There has been a rapid rise in the use of smart devices amongst medical practitioners throughout the world. This study aimed to identify how smart devices were being used by medical practitioners at the Universitas Academic Hospital (UAH), Bloemfontein, and the associated factors thereof. We also identified the views of medical practitioners regarding the usage of smart devices at their workplace.
A prospective cross-sectional study was conducted. Anonymous questionnaires were distributed to medical practitioners working at UAH during weekly departmental meetings or monthly morbidity and mortality meetings. The following largest departments were included: Surgery, Anaesthetics, Paediatrics, Internal Medicine, Family Medicine, and Obstetrics and Gynaecology.
The response rate was 82.7% of those attending the meetings. All the respondents owned a smart device and brought it to their workplace. The most common applications used on these smart devices were that for drug references (65.9%), medical textbooks (63.6%) and medical calculators (58.1%). Significantly larger percentages of doctors aged 21–39 years compared with those aged 40–65 years used drug reference applications and medical calculators. A quarter (24.8%) of respondents communicated with patients through a smart device, 21.7% used an online storage platform to backup patient data, whilst 56.6% used their devices to store and view patient information. More than one-third (36.7%) agreed that smart devices threatened patient confidentiality, but the majority (58.8%) did not agree that these devices hinder patient communication. The majority felt that these devices improved both personal performance (69.2%) and patient care (79.0%).
Smart devices usage is common in this setting. Hence, integration of such usage in medical curricula, discussion on professionalism, ethics and confidentiality in this context, and guidance from institutions and professional bodies become necessary.
There has been a rapid rise in the use of smart devices (mobile devices such as tablets, laptops and cell phones) amongst medical practitioners throughout the world.
Communication between different staff within a hospital has changed considerably.
Progress in technology has made the transfer of information easier. Improvement in the quality of mobile cameras and speed of the Internet have allowed the sending of patient X-rays, computerized tomography (CT) scans and other images and videos much more conveniently.
Confidentiality of patient information is of concern because medical practitioners could easily distribute and share this information.
Limited research has been published on how medical practitioners in South Africa use their smart devices for professional purposes. We identified only two South African reports, but they did not match the context with which this study has been initiated.
The aim of this study was to identify the ways smart devices are being used by medical practitioners at the Universitas Academic Hospital (UAH), Bloemfontein, and the associated factors thereof.
Specific objectives:
To identify the types of smart devices used for work purposes at the hospital.
To determine which medical applications are there on the smart devices of medical practitioners.
To identify the work-related activities for which smart devices are used by medical practitioners.
To identify the views of medical practitioners regarding the use of smart devices at their workplace.
To identify whether age plays a role in the use of medical applications.
To identify the difference in the use of smart devices between different departments.
This was a prospective analytical cross-sectional study. The study population comprised medical practitioners working in the largest departments of UAH, namely, Departments of Surgery, Anaesthetics, Paediatrics, Internal Medicine, Family Medicine, and Obstetrics and Gynaecology. The inclusion criteria being the head of department or unit, consultants, registrars and interns in the age group 21–65 years.
Arrangements were made with the head of each department, and a convenient day was fixed for data collection using an anonymous and self-administered questionnaire. The questionnaire was compiled by the authors using related questionnaires
The pilot study was performed on 10 medical practitioners from the Department of Orthopaedics. Subsequent changes made to the questionnaire included removing some of the questions and correcting spellings and grammatical errors. The pilot study results were excluded from the main study.
The data were coded and entered into an Excel spreadsheet. Data analysis was performed by the Department of Biostatistics, Faculty of Health Sciences at the University of the Free State (UFS) using SAS software, version 9.3. Results are summarised by frequencies and percentages. Denominators are indicated throughout because some respondents did not complete all the questions. Subgroups were compared using chi-square or Fisher’s exact tests.
Each respondent received an information leaflet about the aim of the study. By completing the anonymous questionnaire, respondents agreed to participate in the study. Participation in the study was voluntary and respondents were free to withdraw from the study at any time.
The protocol was approved by the Health Sciences Research Ethics Committee, UFS (HSREC-S 15/2017), and the Free State Department of Health gave permission to conduct the study.
Of the 156 medical practitioners who attended various meetings, 131 completed the questionnaire. Two questionnaires were excluded because their respondents did not comply with the inclusion criteria; hence, 129 questionnaires were included in the study (response rate 82.7% of those who attended various meetings).
Most of the respondents (80.6%) were in the age group 21–39 years (
Demographic information of participating medical practitioners.
Variable | % | |
---|---|---|
21–39 | 100 | 80.6 |
40–65 | 24 | 19.4 |
Head of department/unit or consultant | 43 | 34.1 |
Registrar | 37 | 29.4 |
Intern | 43 | 34.1 |
Other | 3 | 2.4 |
Surgery | 39 | 30.2 |
Internal Medicine | 30 | 23.3 |
Obstetrics and Gynaecology | 20 | 15.5 |
Family Medicine | 19 | 14.7 |
Paediatrics | 13 | 10.1 |
Anaesthetics | 8 | 6.2 |
All the respondents (
Applications on smart devices and work-related usage (
Variable | % | |
---|---|---|
Drug reference | 85 | 65.9 |
Medical textbooks | 82 | 63.6 |
Medical calculator | 75 | 58.1 |
Literature search | 60 | 46.5 |
Disease diagnosis | 56 | 43.4 |
Medical training | 33 | 25.6 |
Patient communication | 16 | 12.4 |
Patient education | 9 | 7.0 |
Clinical communication | 11 | 8.5 |
Colleague communication | 112 | 86.8 |
Storage and usage of medical books | 92 | 71.3 |
Patient information storage and viewing | 73 | 56.6 |
Patient communication | 32 | 24.8 |
Online backup of patient information | 28 | 21.7 |
More than half of the respondents had applications for drug reference (65.9%), medical textbooks (63.6%) or a medical calculator (58.1%) on their smart devices. Few respondents had an application for clinical communication (8.5%) or patient education (7.0%). Respondents mostly used their smart devices for communication with colleagues (86.8%) or storage and use of medical textbooks (71.3%). The median number of types of applications was three (range 0–9).
When comparing the age groups 21–39 years and 40–65 years regarding medical applications, statistically, a significantly larger percentage of younger age group had drug reference applications (72.0% vs. 45.8%,
Departments of Surgery and Internal Medicine, the two largest departments, were compared in a similar manner. Statistically, there was a significant difference between the two departments regarding having an application to communicate with patients (21.1% vs. 0.0%,
Frequency of work-related activities performed on their smart devices.
Question | Always |
Sometimes |
Occasionally |
Never |
||||
---|---|---|---|---|---|---|---|---|
% | % | % | % | |||||
I record patient information on my smart device | 13 | 10.1 | 34 | 26.4 | 48 | 37.2 | 34 | 26.4 |
I use my smart device to send information to other doctors | 38 | 29.5 | 57 | 44.2 | 30 | 23.3 | 4 | 3.1 |
I use WhatsApp to send images of patients for opinions | 29 | 22.5 | 54 | 41.9 | 29 | 22.5 | 17 | 13.2 |
I use my device to email patient information | 2 | 1.6 | 12 | 9.3 | 41 | 31.8 | 74 | 57.4 |
I look up images of patients on social media ( |
3 | 2.4 | 6 | 4.8 | 15 | 11.9 | 102 | 81.0 |
I post images of patients on social media ( |
2 | 1.6 | 1 | 0.8 | 5 | 3.9 | 119 | 93.7 |
I look up diagnoses on Google | 10 | 7.8 | 48 | 37.2 | 50 | 38.8 | 21 | 16.3 |
I look up diagnoses on medical apps ( |
23 | 18.0 | 36 | 28.1 | 54 | 42.2 | 15 | 11.7 |
I look up drug dosages | 29 | 22.5 | 67 | 51.9 | 26 | 20.2 | 7 | 5.4 |
I use my device to look up drug interactions | 19 | 14.7 | 62 | 48.1 | 41 | 31.8 | 7 | 5.4 |
I manage patient admissions/operations/investigations etc. ( |
8 | 6.3 | 28 | 21.9 | 26 | 20.3 | 66 | 51.6 |
I maintain a logbook on my smart device | 17 | 13.2 | 6 | 4.7 | 17 | 13.2 | 89 | 69.0 |
I use medical calculators to assist me in working | 10 | 7.8 | 46 | 35.7 | 45 | 34.9 | 28 | 21.7 |
I look up anatomy on my device | 10 | 7.8 | 31 | 24.0 | 50 | 38.8 | 38 | 29.5 |
I look up diagnostic criteria | 13 | 10.1 | 62 | 48.1 | 42 | 32.6 | 12 | 9.3 |
I use my device to look up procedure codes (ICD10, CPT4, etc.) | 38 | 29.5 | 28 | 21.7 | 34 | 26.4 | 29 | 22.5 |
I answer private calls whilst with a patient ( |
2 | 1.6 | 12 | 9.4 | 55 | 43.0 | 59 | 46.1 |
I sms/WhatsApp whilst interacting with a patient | 0 | 0 | 9 | 7.0 | 53 | 41.1 | 67 | 51.9 |
I use my smart device for emergency care ( |
9 | 7.6 | 40 | 33.6 | 53 | 44.5 | 17 | 14.3 |
Note: All
, ‘always’ = every day or second day, ‘sometimes’ = once or twice a week, ‘occasionally’ = a few times a month.
Regarding information handling and administrative work, 37.2% of the respondents occasionally recorded patient information on their smart device and sometimes send information (44.2%) or images (41.9%) to other doctors. Only a few respondents reported that they always looked at (2.4%) or posted (1.6%) images of patients on social media. Half of the respondents (51.6%) never managed patient admissions or operations through their smart device, whilst 69.0% never maintained a logbook on their device.
Respondents occasionally referred to Google for diagnosis (38.8%) or medical application (42.2%). Half of the respondents used their smart device sometimes to look for drug dosages (51.9%) and drug interactions (48.1%), whilst 44.5% occasionally used their smart device for emergency care.
Regarding private communication, approximately half of the respondents never answered a private call (46.1%) or sent a message (51.9%) whilst in the presence of a patient, and about 40.0% indicated that they did occasionally answer a private call (43.0%) or send a message (41.1%).
More than one-third (36.7%) of respondents agreed that smart devices threaten patient confidentiality, but the majority (58.8%) did not agree that these devices hinder patient communication (
Perceptions and practices of medical practitioners on the work-related use of smart devices.
Statement | Agree |
Neutral |
Disagree |
|||
---|---|---|---|---|---|---|
% | % | % | ||||
I think that smart devices improve patient care ( |
94 | 79.0 | 19 | 16.0 | 6 | 5.0 |
I think smart devices are a vital component of patient care ( |
66 | 55.0 | 40 | 33.3 | 14 | 11.7 |
I believe that my device can improve my performance at work ( |
83 | 69.2 | 29 | 24.2 | 8 | 6.6 |
I think devices have improved the performance of colleagues at work ( |
56 | 47.1 | 41 | 34.4 | 22 | 18.5 |
I think that my device hinders communication with patients ( |
16 | 13.5 | 33 | 27.7 | 70 | 58.8 |
I think that the usage of smart devices can slow down doctors ( |
23 | 19.2 | 43 | 35.8 | 54 | 45.0 |
I think the usage of smart devices around patients is disrespectful ( |
47 | 39.2 | 45 | 37.5 | 28 | 23.3 |
I think the usage of smart devices for diagnosis is unprofessional ( |
13 | 10.8 | 25 | 20.8 | 82 | 68.4 |
I think smart devices threaten patient confidentiality ( |
44 | 36.7 | 51 | 42.5 | 25 | 20.8 |
I believe the risk to expose patient information is minimal ( |
32 | 26.7 | 47 | 39.1 | 41 | 34.2 |
I only trust information from applications bought through an app store ( |
29 | 24.2 | 60 | 50.0 | 31 | 25.8 |
I think that Google is a trustworthy browser to look up medical information ( |
23 | 19.2 | 45 | 37.5 | 52 | 43.3 |
I believe that smart devices improve medical education ( |
87 | 73.1 | 27 | 22.7 | 5 | 4.2 |
I think that hospitals should provide smart devices ( |
53 | 44.2 | 38 | 31.7 | 29 | 24.1 |
All of the medical practitioners at UAH brought a smart device, mostly their cell phone, to work. Work-related usage mainly included communication with colleagues and storage and usage of medical books. The most common applications on their smart devices were drug referencing and medical textbook applications.
Statistically, the age group 40–65 years had a significantly smaller percentage of medical practitioners with drug reference applications as compared with the age group 21–39 years. We hypothesised that this could be because the younger doctors had lesser knowledge regarding drugs and therefore used the applications to ascertain their prescription. Another reason could be that the older generation preferred to use medical formularies than using electronic drug referencing. There was also a general decrease in the number of applications uploaded from the age group 21–39 years to that of 40–65 years. Thus, we conclude from this trend that younger medical practitioners preferred to keep various applications pertaining to healthcare on their devices as opposed to their older counterparts.
In our study, 86.8% (including always, sometimes and occasionally) of the medical practitioners indicated that they send medical-related images of patients to their colleagues through WhatsApp for a second opinion. This is in line with a study
In our study, nearly one-fifth of medical practitioners stated that they searched for images of their patients on social media. Furthermore, a few indicated that they placed images of patients on social media platforms. This was an unexpected finding because of the ethical and legal implications regarding this action, especially if it was without patient consent.
In terms of using secondary sources to assist in obtaining a diagnosis, nearly one-fifth of the respondents always used medical applications, with less than half of this proportion indicating that they always used Google as a source of reference. One of the reasons why the use of applications was preferred over Google could be because of an increase in the number of healthcare applications as well as their accuracy in recent years.
Only 5.4% of the medical practitioners indicated that they never searched drug dosages or drug interactions on their smart devices. When compared with a study
A total of 89% of respondents said that they never (46.1%) or only occasionally (43.0%) answered private phone calls in the presence of their patients. This could indicate that most medical practitioners still found it disrespectful to answer private calls in the presence of patients unless it is an emergency. A study
Only 7.6% of medical practitioners indicated that they always used their smart devices for emergency care. In a study
A quarter of medical practitioners in this study used their smart devices for patient communication. Even though the vast majority agreed that smart devices could improve patient care, just over half felt that it was vital for patient care. Therefore, it seems that the medical practitioners of this study did not consider communication with their patients through smart devices a crucial element regarding patient care.
In terms of confidentiality, 37.7% agreed that smart devices threaten it, whilst the majority (42.5%) took a neutral position. This showed the controversy over the usage of smart devices within the clinical environment. A study conducted at the University of Toronto has shown that 68% of the students believed that the usage of their smartphones posed a risk to patient confidentiality.
If more medical practitioners feel the same way as the 68.4% of medical practitioners at UAH who indicated that the use of smart devices in diagnosis was not unprofessional, then smart devices would eventually play an important role in the assistance of obtaining a clinical diagnosis. This is also supported by the fact that the respondents of the study agreed that smart devices improved personal and colleagues’ performance. Based on the findings in a qualitative study of smartphone and tablet usage by house officers at a Ghana teaching hospital, Barnor-Ahiakor
Results reflect only the practices and opinions of medical practitioners from the largest departments and those who attended the selected weekly departmental or monthly morbidity and mortality meetings and chose to answer the questionnaire.
At some meetings, the questionnaires could be collected only after the meeting was over or on the next day because of the urgency of the meetings. This resulted in low response rates as we struggled to collect questionnaires. We could only compare responses from the Departments of Internal Medicine and Surgery because of the low number of responses from other departments.
Medical practitioners at UAH all used smart devices at their workplace. The most common application used by medical practitioners was that of drug referencing. The medical practitioners found smart devices useful in their professional lives and felt that these improved their performance, although they had varied opinions about the ethical issues pertaining to smart devices and patient care. The younger generation made use of their smart devices more at work compared with the older generation. Thus, as more medical professionals start using smart devices in the medical environment, integration of such usage in medical curricula, discussion on professionalism, ethics and confidentiality in this context, and guidance from institutions and professional bodies become necessary.
The authors thank the respondents of the study for providing valuable data; Mpendulo Mamba, Department of Biostatistics, Faculty of Health Sciences, University of the Free State, for statistical support and Theanette Mulder, Faculty of Health Sciences, University of the Free State, for editorial and technical manuscript preparation.
The authors have declared that no competing interests exist.
Y.X., Z.F., K.S., S.S., K.M. and B.M., who were undergraduate medical students at the time of the study, compiled the protocol, performed the data collection and wrote the report that served as the basis of this manuscript. N.P. was the study leader who suggested the topic and supervised the students through the project process. G.J. advised with the planning of the study, performed the analysis and compiled the final manuscript.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.