gms | German Medical Science

Objective: The tremendous development in the competitive field of information technology (IT) during the last decade is continously generating new products, especially for the mobile usage. The Apple iPhone is the most widespread mobile device among physicians with 61% of all U.S. physicians owning one at the end of 2011. A variety of medical iPhone applications (apps) are available to simplify the daily work of physicians. However, most of these applications are only replacing medical reference books. The physician's work in the emergency department is characterized as non-routine, mobile, context-driven, multi-tasking, time-critical and information-rich. Therefore, in this project we were focused in developing a software not merely as a reference tool but rather a tool for a structured hand examination for physicians confronted with hand trauma patients. Furthermore, this handsurgery app allows the user to apply multiple cases at the same time making the workload in an emergency room more organized.

Methods: To achieve a userfriendly interface different physicians at different time-points have been observed during their work-shift in a surgical emergency department. Patient interaction as well as the complete workflow from admission to discharge was documented using an observation tool. According to the most common hand injuries, diagnostic trees have been compiled for the different regions of the hand (wrist, metacarpal, thumb, long fingers). To realize both, a userfriendly interface as well as realistic 3-dimensional imaging of the hand, human 3D-Model (Plasticboy Pictures, Cape Town, South Africa) was implemented and modified using 3ds max (Autodesk, San Rafael, CA, USA).

Results: The physicians observation showed activities including admission, examination, treatment and discharge. However, in most of the cases the workflow was non-linear (see Figure 1 [Fig. 1]) as the patients have to be sent for further examinations (e.g., x-ray) and the physician is commonly interrupted in his workflow due to other emergency patients as well as phone calls. Using the Handsurgery APP the physician can organize his patient files and status (e.g., “sent to x-ray”) and, by following the implemented diagnostic trees, obtaining a detailed examination result of the hand injury. Furthermore, using the iPhone-camera, a complete documentation of each patient file is possible. Finally, with the 3-dimensional imaging the physician can present the injured structures to the patient for further explanations. (Figure 1 [Fig. 1], Figure 2 [Fig. 2])

Conclusions: Mobile devices like the Apple iPhone are widely used and, from the technically view, are able to assist physicians in their daily routine work. Thus, the Handsurgery APP is offering a variety of helping tools like patient documentation with complete examination using the diagnostic trees, photo and x-ray-documentation as well as a userfriendly 3-dimensional interface. With these features, the Handsurgery APP might also become an interactive helping tool between physicians at different locations to decide a possible treatment and the urgency of it.