WINNIPEG | Being on call doesn’t mean Dr. Rob Grierson has to stop cheering his son’s team at the local soccer pitch when a heart attack victim needs attention—thanks to his smart phone.

With the hand-held device, he can review an ECG tracing uploaded by a paramedic to decide if the patient is a STEMI (ST-Segment Elevation Myocardial Infarction), co-ordinate with that paramedic at the victim’s side about immediate thrombolitic drug intervention, choose what hospital the patient should be transported to and confirm the cath lab team is on the way when needed—all in about the same amount of time it takes to set up a corner kick.

That’s just one of the plethora of new medical services that are quickly becoming the norm with the advent of smart phones.

While Dr. Grierson, the medical director of the Winnipeg Fire Paramedic Service, and his physician colleagues use the ubiquitous BlackBerry to carry out their work duties, “smart phones” also include Apple’s popular iPhones and any number of cellular telephones with computer-like capabilities supplied by Palm, Nokia, Sony and a range of other manufacturers.

Saving time and lives
And, to push the soccer analogy, this technology is a real game-changer. In the first 10 months of using smart phones to connect paramedics with on-call doctors, the mortality rate for MI cases has been reduced from 8% to 2.5% in Winnipeg, according Dr. Grierson. “Time is being saved,” he said. “It’s a unique blend of cutting-edge medicine and cutting-edge technology.”

For instance, when paramedics respond to a suspected MI call, uploaded ECG tracings are sent to all six Winnipeg doctors who share emergency cardiac on calls to avoid any mix-ups in case paramedics mistakenly contact the wrong on-call doctor to discuss what care to provide.

More impressive is the amount of time saved by co-ordinating cardiac-care teams so that the patient is sent to the proper hospital to receive advanced care immediately. As paramedics get ready to start transporting a patient, the cath lab team is already on its way in, Dr. Grierson said.

“You’ve saved another 40 minutes.”

All of this because of the little Canadian-designed device—created by wireless device company Research in Motion (RIM)—that he calls: “Quick, accurate, secure.”

For Fraser Edward, RIM’s manager for market development in health care, those three words are what he believes sets his company’s Blackberry line apart from other smart phones. “In health care that becomes really important,” he said. “Blackberry gives you the tools to provide security and privacy.”

RIM, through its secure servers and other methods of securing client services, has become the de facto smart-phone supplier to the business community.

Although charts and electronic medical records could be downloaded and uploaded using smart phones or similar devices, Edward said he thinks privacy concerns will ensure that those functions will remain in proprietary, safe, secure communication networks that have government approval.

But Edward said he does think GPs might find the use of smart phones is going to change the way they interact with their patients just as much, or more, than smart phones will change interprofessional communications—a patient sitting in a doctor’s office can quickly use his or her smart phone to get a “second” opinion, even if it is obtained from the web.

Tool for collaboration
The immediacy of communication is one of the advantages, collectively, doctors will find as they use smart phones more and more. He said the University Health Network in Toronto is using BlackBerrys in an ongoing hypertension trial and everyone is finding that the devices are “a collaboration tool.” They have found that to make a decision in disease management, it’s not a single doctor making the decision—“it’s a team of doctors, nurses and other professionals,” Edward said.

With a single click of a button a single person can conference a call and a decision will be made quickly.

Dr. Rob Grierson's 10-year-old son Evan doesn't mind when is father is distracted at one of his soccer games by an emergency call. He thinks it's great his father is using new technology.

“What once was taking many hours and days to get a decision, . . . through a smart phone decisions can be made more quickly. The patients are really beginning to benefit,” he said.

Patients themselves, with or without the intervention of doctors, might soon have some kind of “health coach” on their smart phones that will help with monitoring patients with hypertension, weight problems and diabetes. These services may or may not be connected to some form of a health record, and doctors may not be involved in all of their uses.

“Doctors are all different. They are all doing things slightly different,” Edward said.

Medical applications
Edward noted that many major health-care suppliers are now investing in developing applications—or “apps”—that will improve connectivity and the types of services offered by smart phones. RIM, for instance, recently started its own “app store” that allows people and businesses to purchase applications that can then be used on BlackBerrys; however, only a few have medical-related uses.

The real winner in the medical apps contest for use on smart phones has to be Apple, which currently offers at least 1,500 apps—some free and some at a cost—that have health-care use, ranging from ones that provide normal lab values to a list of ongoing clinical trials to a number of swine flu tracker maps to the Merck Manual.

Dr. Joseph Noora, a cardiac surgeon at Trillium Health Centre in Mississauga, Ont., enthusiastically endorses iPhone’s “incredibly easy interface,” noting that he has downloaded free apps that help with literature searches, pharmaceutical and medication questions, and medical calculators.

He has seen such fee-based services as an MRI reader, but candidly admits: “I’m a bit of a cheapo. I don’t like to pay for applications.” He said he believes even the free apps he gets from the online iTunes store are more numerous than all the apps available for the BlackBerry.

But he laments the fact that at Trillium they won’t allow him to synchronize his iPhone with the hospital calendars, as the IT department at the hospital will do for BlackBerry users. It is a question of security, he was told. For instance, if a doctor looses his or her BlackBerry, the hospital can remotely lock the device off hospital networks, something they are incapable of doing for the Apple product.

Dr. Noora said he understands the importance of security, but he isn’t about to join his fellow Trillium doctors, most of whom sport BlackBerrys. He said he just hopes hospitals and apps makers will move toward making all smart phones secure in medical settings so that one maker won’t dominate the market.