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The Smartphone Physical: Checkup of the Future?

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Imagine a comprehensive, clinically relevant well-patient checkup using only smartphone-based devices. The data is immediately readable and fully uploadable to an electronic health record. The patient understands -- and even participates -- in the interaction far beyond faking a cough and gulping a deep breath. For real?

Johns Hopkins medical student and Medgadget editor Shiv Gaglani says it is not only possible, but may in fact be the checkup of the future. Gaglani and a team of current and future physicians will do a first-of-its kind demo of a "smartphone physical" for hundreds of attendees at TEDMED 2013 on April 16 to 19 in Washington, D.C.

The checkup will capture quantitative and qualitative data, ranging from simple readings of weight and blood pressure to more complex readings such as heart rhythm strips and optic discs. Measurements and instruments will include:

• Body analysis using an iHealth Scale.

• Blood pressure reading using a Withings BP Monitor.

• Oxygen saturation/pulse measured simultaneously with blood pressure, using an Masimo iSpO2 placed on the left ring finger.

• Visual acuity via an EyeNetra phone case.

• Optic disc visualization using a Welch Allyn iExaminer case attached to a PanOptic Ophthalmoscope.

• Ear drum visualization with a CellScope phone case.

• Lung function using a SpiroSmart Spirometer app to conduct a respirometer test.

• Heart electrophysiology using the AliveCor Heart Monitor.

• Body sounds: A digital stethoscope from ThinkLabs auscultates and amplifies the sounds of a patients lungs and heart.

• Carotid artery visualization using a Mobisante probe.

While it all sounds very slick and tech-y, Gaglani says the smartphone-enabled checkup will actually improve doctor-patient relationships. For one thing, the related medical devices are generally smaller and less invasive than their predecessors.

"For example, thanks to the AliveCor Heart Monitor, it has never been easier to get a one-lead ECG reading. Similarly, the Withings and iHealth blood pressure cuffs are plug-and-play so a clinician doesn't have to fumble around with both a stethoscope and sphygmomanometer to assess whether her patient is hypertensive," Gaglani says.

Second, smartphone-based devices usually provide a visual or auditory output that patients can actually see and hear, hopefully increasing their understanding of their bodies and engagement during the checkup. For example, the Welch Allyn iExaminer captures an image of the retina that is displayed on the phone screen, and digital stethoscopes like ThinkLabs' record heart and lung sounds that can be replayed through the microphone.

Third, the patient can participate in data gathering. As Gaglani says:

"These devices can abstract away the mundane and standardize the unreliable aspects of the physical exam. Measurements such as weight and blood pressure are so variable day-to-day, or even hour-to-hour, that an annual exam doesn't provide much insight into an individual patient's health status. Some of the smartphone devices are already being used by patients to collect and store their data so when they see their clinicians they can have productive and informed conversations, rather than relying on fragmented and unreliable metrics."

Hypothetically, once the data is uploaded to an electronic medical record, back-end clinical decision support software can help both patients and clinicians come up with treatment plans.

The technology may of course be particularly helpful for mobile physicians, particularly in emergency health care settings, and for global health workers, as even untrained staffers can carry the tools to low-resource settings to collect data and then, via telemedicine, receive instructions for how to treat patients. Some of these tools are already being combined into a versatile clinical data-gathering device, called a Tricorder, Gaglani says.

How long will it be before we're all having our own smartphone physicals every one or two years? Devices such as the body analysis scale, blood pressure cuff, pulse oximeter, and ECG are already in use as teaching devices in med schools and by some patients, and some early adopting clinicians are using them in daily life. Dr. Eric Topol, for example, has used his AliveCor not once but twice to diagnose patients with arrhythmias on airplanes.

While there will be an inevitable learning curve and hopefully constant assessments of cost-effectiveness and value to patients, Gaglani says some of these devices, or at least second and third generation versions, will successfully make their way into the clinic.

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