Checking the condition of a patient in labor is just an app click away for obstetricians serving Forsyth Medical Center.
And Wake Forest Baptist Medical Center is using internally created mobile technology to help detect sepsis — a severe illness in which the bloodstream is overwhelmed by bacteria — in patients in its intensive-care unit.
They are — at this point — the primary local examples of how technology on mobile devices is going beyond providing educational links to providing real-time medical data.
"It's a new field, truly allowing for the untethered physician," said Iltifat Husain, editor and founder of iMedicalapps.com.
Husain's group has reviewed more than 300 health-care apps since the website debuted in 2009. Husain also is an emergency-medicine resident at Wake Forest Baptist.
"The apps are providing a value-added service that can differentiate a hospital or system in the marketplace, leading patients to go where they feel the medicine is more technologically advanced," Husain said.
The fetal-monitoring app being used at Forsyth was developed by AirStrip Technologies. It sends real-time information about a patient's condition, such as changes in heartbeat or contraction patterns, to an obstetrician's mobile device. The system works by plugging in to the existing hospital computer infrastructure.
"Any member of an authorized care team is able to get the fetal information wherever they are," said Dr. Melvin Seid, director of clinical research at Lyndhurst Gynecologic Associates.
The fetal-monitoring app has been available at Forsyth for about a month. Of the 58 obstetrician and gynecologist family practices and residents providing services to Forsyth, 56 have registered to use the app and 38 are active users.
Seid said that before the fetal-monitoring app device was available, offsite monitoring was available, but it was linked to a computer terminal.
"Most deliveries are uncomplicated, but the app can save minutes, if not seconds, off the response time to a situation," Seid said.
Chris Lato, a spokesman for AirStrip, said that more than 300 U.S. hospitals are licensed to use the app.
AirStrip also offers an app for cardiologists to monitor electrocardiograms and other heart tests. The app was launched recently at three HCA East Florida hospitals.
"The technology has an app application in intensive-care units, emergency departments, operating rooms, pretty much anywhere there is a squiggly line connected to a patient," said Bruce Brandes, an executive vice president for AirStrip.
"The information is the same as what the doctor would see at the bedside, with no more than a three- to five-second delay. We believe that eventually every hospital bed will have a patient-monitoring system that is accessible by mobile devices."
The Translational Science Institute at Wake Forest Baptist is developing technology aimed at lowering the risks of using inaccurate or untimely information in making decisions, said Dr. Jeff Carr, director of the institute's Biomedical Informatics Center.
"One of the key factors following trauma that determines life or death is whether the patient develops an infection," said Lisa Davanzo, a spokesman for Wake Forest Baptist.
"We use iPhone/iPads to monitor real-time key indicators from patient beds in ICU to alert the physician if the patient appears to be getting worse."
Carr said that the goal is to mine patient data to identify potential risk factors and to use mobile devices to alert physicians and nurses when the patient's condition changes for the better or worse. The technology allows personnel to have access to updated information no matter their shift, Carr said.
"I imagine that within five years, mobile devices will permeate the health-care environment, and the interface between patient and physician will shift," Carr said.
"Patients will be able to ask questions or enter information about their condition on their time, such as how much pain they are feeling on a range of 1 to 10."
Analysts said that mobile devices will be a piece of the overall puzzle for the patient-center medical home (PCMH) concept that is slowly rolling out in the Triad.
The concept is geared toward providing better care and lower costs by emphasizing preventive care through a family physician, pediatrician or internist.
Patient-friendly aspects of a PCMH are expected to include accessibility to someone in the practice by phone at night or on weekends, getting test results quickly via email, telephone or online and offering a system for easily tracking a chronic condition.
"Mobile technologies hold great promise for keeping people healthy, managing diseases and lowering health-care costs," according to a September report by PricewaterhouseCoopers.
"Mobile devices are the most personal technology that consumers own. They enable consumers to establish personal preferences for sharing and communicating. They can enable health and wellness to be delivered through mass personalization."
For example, Emerging Healthcare Solutions is developing an app that allows users to store critical personal medical information on their iPhone. The info can be sent to health-care providers and first responders when they dial 911.
A major challenge for widespread adoption of mobile health-care technology is who pays for it, according to analysts and local health-care officials.
The PricewaterhouseCoopers report found that 40 percent of consumers would be willing to pay for remote monitoring devices and a monthly service fee to be able to send data automatically to their doctors.
The Health Research Institute estimates the annual consumer market for remote/mobile monitoring devices to range from $7.7 billion to $43 billion, based on the service and what consumers are willing to pay.
PricewaterhouseCoopers said that "unfortunately, the payment wires are crossed."
"Providers get paid based on volume of services delivered, and mobile health has been shown to reduce the need for hospital admissions and physician office visits. An industry that is paid based on volume will not adopt technologies that reduce volume," according to the report.
However, new payment models in the health-reform law set up a framework to pay providers based on outcome, not volume.
"In this environment, mobile health could provide needed connections for patients who delay care because they're too busy to wait in a doctor's office, for physicians who don't have enough time to spend with patients, for pharmaceutical companies that want to ensure patients are taking the medicines they need and for hospitals that don't have the capital to build more beds," according to the report.
PricewaterhouseCoopers said that there is revenue-stream potential. Consumers cited hospitals as the preferred place to buy mobile-health products.
"Even though most Americans are insured through group health policies, the survey showed that individual policyholders were more likely to buy mobile-health applications, and to pay out of pocket for electronic visits with physicians," the report found.
Husain said that determining who absorbs the cost of the data transmission is another challenge. "Telemedicine and electronic records can churn up data, which can lead to overcharges if a person's mobile-device plan has a data cap," Husain said.
Carr said the savings from preventing an illness or keeping it from advancing "is much greater than the cost of making mobile technology available to health-care personnel."
Another challenge cited by PricewaterhouseCoopers is "hospital IT networks struggling under the need for more bandwidth to support rapidly expanding data transactions and exchanges."
The other key issue is information security, particularly given the vulnerability of some smartphones to having info lifted from them. More than a third of doctors listed concerns about privacy and security as their chief issue with mobile-device apps, PricewaterhouseCoopers said.
Carr said that communications made on the Wake Forest Baptist mobile-technology information are secured. Husain said that most devices don't store patient data but just allow access from internal data services. Brandes, the AirStrip official, said its devices' security measures have been approved by the FDA.
Some analysts question whether using medical apps in real-time settings opens doctors to more exposure to malpractice lawsuits. For example, does it create greater liability if a doctor with the app doesn't respond quickly enough to data provided to a mobile device?
"There is no assumption that physicians will have to use the devices all the time," Brandes said. "The expectations are that physicians and their practices will use best practices, including assuring there is an around-the-clock response to the data flow.
"There also is the point that not having an AirStrip app could make a hospital or health system more vulnerable since the technology is available."
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