It’s funny to me, actually. I feel that I am a pretty progressive guy when it comes to the use of informatics in pathology, but there’s an idea that I have heard being tossed around recently that even I silently swore off: telepathology on your phone.
First things, first. Medgadget had an article the other day about the usability of PDA/Smart Phones in actual clinical practice. The study quoted was about usability of different phones/OS’s according to nurses. This is intreaguing to me. I dislike the concept of heavy patient business being conducted on something that receives phone calls. I can just see it now: “Doctor, the patient’s heart rate has dropped to…” RING RING and up pops the nurse’s mother’s face, answer?. Plus what if you forget to charge it, what about the browser cache, etc. etc. FAIL. The alternative is to turn off the phone part while at work (but then why use a phone in the first place?) or use a dedicated non-phone PDA (like we use already here at AMC (running Windows Mobile)). I just don’t see why phones are the vehicle of interest (other than the dying PDA market, but then again, look at beepers… go figure). I’m not trying to say that smartphones are useless in the medical setting, however. Valid uses might include using ePocrates, calculator, or even ordering and signing perscriptions. But I say nay to their use in the active delivery of care. For the record, according to the study, Blackberry wone (sorry iPhone).
In pathology, I think the application is very different. In general, we are not intimately involved in the ongoing direct care of a patient (save for an occasional string of frozens). So to demand the use of PDAs over smartphones becomes less justified; however, pathology also differs in that the visual information presented requires far more image definition than other specialties. While the iPhone has a relatively high-resolution screen with good contrast, ultimately, it’s not enough. I suppose if a colleague wanted to show you a single diagnostic cell in a cytology prep… mayyybe, but to have to navigate a slide at a size that is ledgible on that tiny screen would be completely futile. Sure there is an MRI app, but, come on, no radiologist is really using that. So what is the minimal size screen of diagnostic usefulness? I think netbooks are a great compromise. Take the Sony Vaio P (not a netbook according to sony); it appears to be the perfect size to fit in a labcoat pocket and it sports a 1600 x 768 pixel 8-inch screen.; it’s about the same DPI as the iPhone, but is bigger, making it easier on the eyes view as well as easier to unobtrusively navigate; however, you then give up the touch screen aspect. There are touchscreen netbooks coming down the pipe, soon, though, and those could hold a lot of promise for this application. Final considerations are bandwidth and storage. iPhones top out at 16GB and run on a 3G network. It’s not difficult to imagine that both of these are significant bottlenecks as well considering most WSI’s are hundreds of megabytes if not gigabytes. Even on WiFi (aka with more bandwidth), the number of slides you could store on your device is quite small.
Of course neither of these is a good solution for regular sign out. Ideally, one would use a hard-wired Microsoft Surface with multi-touch and gestures, or at least that’s how I envision it. Kind of like John King from CNN, but instead of states, they are biopsies (note: this clip isn’t John King, but it does illustrate playing with images)…
I still remain skeptical of whether or not there is a real niche for this. I think I harshed on it a little too much above, but in all reality, it’s niche would be for a quick consult to someone in your department: “hey, do you think this is at the margin or not?” or it might enable the attending to stay home if the resident goes in overnight for a simple frozen (although, you’d probably video stream a frozen and not use WSI), but I can see that happening. Nobody, however, will be taking very difficult or simple consults over the phone because it is too dangerous or unnecesary, respectively. So, it could have its niche, but to me, it’s more of a cool factor than a practical work aid. Even Aperio played if off a little, “We didn’t plan to have an iPhone viewer, but Room 4 saw a need and filled it, and we all benefit”. I will hail it as a cool proof of concept, though!