Gadgets for Hospitalists

MDNG Hospital Medicine, May 2008, Volume 2, Issue 2

The Web has finally arrived on our shiny little toys we carry in our white coats or clipped to our belts. Web access has been a feature of PDAs and smartphones for several years now.

There's a buzzword that has been floating around since late 2004 to describe a new breed of internet sites. You've probably heard it used to describe the latest excuse for rocketing (and now dropping) share prices. The phrase is "Web 2.0". Defined loosely as using the web as a platform for delivering applications. Or perhaps defined by sites that rely on user-generated content. Or perhaps it means nothing more than the name of a tech conference back in 2004, when silicon valley VCs were getting exciting about the web again!

So what's this got to do with gadgets? Well, the Web has finally arrived on our shiny little toys we carry in our white coats or clipped to our belts. Of course, web access has been a feature of PDAs and smartphones for several years now. But the web on a smartphone has never really represented the full, interactive, high-speed web we enjoy on our laptop and desktop computers.

Apple iPhone

Storming into the lead of a new generation of web-browsing mobiles is the Apple iPhone. The clear, high-resolution screen combined with an innovative multi-touch display means that browsing the web is a cinch. Load up a page and double tap on a section and the screen smoothly zooms in to paragraph you are reading. Flick your finger down the surface of the phone and the screen smoothly follows, and keeps scrolling with a virtual momentum based on the speed of your finger-stroke. Double-tap again and the screen zooms out to full size. Double tap on another section. Repeat until you've browsed enough. If the screen is still too small, turn the phone on it's side and the page will automatically swing from portrait to landscape as you turn.

The iPhone works best for web-browsing in a wireless network as it is currently only capable of 2.5G mobile broadband speeds using the EDGE or GPRS networks. Other devices, however, are available that use the faster 3G networks which mean that web-browsing outside of a wireless network approaches the speed of a standard broadband connection. Here's a selection of some of the hottest 3G smartphones on the market today.

Nokia N95

This phone has more features that your local megaplex. A 5 megapixel camera, super-fast 3G mobile data and built-in GPS to name but three. No multi-touch so browsing and text entry is a little fiddly. If you want to replace your camera, GPS system and phone all in one go, this is definitely the device for you.

Palm Centro

The latest offering from Palm, the Centro offers 3G browsing in a handy smartphone format. They've also managed to squeeze in a full QWERTY keyboard.

Treo 755p and Treo 750

Both Palm OS and Windows Mobile Treos are feature packed and browse the net at breakneck speeds. You can even plug these devices into your laptop and use them a totally wire-free broadband modem. Having a built in physical QWERTY keyboard is a must for some thumb-typers and both these devices provide in this department.

BlackBerry Curve 8330

Built in GPS, 3G data speeds and all the corporate e-mail functionality we've come to expect from BlackBerry make this a very slick-looking device. Although the lack of built in wifi could be an issue for some.

Mobile Medical Software

I get a lot of emails to my blog (DoctorsGadgets.com) from people unsure of which medical tools are available for their web-enabled smartphones. Most doctors just use their smartphones for email, calendar functions and perhaps a little web browsing. With older, non-connected PDAs, doctors could download medical textbooks to their desktops and sync them with a PDA to use as references on the go. However, with these new smartphones, instead of carrying the latest pocket handbook on SD-cards, we now have access to the entirety of the internet. Terabytes of information are now at our fingertips, quite literally. Medical software companies are starting to react to this trend. The introduction of the iPhone with its innovative browsing style has accelerated the growth in specialist medical web references.

Epocrates

Epocrates (mobile.epocrates.com) was once the killer app for the Palm-Pilot PDA. Thousands of doctors rushed to buy PDAs for the sole reason of running the Epocrates drug reference software. Once downloaded and installed, doctors could look up drug doses, interactions, contra-indications and side-effects on the go, by the bedside or wherever they needed the information.

In recent years, Epocrates developed a web version of their drug database, accessible through desktop browser software connected to the internet.

Epocrates Mobile is a version of their online offering trimmed down to fit a PDA browser screen. The iPhone version even uses the iPhone look and feel to enhance the mobile version.

Even though web-enabled apps are probably the future for this kind of software, there is still a demand for offline versions. Epocrates continues to sell its download-and-install PDA software for Palms, Windows Mobile and Blackberry. The exception here is the iPhone, as developers were initially barred from developing download-and-install software. This is set to change though. During a recent keynote announcing Apple's plans to allow developers to produce installable applications, Steve Jobs, CEO of Apple, mentioned a new version of Epocrates for the iPhone that users will be able to download and install directly on the device.

Unbound Medicine

Unbound Medicine offer hundreds of medical textbooks available for browsing through a smartphone browser. As yet, Unbound Medicine hasn't announced any plans for an offline version using the Apple SDK, but if you are a Smartphone, Blackberry, Palm or Windows Mobile user, you are able to buy subscriptions to their large library of textbooks for download as well as having access to the mobile web version.

Skyscape

You can access many of the Skyscape articles while connected to a wireless or mobile connection, formatted for viewing on the iPhone Safari web browser (iphone.skyscape.com). Other mobile users can download and install titles from Skypscape's vast medical reference collection.

The Mobile EMR

Many hospital electronic medical record (EMR) systems allow physicians to look up and enter information through a web browser interface.

It's a relatively small step from accessing the hospital EMR through a desktop browser to accessing on a mobile browser over a secure wireless network. Over the years, low screen resolutions and difficulties with data entry have inhibited development in this space. However, the rise in popularity of mobile web-browsing is now motivating some EMR companies to start providing smartphone interfaces for their software.

Life Record

Life Record claims to be the first and only EMR to run perfectly on the iPhone. The screenshots are indeed impressive and demonstrate that accessing the EMR via an iPhone interface is feasible. Perhaps more EMR companies will follow suit, delivering access through the browser. Or they may be waiting to develop stand alone applications using the new SDK.

Accessing Medical WebsitesOf course, you are not just limited to websites that have been formatted for mobile browsing. Many of the newer smartphones offer high enough resolution screens that browsing full-size websites is possible. This means you'll have access to PubMed, the New England Journal of Medicine, or any other website you would use on your desktop or laptop. Some websites are more readable than other on the small screen, but as time progresses more websites are producing mobile versions. At the same time, we're seeing the development of higher resolution screens and mobile browsers are becoming more intuitive to use.

Social Networking Applications

The real power of accessing the web through your mobile device is the ability to reach out and touch someone. Social networking tools are now a part of many a gadget-addict's way of life, and access to these tools on their mobile is essential. Unsurprisingly, many popular Web 2.0 applications are now available in a special mobile format, often optimized for the smaller screen size.

Facebook

Facebook's iPhone interface (iphone.facebook.com) gives a simpler look and feel in keeping with other iPhone applications. Still very easy to use, navigation is simple and reading and posting messages is a breeze.

Twitter

Now you can tweet away from your iPhone all day long (iphone.twitter.com). Twitter is a new type of social media application. Users post short messages and links to their twitter page and all their friends get notified as soon as they post. Public conversations ensue, new friendships and connections are made.

Productivity Tools

Google Maps for the iPhone

Google Maps is one of the few third party applications that come pre-installed on the iPhone. The multi-touch screen makes zooming in and out easy and the searching for towns and planning routes is intuitive and fast. Google maps performs best in a wireless connection although is still usable over the EDGE or GPRS networks. It would be nice to see GPS built into this feature but we'll have to wait for that one.

Google Apps

Google Apps have been formatted for mobile devices. This means browser access to Gmail, Google Calendar, Docs and Spreadsheets. If you use these on your desktop systems, it means that you can update your appointments and check your emails on the go without needing to sync with a desktop to update everything.

Mobile Medicine Meets Web 2.0

As existing web sites develop mobile versions and new software companies create web sites formatted for mobile devices, we'll see a renaissance in mobile web use. The iPhone may be leading the way but we can be sure Nokia, Blackberry, Palm and others won't be far behind.

Browser based "Web 2.0" interfaces to enterprise and medical reference software have smoothed the way for doctors to browse the web on mobile devices. Additional formatting for mobile versions helps with usability as does the use of multi-touch displays.

Low speed connections and mobile phone bans in hospitals are potential limitations to mobile web browsing. As safety fears lessen and connection speeds increase, more doctors will be able to utilize their phones as reference tools or even for accessing hospital computer systems.

Easier access to the latest evidence-based resources will keep doctors informed and hopefully improve patient outcomes. And of course, we can continue to satiate our lust for latest, smallest, shiniest gadgets!

Dr. Paton is a lecturer in Health Informatics at Otago University in New Zealand, the editor of the Doctors’ Gadgets blog, and CEO of New Media Medicine, a medical e-learning and website development company.