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Physicians use photos from patients' cellphones to deliver 'mobile health'

By Leslie Tamura
Washington Post Staff Writer
Tuesday, August 31, 2010; HE01

The night before his fourth birthday, Rohan Giare of Rockville rolled off his bed and gashed the bridge of his nose. Rohan's dad, not knowing whether he should focus on getting the bleeding to stop or go immediately to the emergency room, snapped pictures of the cut with his BlackBerry and sent them to his doctor friend, Neal Sikka.

"I just gave [Sikka] a ring," Vishal Giare said, "and got initial input on how serious it might be."

Sikka, an emergency physician at George Washington University, looked at the photos and recommended a trip to the hospital.

Sikka has gotten comfortable using his camera phone to make informal diagnoses for friends and family since he became a doctor in 1999. And as he embraced cellphone culture, Sikka said, he wondered if he could confidently and consistently make diagnoses if regular patients sent him injury snapshots.

In May, Sikka began a six-month study examining how accurately emergency doctors and physician assistants at GWU Hospital could diagnose wounds from patient-generated cellphone images. According to Sikka, it is the largest "mobile health" study looking at acute wound care.

"Mobile health" does not mean a clinic on wheels. It is an emerging field within telemedicine that comprises all aspects of care generated from or available on a portable mobile device such as a cellphone.

Doctors already use traditional forms of telemedicine -- teleconferencing and videoconferencing -- but Sikka said "mHealth" goes further, eliminating the need for scheduling conference rooms and reserving equipment.

MHealth could especially benefit patients living in isolated areas and those who don't want to spend the time, money and energy waiting for evaluation of a superficial injury, Sikka added.

"For emergency medicine," Sikka said, mHealth "allows us to reach out into the community and provide a service that crosses that whole issue of time and space."

In the new study, researchers recruit people who have arrived at the hospital with cuts, skin infections, rashes and other flesh wounds.

Patients use their own camera phones to document their injuries. After filling out a questionnaire about their medical history and symptoms, they send the images to a secure e-mail account. All images are downloaded and stored on a secure hard drive.

"We'll look at their picture along with the questionnaire and make a diagnosis," Sikka said. Researchers use a PC to zoom in and focus on specific parts of the photo. Then the doctor will see the patient to see if the cellphone diagnosis was accurate.

"The initial data is encouraging," Sikka said. The study will continue through October, but so far, he says, about 90 percent of diagnoses are accurate. Sikka said camera phones with at least three megapixels, autoflash and autofocus work well.

Sometimes, however, the picture quality is poor or the patient information is not specific enough. Fifty percent of the cases where the doctor did not make an accurate diagnosis involved images that Sikka said were too grainy.

After the consultation, patients fill out a survey about their perceptions of mHealth.

"Our data suggests few people are worried about privacy and security," Sikka said. "A lot of people think it could save time, improve access, reduce cost and even improve communications with their doctor."

Using mobile devices to enhance medical services is nothing new -- remember the pager? -- but today's phones are "game changers," said David Armstrong, professor of surgery and director of the Southern Arizona Limb Salvage Alliance at the University of Arizona College of Medicine.

In June, Armstrong used his iPhone4's FaceTime application to consult with Lee Rogers, a podiatrist in Van Nuys, Calif. Armstrong's patient was in the exam room with Armstrong, and she also participated in the mobile-phone video chat.

"We sort of live at the intersection of technology and medicine," Armstrong said. "It very well could change how doctors and patients interact."

Not everyone is going to be comfortable with this, Armstrong added. The self-described "gadgeteer" warns that mobile medicine may not work as well for the "non-techie, non-geeky kind of doctor" and that he still has concerns about privacy, physician workload, payment plans, diagnostic accuracy and medical-legal risks.

When Giare was trying to decide whether to take his son to the hospital, he says, such things were "secondary to trying to get the best medical information . . . in an expedient fashion."

Jonathan Linkous, chief executive of the American Telemedicine Association, a nonprofit promoting telecommunications technology in health care, said, "We're getting there, but it's not quite at the immediacy [that] people would like to see." Linkous is "strongly in favor" of studies, such as the one at GWU, that might help create new options for patients and doctors, but he recognizes the challenges mHealth will bring for those regulating this technology.

Sikka said he does not know how the market will sort it all out. He imagines a future in which patients send photos of injuries to a call center where doctors, nurses and physician assistants can diagnose. Work will be distributed in a different way to improve patient care and emergency room efficiency.

"Talking to somebody you trust," Giare added, "and being able to show a picture of what the wound looks like has been helpful."

Because of Sikka's mobile-phone recommendations, Rohan Giare celebrated his birthday with a row of stitches across his nose.

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