Swiss study: iPhone medical consultations more effective with annotated imagery

By Jonah Comstock

hand fracture JMIRSpecialist consultations via smartphone are most effective when they make use of not only speech, but annotated images, according to a clinical trial recently published in the Journal of Medical Internet Research.

In a randomized trial of 42 Swiss medical students, all participants were given a hypothetical case of a patient in need of hand surgery. They all prepared by looking at an X-ray image, photos of the hand, and a textual description of the case, but they were then broken into three groups to consult with a specialist remotely. One group only spoke to the specialist on the phone; one group consulted with the specialist verbally, but the specialist was also able to send them images; and, in the last group, the specialist spoke to the group, sent images, and annotated those images with drawings and angles.

All the consultation was done via an iPhone 4, using Skype for image-sharing and Google Drive for the annotations. After the consultations, participants were asked to evaluate the consultation, and also tested on their recall of the information, by being asked to explain and draw the hand surgeon's recommendations.

The researchers found a disconnect between the self-reports and the recall test. Both the image group and the image plus annotations group evaluated the specialist's support considerably more positively than the speech group. But on the recall test, the image-and-speech group scored comparably to the speech-only group, while the annotation group had markedly better recall.

"The finding that the actual effectiveness of mobile multimodal communication is different than the self-perceived effectiveness is critical and may negatively affect patient treatment, such as during a specialist consultation;" the study authors write, "if a requesting doctor were to deem phone-based advice from the specialist (without annotation) as sufficient, this could result in poor decision making with regard to the requesting doctor’s further treatment of the patient."

Hospitals are increasingly looking to remote specialist consultations as a way to maximize resources in rural areas and large hospital systems. This study suggests that, despite what physicians might think, those consultations might be most effective if paired with annotated images.