Smartphones make smarter surgeons

The time when a mobile phone was used simply to make and receive telephone calls is long gone. The explosion in mobile technology has meant that only one-quarter of the time spent on a ‘smartphone’ is used to make calls. The rest is spent browsing the internet and on social networking sites. For clinicians, there are already recognized time savings and improvements in efficiency through the use of mobile devices: to review patient records, access radiology and laboratory results, and request investigations1. These are only the beginning; mobile technology and smartphones offer further uses in a clinical setting with potential applications for improvements in communication, telemetry, research and education. Surveys have shown that over 80 per cent of clinicians own and use smartphones regularly, and they have become the main form of in-hospital communication2. Smartphones can connect e-mail, short message services (SMS) texts and voice calls, which in turn allows interaction with other telephones, tablets or computers from one device3. This means that important messages and documents are seen regardless of location, and can be acted on more quickly than ever before. There is already evidence that this helps in acute medical wards4. For the surgeon, consultations held using smartphones may offer cost-effective postoperative follow-up with patients in remote locations. Furthermore, SMS text messages have been shown to facilitate improved medical interventions such as smoking cessation5, which in turn may improve fitness before surgery. The potential of smartphones has been revolutionized by the development of mobile applications or ‘apps’. Apps provide a website’s functionality in a mobile-friendly format that can run independently of web-based browsers while storing information on a device6. There are over 720 000 applications available, with nearly 20 000 medical and surgical applications offering access to clinical reference, medical education and decision-making tools. Formative sites, such as iMedicalApps and MedicalAppJournal, can help identify apps through peer reviews by other healthcare professionals. Many medical organizations including Journals and Associations have, or are developing, their own individual apps. Although inherently useful, it is becoming clear that they need to offer specific features that engage and retain users given that many apps lie dormant on smartphones. Development costs can be high as screen sizes vary from device to device and because of differences in the various operating systems. There are, however, some clinical apps with novel features that seem to appeal to trainee surgeons in particular. ‘Touch Surgery’ offers surgeons the opportunity to practise key stages of common operations such as laparoscopic cholecystectomy using cognitive task-based analysis. Another exciting idea has been the integration of ‘game play’ into apps like the Resuscitation Council’s ‘Lifesaver’ app that can act as an adjunct to more conventional educational techniques. Apps can interact with other features within the smartphone, for example Bluetooth. This allows patients to be monitored remotely using physiological sensors. This could have a dramatic impact on ward care and follow-up in the early postoperative period, and seems a fertile area for research to assess feasibility, safety and potentially to alter practice. Surveys suggest that 59 per cent of the general population own or use smartphones and 20 per cent regularly use health applications7. Physiological data may be collected and uploaded directly from a patient’s own device. This could have significant economic impact, for instance in avoiding unnecessary hospital attendances. Automated reminders to patients and trial participants may improve compliance with treatments, achieve better response rates and reduce missing data8. An exciting challenge exists to capture, store, search, share, transfer and analyse these ‘big data’, which may lead to breakthroughs in treatments and patient outcomes. There are some important caveats and limitations to smartphone technology. The biggest issue is battery life. Regularly accessing messages, emails and apps rapidly drains the battery such that many devices will not last an average clinical working day, limiting their practical use9. In addition, most hospitals have poor mobile coverage, currently making it impossible to rely solely on these