring of personal/professional boundaries: Innovative and technologically-inclined physicians,
Concerns have been expressed about mobile epidemiologists, and reconstructive surgeons are
computing devices allowing potential intrusion particularly well placed to utilize the existing mobile
of personal matters (e.g., personal texts and video software applications and also to create applications that
messages) into professional and clinical duties. could address public health issues affecting the population
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like cutaneous malignancies, tuberculosis, clefts, burns,

Some researchers have suggested that synchronous acute wounds, chronic ulcers, and congenital and acquired
sharing may not be possible as a result of unreliable, hand deformities. Educators in medicine, dermatology,
unstable, or unavailable mobile access.[2,14] There are public health as well as the practicing physicians and
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hardware-based concerns like battery life, which would surgeons need to embrace this new technology, study its
limit their uses. Considering these disadvantages and further adoption, and assist in the responsible integration
perceived benefits, researchers have suggested that of these devices into the art and practice of medicine.
mobile technology be used only as a complimentary
tool, in addition to the primary mode of education. The
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How to cite this article: Mohapatra DP, Mohapatra MM, Chittoria RK, Friji
and controlled trials regarding the use of mobile devices MT, Kumar SD.The scope of mobile devices in health care and medical education.
in medicine, especially in developing and resource-poor Int J Adv Med Health Res 2015;2:3-8.
nations need to be carried out. Source of Support: Nil, Conflict of Interest: None declared.

8 International Journal of Advanced Medical and Health Research | Volume 2 • Issue 1 • Jan-Jun 2015