More than 50% of physicians report using medical apps for their daily work, and more will join them as younger generations of clinicians begin their practices and mobile devices become increasingly widespread. These physicians have an astonishing 40,000 medical apps from which to choose. While most of these applications are of dubious quality, not to mention utility, there are gems among them, particularly in the field of cardiology. Here are five apps and devices that you or your patients may soon be using, if you are not already. Note that there are countless other apps that you may find useful, including Epocrates, Calculate by QxMD, and—of course—the CardioSource WorldNews app, but the focus here is on novel tools for clinical data collection and analysis.

iHealth (ihealth99.com; $99.95) and Withings (withings.com; $129) Blood Pressure Monitors

Even a freshman medical student knows that BP measurements can be notoriously fickle. Consistent ambulatory monitoring often provides a more accurate and clinically relevant picture of hemodynamic status by enabling nocturnal readings and regressing out confounders like white coat hypertension. Though ambulatory BP monitors are not a new technology, they are now available in sleeker, more user-friendly incarnations capable of syncing with your smartphone or tablet. iHealth and Withings are two leading brands that measure both BP (0-285±3 mm Hg, or 2%) and pulse (40-180±5 bpm, or 5%). Unlike their predecessors, these cuffs allow patients to store hundreds of readings electronically, generate charts to detect patterns and provide insight, and transmit this data to their providers via email or an EHR. You can be certain that your patients will be using cuffs like these in the near future, if not already. Some physicians are also using these smartphone- and tablet-enabled cuffs in their offices to allow for streamlined collection of vital signs, though at present these devices are meant for consumers and are not as easily implemented in the practice setting. 

Cardiio (cardiio.com, $4.99)

The cuffs listed above make pressure and pulse measurement easier, but imagine being able to measure your patient’s pulse just by looking at him. With the aid of your smartphone or tablet, now you can. Cardiio transforms your mobile device's front-facing camera into a biosensor capable of estimating heart rate. How does it work? The underlying principle is that immediately after systole the increased blood volume in your face leads to subtle changes in color that human eyes cannot detect. Your smartphone camera, however, is capable of detecting this increased blood flow because more blood corresponds to greater light absorption. Thus, Cardiio measures these changes in light absorption over a 15-second sample to estimate pulse. Almost as if he were describing this app, the famous science fiction author, Arthur C. Clarke, once wrote, "Any sufficiently advanced technology is indistinguishable from magic." According to a 2011 paper in IEEE Transactions on Biomedical Engineering, the technology can estimate heart rate (accuracy ±3 bpm of that collected by a pulse oximeter), heart rate variability, and respiratory rate, raising the potential for more effective telemedicine and other remote monitoring health solutions. For example, basic vital signs may be collected regularly via a computer webcam or even bathroom mirror and thus allow for earlier detection of progressive changes in health, such as worsening pulmonary edema or arrhythmias.

AliveCor iPhone ECG (alivecor.com; pending approval for sale)

Perhaps the most anticipated and publicized of consumer medical devices, AliveCor's iPhone ECG began receiving attention after its inventor, physician David Albert, MD, posted a demo video to YouTube. Essentially, the device is a one-lead ECG that is embedded in an iPhone case. It can function as lead I or alternatively be placed on the chest to serve as a precordial lead, albeit presently limited by a fixed electrode spacing of under 3 inches. Recordings may be stored and analyzed on the iPhone or sent via email or directly to a printer.

In just over a year, AliveCor has reached many milestones including a $10.5 million Series B financing round, a European CE mark, and entry into the related market of ECG monitoring of animals (AliveCor Vet; $199). The device is currently undergoing FDA review and is expected to sell for less than $200. In terms of use cases, the device may appeal to patients as an ever-present event monitor, to emergency response personnel as a quick way to understand cardiac activity, and to cardiologists and other physicians as a low-cost addition to their practices, both in developed and developing nations. Dr. Albert and USC's Leslie Saxon, MD (interviewed in August 2012's Gaglani’s Gadgets), coauthored a study demonstrating the clinical relevance of the device that was presented at the 2012 ACC scientific meeting in Chicago. Be on the lookout for a full column devoted to this provocative device pending FDA approval.

AirStrip Cardiology (airstriptech.com; free app, but requires institutional subscription)

While the apps and devices above simplify the collection of vital signs, AirStrip streamlines the analysis and response to such data. The app aims to replace faxes, emails, and PDFs of ECGs by providing cardiologists and other health care professionals access to complete 12-lead ECG waveforms collected directly from the ambulance. These can be remotely analyzed on a smartphone or tablet so that, regardless of the physician's location, he or she can assess whether the patient may be managed at the emergency department or needs more specialized intervention—even before the patient arrives at the hospital.

MobiSante Smartphone Ultrasound (mobisante.com; ~$7,400)

Ultrasound systems tend to be as bulky as they are useful, but a company called MobiSante has managed to reduce the former while preserving the latter. Their smartphone ultrasound system enables the portable collection, storage, and transmission of ultrasound data using 3.5-, 5.0-, and 7.5-MHz transducers. It can store up to 32 gigabytes of data including 6-second video segments (~5.5 megabytes) and 480 x 480 pixel images. Though their system comes with the Toshiba TG01 touchscreen phone included, the phone is not capable of making calls or sending text messages. The company plans on releasing a Windows tablet version soon for enhanced resolution and usability. This device may benefit cardiologists by enabling them to visualize stenotic vessels rather than only being able to listen for bruits, and also by having access to cardiac ultrasound on demand. At a price point significantly lower than traditional systems, the smartphone ultrasound system may come to your hospital sooner than you think.

There is significant potential for the apps and devices above, and others like them, to improve the delivery of care. However, it is important to realize that these technologies may be at best useless and at worst harmful in the hands of someone who does not understand how to use them. The American writer and philosopher, Elbert Hubbard, said it best: "One machine can do the work of 50 ordinary men. No machine can do the work of one extraordinary man." The future of patient care is a bright one if extraordinary physicians begin using these extraordinary technologies.

Keywords: Pulmonary Edema, Patient Care, Biosensing Techniques, Blood Volume, Respiratory Rate, Electrocardiography, Blood Pressure Monitors, Heart Rate, Systole

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