Apps for your practice

December 31, 2012

A look at the new technology available for stethoscopes, endoscopy, and otoscope.

Ob/gyn clinicians must make a variety of decisions as we treat patients. Several smartphone apps have changed the way that we do things. Below are a few apps that take advantage of smartphones’ cameras and data transmission abilities.

A special note: There is no government oversight of commercially available apps. A manufacturer can sell a “virtual” stethoscope app without going through the FDA approval required for traditional diagnostic medical equipment. So be warned that when you download an app that promises to “replace” a piece of your diagnostic equipment, it may not serve in the same capacity as that traditional diagnostic tool.

Stethoscope apps

One of the most popular medical smartphone apps attempts to replace the traditional stethoscope. This app works by taking advantage of a smartphone’s camera or microphone. It uses either the camera-to look for changes in capillary colors, thereby interpreting flow and ultimately calculating a heart rate-or the microphone, to amplify audible heart tones.

Apps relying upon the camera are subject to the patient’s skin color and the lighting in the exam room, and apps using the microphone will be subject to the patient’s habitus and the distance between the microphone and the patient’s skin. These 2 different methods of heart rate calculation are second nature to a well-seasoned physician
but are nearly impossible to integrate simultaneously in a smartphone app.

As such, even though this smartphone app might be able to replace the stethoscope in some respects, the quality of the information
that it obtains might not be worth
the benefit of shedding your traditional stethoscope.

Otoscope apps

Another example of an app that developers hope will replace a diagnostic tool is the virtual otoscope. A few manufacturers are working on competing apps that require a clip-on attachment that will direct the smartphone’s camera and flash to the ear canal. The goal is to allow clinicians (and even parents, since 1 company is planning to market this to lay consumers) to clearly visualize the inner ear canal and not only assess patients for ear infections, but also monitor their progress remotely.

While these apps may allow for reproducible images that can be easily inserted into the electronic chart, they do not entirely replace otoscopy, since they lack an insufflator bulb and the clip-on attachment is not likely to come in various sizes to accommodate different-sized
ear canals.

Endoscopy expands its scope

One last example of smartphone-based technology involves pill-based endoscopy. The concept for these devices has been around for approximately 10 years. Essentially, a patient swallows a capsule that houses a number of cameras. This allows clinicians to visualize the entire gastrointestinal tract from mouth to rectum and to diagnose a number of life-threatening conditions.

When this technology was first developed, the patient had to “recover” the device upon passing it with a bowel movement. This was overwhelmingly unpopular, and the manufacturers quickly developed remote transmitters that delivered information from a disposable device to a wearable harness.

Now that smartphones have Bluetooth capabilities (near-field remote communication via radio waves), a patient can simply download an app and have an entire upper/lower endoscopy in the comfort of his or her home and easily transmit the results to his or her physician without having to interrupt any daily functions.

This technology has liberated many patients and also allowed for remote medical care. However, it also raises concerns about the transmission of protected health information over a cellular network, the ability to capture protected health information from the pill itself, and the ability of patients to access medical images themselves.

Although new technology tools are exciting, they have their limitations. We now have the ability to over-analyze the simplest of clinical questions and to solve some of the toughest medical mysteries in a matter of seconds. Through the judicious use of technology and its integration into clinical practice we can follow the Hippocratic Oath while taking advantage of Moore’s Law.

[Moore’s Law: The number of transistors on a chip will double approximately every two years.]

Dr. Levine is a clinical fellow at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at the Weill Cornell Medical College, New York-Presbyterian Hospital, New York.

Dr. Goldschlag is an assistant professor at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at the Weill Cornell Medical College, New York-Presbyterian Hospital, New York.