On March 5 on a United Airlines flight 30,000 feet in the air, somewhere between New Orleans and Houston, a passenger suddenly began experiencing nausea and felt her heart beating irregularly. The concerned flight attendants sought medical attention right away, polling the other passengers to find one who had clinical experience. Fortunately for them, and for the passenger, there was a cardiologist only a few rows ahead.
Thanks to a wide range of new smartphone-based medical devices, the emergency physician’s portable toolkit has grown exponentially.
On March 5 on a United Airlines flight 30,000 feet in the air, somewhere between New Orleans and Houston, a passenger suddenly began experiencing nausea and felt her heart beating irregularly. The concerned flight attendants sought medical attention right away, polling the other passengers to find one who had clinical experience. Fortunately for them, and for the passenger, there was a cardiologist only a few rows ahead. Not just any cardiologist, but one who has arguably embraced mobile medical technology to a greater extent than any other physician.
Dr. Eric Topol had just finished giving a keynote at the HIMSS conference and was on his way back to San Diego, where he serves as Director of the Scripps Translational Science Institute. Little did he know that a few hours after his talk he would be tasked with applying what he has been writing and speaking about in recent years: the application of mobile technologies to improve the practice of medicine. Back on the United Airlines flight, Topol quickly pulled out his iPhone and his AliveCor Heart Monitor attachment and rushed to his fellow passenger’s side. The AliveCor device is a phone case with two electrodes that can be used to generate and transmit a one-lead ECG to a phone. By applying the smartphone-based device to the passenger in distress, Topol was able to see “unequivocally” that she had atrial fibrillation. He assured the passenger that she would be okay and that they would not have to make an emergency landing.
Coincidentally, Topol was in a similar position 17 months prior on a coast-to-coast flight. On that occasion he was able to apply the AliveCor to a male passenger who was experiencing chest pain and palpitations. The ECG reading was concerning for an acute myocardial infarction so Topol advised they do an emergency landing. As a result of rapid, point- of-care information Topol was able to make the appropriate medical decision and decide whether the emergency was in need of immediate intervention. These anecdotes illustrate the potential for mobile health technologies to shake up emergency medical situations, not to mention healthcare in general.
I’ve spent almost two years researching and reviewing such technologies. A culmination of this work took place in D.C. this past April at TEDMED, a large medical innovation conference, and came to be known as the “Smartphone Physical.”
The Smartphone Physical featured 10 smartphone-based devices that can generate clinically-relevant information which can be leveraged to improve patient engagement and care. Though hardly a comprehensive physical exam, the Smartphone Physical showcases the state of current technology and provides a glimpse into the future toolkit of clinicians, beginning with the tech-savvy early adopters. These devices collected both quantitative and qualitative data, ranging from simple vital sign measurements to more complicated optic disc and ultrasound images. These smartphone-based devices, most of which were in the $100-$500 range, include the following:
iHealth Body Analysis Scale, a consumer-facing wifi scale that measures weight and body composition,
Withings Blood Pressure Monitor, a consumer-facing device that simply plugs into an iPhone or iPad to record data
Masimo iSpO2 Pulse Oximeter, measures heart rate and oxygen saturation and at the time of this writing was not FDA approved so it was marketed to climbers and pilots. [04,05]
Welch Allyn iExaminer, an iPhone 4 case that attaches to a PanOptic ophthalmoscope and allows one to take pictures of the optic disc using the phone’s camera 
CellScope Otoscope, an iPhone 5 case that is still in prototype stage but allows one to take pictures of tympanic membranes using the phone camera.
SpiroSmart spirometer, an app that performs some pretty impressive cloud-based signal processing to generate a flow- volume curve and measure FEV1, FVC, and PEF.
AliveCor Heart Monitor, a phone case with two electrodes that can be used to generate and transmit a one-lead ECG to a phone. 
ThinkLabs ds32a+ Stethoscope, which can plug into an iPhone and display the phonocardiogram. 
Mobisante SP1 Ultrasound system, a probe that attaches to a Windows phone and tablet and enables everything from vascular studies to FAST exams. 
While all of these may be useful to primary care physicians, we at Emergency Physicians Monthly are interested in which of them specifically may be used by emergency physicians. We’ve already seen how the ECG can inform care during emergency situations. The same would likely be true of the pulse oximeter (a source informs us that a smartphone-based hemoglobin monitor is also in the works), ophthalmoscope and otoscope (for understanding acute injury), and of course the ultrasound, which is capable of doing FAST exams.
Though most of the devices featured in the Smartphone Physical have been FDA approved, their adoption rates are still quite low. There are a few reasons for this ranging from the characteristically slow rate of change in the healthcare system to the fact that EDs are already equipped with many advanced and useful devices. In what context does it make the most sense for emergency physicians to adopt these?
Some devices have small form factors such as cases that attach to the smartphones, so there may be a time in the not-too-distant future when a large percentage of clinicians are wielding such devices, ready to collect and analyze clinical data on the fly. Perhaps the not-so-small devices will continue to miniaturize and become pocket-size, but in the interim we may see the return of the doctor’s travel bag that enables him or her to essentially carry around a mobile clinic.
I predict that these devices will have a particularly strong impact on medical education, where they are likely to be introduced earlier. This is especially true for devices such as the smartphone-based ophthalmoscope, otoscope, and stethoscope because they enable users (clinicians-in-training) to visualize and record clinical images and sounds that can be analyzed together with instructors.
While it may not be the current devices in The Smartphone Physical that gain widespread adoption, it is likely that successors of these gadgets will continue to decrease in price while concurrently increasing in utility, making them more likely to enter a clinician’s work flow. Key drivers of adoption include whether these devices and tests will be reimbursable and if they successfully integrate with EHRs.
Have you used or integrated any of these devices?
Which do you think are the most useful clinically? What’s missing from the list?
Join the dialogue
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