✚ The fallacy of the 'Smartphone Physical'

Singularity Hub recently featured a post on the ‘Smartphone Physical’, a concept debuted at TEDMED 2013. While I commend the two medical students who conceptualized the Smartphone Physical, I am not as enthusiastic about it’s potential impact on patient care as many of its supporters. The so-called Smartphone Physical involves much more than a smartphone and provides much less information than that collected by a physician during a physical.

A physical is more than measurement—Walk into any doctor’s office for any kind of physical and they will do more than just measure your vital signs and take a look at you through their special scopes. Arguably, the most important part of a physical is taking a detailed history, as it is with any medical encounter. Simply speaking with a patient about what has been going on with them for the past year or more reveals far more than anything displayed on a smartphone. Experienced clinicians know the right questions to ask and how to ask them. Such clinicians are also skilled in the physical exam. While some components of the physical exam include the use of specialized equipment, most of it is accomplished through the clinician’s unaided senses.

The ‘Smartphone Physical’ requires much more than a smartphone—Of the ten components included in the Smartphone Physical, only one does not require an additional piece of equipment. While the creators list “expense” as one of the limitations of the traditional physical exam, I think one look at the Welch Allyn iExaminer puts the ‘Smartphone Physical’ in perspective. It retails at $80 for a piece of molded plastic and they ask for another $30 for the “pro” version of their accompanying app (in-app purchase). Or take the AlivCor Heart Monitor, it retails for $200. Then we have the $7,500 or more you have to shell out for the MobiSante ultrasound device (admittedly much cheaper than most ultrasound machines). All told, putting together a “digital doctor’s bag” with the devices included in the ‘Smartphone Physical’ would cost you over $8,300 (for those devices that are commercially available at this time). Also, be aware that many of these accessories are device specific and may need to be replaced as smartphones change (i.e.–Welch Allyn’s iExaminer only fits the iPhone 4/4S; the AliveCor Heart Monitor has separate cases for the iPhone4/4S and iPhone 5).

The data remains siloed—None of these devices, as far as I can tell, has any sort of integration with common electronic medical records. To be fair, this is not the sole fault of the creators; I am unaware of any EMRs that have data APIs that would allow people to send data from a smartphone app to an EMR. However, this is where there is some true promise. Adding objective data from the physical exam directly to the EMR would be of great benefit. Actual pictures of optic discs and ear drums would be of very beneficial for documenting the acute presentation and progression of disease.

Nothing here is new—With the exception of the NETRA-G and the recently added Biomeme qPCR Molecular Diagnostic, nothing in the ‘Smartphone Physical’ is particularly innovative. We have had electronic devices to take vital signs for a long time, cameras exist for all medical scopes, and we obviously have EKG, spirometry, and ultrasound machines. The common thread among these devices is reduced cost, which I would argue is evolutionary not revolutionary. Non-smartphone based versions of these devices would be low-cost if their manufacturers thought there was a broad-based consumer market to be exploited.

What consistently bothers me most about the ‘Smartphone Physical’ is the hyperbole surrounding it. A quick perusal of the headlines from the ‘Smartphone Physical’ media page gives you a flavor for this. Many times in the media and even on the TEDMED stage, people alluded to a checkup or physical from a smartphone [1]. As I explained above, that couldn’t be further from the truth. No matter how many accessories we connect to a smartphone, the physical will remain the purview of an experienced clinician.

I look forward to seeing these devices evolve, but the true innovation will be integration of objective clinical data with the patient’s subjective experience and augmented with longitudinal data from personal devices, stored in a single electronic record.

[Note–A version of this post appeared on my previous blog.]

  1. Fast Co Exist, “If we’re able to monitor our vital signs, we may not need doctors for check-ups.” (1) You can already monitor your vital signs at home, without smartphone-based equipment. (2) If all your doctor is doing during a visit is monitoring your vital signs, find a new doctor.  ↩