Smartphone and App Usage in Orthopedics and Trauma Surgery: Survey Study of Physicians Regarding Acceptance, Risks, and Future Prospects in Germany

Abstract

Background: In the course of digitization, smartphones are affecting an increasing number of areas of users' lives, giving them almost ubiquitous access to the internet and other web applications. Mobile health (mHealth) has become an integral part of some areas of patient care. In contrast to other disciplines, routine integration of mobile devices in orthopedics and trauma surgery in Germany is still in its infancy.

Objective: This study aimed to investigate physicians' current state of opinion regarding acceptance, future prospects, and risks of medical apps in the field of orthopedics and trauma surgery in Germany.

Methods: A web-based survey among orthopedics and trauma surgeons in German university hospitals on the use of medical apps in everyday clinical practice was conducted between September 2018 and February 2019. The survey consisted of 13 open- and closed-ended or multiple-choice questions. A logistic regression analysis was performed to ascertain the effects of interindividual characteristics on the likelihood of participants' app and smartphone usage behavior.

Results: A total of 206 physicians participated in the survey. All of the participants (206/206, 100%) owned a smartphone, and 79.1% (159/201) used the device, while 64.7% (130/201) used apps regularly in everyday clinical practice. Medical apps were perceived as beneficial, given their substantial future promise, by 90.1% (181/201) of the participants. However, 62.5% (120/192) of the participants were not satisfied with the current supply of medical apps in app stores. Desired specifications for future apps were "intuitive usability" (167/201, 83.1%), "no advertising" (145/201, 72.1%), and "free apps" (92/201, 45.8%). The attributes "transparent app development and app sponsoring" (75/201, 37.3%) and the existence of an "easy-to-understand privacy statement" (50/201, 24.9%) were of minor relevance. The majority of the participants (162/194, 83.5%) considered that future apps in the field of "medical research" would provide the greatest benefit. The greatest predicted risks were "data misuse" (147/189, 77.8%), "usage of untrustworthy apps" (135/189, 71.4%), and "alienation from patients" (51/189, 27.0%). Increasing age was significantly associated with a reduction in the likelihood of regular smartphone (odds ratio [OR] 0.91, 95% CI 0.86-0.97; P=.002) and app (OR 0.90, 95% CI 0.85-0.96; P=.001) usage, while the medical profession grade had no significant impact on the usage behavior.

Conclusions: The study demonstrates that young German doctors in orthopedics and trauma surgery already use smartphones and apps in everyday clinical practice. Medical apps are considered to play an important role in the future. However, a significant discrepancy exists between the supply and demand of mHealth applications, which creates a legal and ethical vacuum with regard to data protection.

Keywords: communication; mHealth; medicine; orthopedics; smartphone; surveys and questionnaires; technology; trauma surgery.

Figure 1

Usage behavior of smartphones and medical apps in orthopedics and trauma surgery (N=206).

Figure 2

Functions or features important to the survey participants in future medical apps (indicated via responses to multiple-choice questions; N=194).

Figure 3

Participants’ responses regarding the greatest benefits of using of medical apps (indicated via responses to multiple-choice questions; N=201).

Figure 4

Participants’ responses regarding the risks that can arise from the regular use of medical apps in the future (indicated via responses to multiple-choice questions; N=189).

Figure 5

Future innovative usage scenarios of apps in daily clinical routines requiring the implementation of smartphones as the central information and communication medium. (1) Collection of patient-related data via smartphones (wearables). (2) Data storage into databases communicating with additional information systems. (3) Data processing by AI (including determination of risk factors or patterns, conducting interdisciplinary case discussions, and facilitating data backflow to the patient (individualized therapy recommendations and patient monitoring). (4) Treatment recommendations (exchange/communicate information with other physicians; eg, digitized guidelines for antibiotic treatment).