Doctors have been quick to embrace the smartphone as an invaluable tool in the practice of medicine. These devices put information at your fingertips, allow you to check medical references, confer with colleagues instantly, and even access patient data and test results.
A report by the Boston Consulting Group and Telenor Group noted that the “smartphone is the most popular technology among doctors since the stethoscope.” Indeed, the share of Americans who own a smartphone—85%—represents a dramatic increase from just 35% a decade ago, reports the Pew Research Center. What’s more, smartphone uptake by individuals earning more than $75,000 a year is near universal at 96%.
But the advancement and proliferation of smartphone technology also brings with it responsibilities and risks that physicians should consider. What follows are some of the most pressing concerns, according to recent guidelines, litigation, and an expert in the field of physician smartphone use.
Avoid ‘distracted’ doctoring
Human attention has a limited capacity. According to the American Psychological Association, talking on a cell phone causes a kind of “inattentional blindness,” whereby individuals can stare at objects but not see them due to an inability to process the visual information. In fact, cell phones are implicated in 1.6 million automobile crashes a year, according to the National Safety Council. More than one study has shown smartphone use to be as impairing as alcohol intoxication. (Think you might have a problem with smartphones? See Most doctors probably have this addiction on MDLinx.)
Similarly, when doctors use their personal smartphones in professional settings, they may experience risky distractions from clinical care. For example they may be interrupted by non-acute clinical concerns, personal communications, or even app notifications, according to a guideline on the use of personal devices in healthcare published by the Journal of Mobile Technology in Medicine.
“Healthcare providers commonly hold the misperception that utilizing smartphones for multi-tasking in the healthcare setting improves efficiency and patient care,” authors wrote. “Attentional shifts while multi-tasking interrupt the cognitive processing of information, situational awareness, and may increase the likelihood of patient care errors.”
The guideline recommends physicians minimize interruptions by using silent, airplane, or do not disturb modes, particularly during important patient care activities. “The amount of information received by providers may be controlled through specialized ring or text message tones and disabling of app notifications.”
Consider apps’ privacy risks
A plethora of smartphone apps promise to promote mental health, manage diabetes, monitor cardiac indicators, or track whether patients are sticking to physical-therapy regimens. However, such apps may create some liability for physicians, explained John Torous, MD, director of digital psychiatry at Beth Israel Deaconess Medical Center at Harvard Medical School, in an exclusive interview with MDLinx.
“When you’re recommending or discussing apps, you may not be aware of the privacy holes these apps entail,” he said. “We may not be thinking about whether they are safe or effective or whether they are protecting patient data. These are issues we haven’t had to think about before.”
Federal rules forbidding disclosure of protected health information under HIPAA (Health Insurance Portability and Accountability Act) often don’t apply to the highly personal information collected by healthcare apps, according to a recent review of mental health apps by Consumer Reports. That’s because the software companies that create them aren’t covered entities under the law.
A recent Federal Trade Commission settlement and class-action lawsuit against the popular period and fertility-tracking app, Flo, illustrates the privacy risks posed by health apps. According to complaints, Flo secretly collected millions of users’ personal information—including home address and location information, weight, and when they were menstruating, having sex, or pregnant, among other personal details. Flo then sold the data to third-party data collectors so they could target users with behavioral advertising across all their devices. What’s more, Flo did not limit how the data could be used. This was despite Flo’s user agreement that stated user’s personal data would only be shared for the purpose of operating and servicing the app.
Look under the hood of smartphone apps
“Healthcare-related apps as a class have very convincing marketing, so sometimes it's hard to understand what an app is really doing. Are they providing medical or clinical services, or is it merely a ‘wellness device?’” Torous said. “Apps that use the former term are putting you on notice that they aren’t proven to diagnose or treat any condition and are not tied to any medical or clinical outcome.”
Torous recommends that doctors do a quick scan of an app’s legal fine print for waivers of medical or clinical liability. “Keep in mind that about 90% of people who download health apps abandon them within a week or less,” he added.
The US Department of Veterans Affairs provides free, evidence-based clinical apps, which are available to treat a variety of conditions, he said. “Keep in mind you really can’t outsource effective care to an app. The best health apps involve both the clinician—as well as the patient—working in partnership for better health outcomes.”
Set reasonable expectations
Contacting a patient outside of work hours on a personal smartphone entails some risk, Torous said. “It may create a legal expectation on the part of the patient of constant contact, that a doctor is available 24 hours a day,” he said. Physicians can be proactive in this area by setting clear boundaries regarding what doctors can and cannot do surrounding communications, response times, and protocols. “Patients are generally respectful, but it’s important to establish boundaries of communication. In an emergency, you don’t want their first call to be to you, and to delay emergency care.” A good time to do this is during the first patient appointment.
Make sure you’re licensed to practice
The popularity of using personal devices for telehealth services has soared in the past year, but could result in physicians unintentionally practicing without a license. “Using a smartphone you can call patients or conduct virtual visits very easily in a different state,” Torous said. “But you might not stop to think whether you’re licensed to practice there.” During the COVID-19 pandemic, most states relaxed or waived licensing requirements for telehealth, according to a report by the Federation of State Medical Boards. Now, many of those waivers are set to expire.