Physicians use photos from patients’ cellphones to deliver ‘mobile health’

Leslie Tamura writes in the Washington Post about how the George Washington Hospital Emergency department has started a 6 month trial enabling waiting room patients to send images from their mobile cameraphones to the emergency Doctors and Physician Assistants.

The article claims that ” “For emergency medicine… mHealth “allows us to reach out into the community and provide a service that crosses that whole issue of time and space” but confusingly states that “In the new study, researchers recruit people who have arrived at the hospital with cuts, skin infections, rashes and other flesh wounds“.

Whilst it’s not entirely clear whether the mobiles being used are the patients or belong to the hospital, I’m assuming they’re patient property because there’s a remark about variable camera quality. Still I’m lost on the benefit of having patients in the waiting room picturing rashes to send them to a Doctor/PA who’s only a few feet away.

A similar initiative was conducted some time ago using Cisco’s Health Presence in a Scottish Hospital and whilst this was to test this clinic based static technology in a safe environment I can’t see why it needs to be done this way when the device being used is a patient owned mobile phone. Even if we ignore the ethics of researchers engaging with acute patients surely there are so many better opportunities to serve patients outside hospitals eg. those who live in isolated areas, are housebound, or who don’t have the financial resources to attend a hospital for evaluation of what seems to be a superficial injury?

Whilst the article claims that this can help the hospital “reach out into the community and provide a service that crosses that whole issue of time and space“. The argument falls down for me when the time we’re talking about is a few seconds and the space a few feet.

According to Sikka, it is the largest “mobile health” study looking at acute wound care

I wonder if this might be because it’s an inherently dangerous thing to do, and doing it in the waiting room is practically pointless? Isn’t it a bit like saying we’re running the “biggest SMS service for patients to report they’ve had a heart attack” – whilst I wouldn’t doubt you are I think it may be due to the fact that it’s probably not a good idea.

Note: “Non acute” advice is a very different matter and there have been lots of trials and service launches of this type of service eg. iDoc 24. Our research also shows that there is a huge opportunity for realtime 3G Mobile Video Calling with an Emergency Doctor to help with acute wound care.

The article also highlights some important lessons for mHealth developers:

> In this service the developers haven’t utilised the potential for the patients to use their mobile phones to complete an interactive questionnaire. To my mind this is crucial as it provides better documentation and record keeping whilst helping avoid the mix ups that can easily happen with a combination of paper and digital records in a busy care facility. By asking the patient all of the relevant questions it will also ensure that detailed patient information is always available to the clinicians – something that the researchers have noted as one of the most significant issues in reaching a diagnosis:

> The need for communications with a Doctor to be secure. Sending “images to a secure e-mail account” is not secure IF the patient is not using a secure email account. It is for this reason that at 3G Doctor we use a secure portal to communicate with patients and the only messages we send via email or SMS are prompts for the patient to log in to retrieve information.

> Dr Neal Sikka is reporting that the biggest factor in inaccurate diagnosis originates from poor picture quality or a lack of specific “patient information”.

Poor picture quality can only be eliminated by better cameraphones and education of the patient. There is a great opportunity here for prerecorded educational mobile video content:

> Dr Neal Sikka reports “few people are worried about privacy and security” which highlights the priority that mHealth service providers must place on these issues if they are to protect the patients and the professionals (who place their careers on the line if they fail to protect these fundamental patient rights).

PS. A funny misprint I found in the story:

Neal Sikka, an emergency physician at George Washington University “has gotten comfortable using his camera phone to make informal diagnoses for friends and family since he became a doctor in 1999

Must have been difficult doing that in 1999 considering cameraphones weren’t actually invented!

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