When Dr. Paul Abramson treats patients, he has the usual assortment of medical tools, tests and protocols. And then there's the patient-gathered data he reserves for his most confounding cases.
Using an iPhone app, Abramson will have a patient with, say, mystifying migraines or seemingly inexplicable stomachaches self-track data such as how much sleep they're getting or what they're eating.
That information is eventually fed back to Abramson as potential clues to whatever medical mystery he's trying to solve. The result is a more complete picture of his patients that in turn makes it much easier for him to figure out what's going on.
"I am getting immeasurably more info about a patient than I could have gotten on my own," Abramson said. "Patients who have been my patients for years I'm finding out are completely different people than I thought they were."
Abramson is on the vanguard of the emerging digital revolution in medicine. Beyond consumer-driven apps that count calories or encourage exercise, mobile technology is beginning to significantly change how doctors practice medicine.
"We're at a very interesting intersection of technology impacting clinical care, which hasn't really changed dramatically in 50 or 60 years," said Dr. Michael Blum, director of the Center for Digital Health Innovation at UCSF. "When we look back in 10 years, we're going to be amazed how far we've gone."
An element of tech
The ubiquity of smartphones has already had an effect on clinical practice in numerous obvious ways. Doctors can speedily access important information such as drug dosage recommendations or disease profiles as well as a patient's medical information. They can also more easily communicate about patients with specialists or other colleagues.
Abramson began experimenting with other uses for mobile medical technologies on himself. He was getting regular headaches, with little clue as to why. A geek of sorts who earned a master's degree in electrical engineering from Stanford before heading to medical school, Abramson enjoys putting himself in the role of lab rat.
Using his phone, he started tracking everything from caffeine intake and mood to barometric pressure and light exposure.
This was possible, of course, because of the incredible number of gadgets all rolled into his iPhone. It turned out the headaches were related to sleep; if he got enough shut-eye, the headaches disappeared.
About a year ago, he debuted the Quant Coach program at his practice. The program's roots stem from the tracking Abramson did on himself.
"I just didn't feel like I had enough information coming back to me from patients," he said.
The Mymee app
Patients are instructed to track varying sets of information, entering the data into an app called Mymee. That data is sent to Abramson's office and compiled in an open-source data visualization software called FluxStream. What is called a "quant coach" in his office then pores over this data, summarizing it for Abramson.
He said the methodology has allowed him to solve some complex medical riddles -- physical ailments, for example, that wound up related to less-than-obvious causes, such as environment. He can keep close tabs on his patients and amass a rich picture of all the factors that might be contributing to an illness.
The potential applications for smartphones in medicine are growing more sophisticated.
At the 2013 TEDMED conference in Washington, D.C., an exhibition introduced the notion of the "smartphone physical." It featured a collection of gadgets that, when hooked into an smartphone, can gather a slew of clinically relevant information.
Tricked-out, the smartphone becomes something akin to a real-life realization of Star Trek's medical tricorder. Plug in the corresponding device, and the phone can determine blood pressure, monitor glucose or perform an electrocardiogram. The NETRA-G is a small, plastic eye piece that, when hooked into a smart phone, can test visual acuity.
Fusing med and tech
As the home to companies such as Rock Health and Health 2.0 that fuse the power of Silicon Valley with medical expertise, the Bay Area has been at the forefront of digital health innovation. Such innovation, though, is still in the early stages.
For one, medicine has been relatively slow to embrace technologies already available. Several doctors referred to that pace as "sclerotic."
"Physicians are still bound to archaic technologies like pagers and fax machines," said Dr. Nate Gross, co-founder of Rock Health, a seed accelerator for mobile and web health startups. In one recent survey, fewer than half of attending physicians reported using smartphones for patient care.
The complexities of developing new medical technologies have also been a hurdle. As Gross explained, young, brilliant techies and investors are more interested in the next Four Square or Angry Birds, which are easily understood and don't require the extensive trials and testing an evidence-based medical iPhone app might call for.
Many of the applications and devices that exist do not measure up to the rigorous standards of medicine. Earlier this year, a study of apps that claim to identify cancerous moles highlighted the disparity of scientific rigor. The best performing app accurately identified moles that had turned cancerous about 98 percent of the time; the worst was accurate less than 7 percent of the time.
The Food and Drug Administration has announced plans to regulate some apps, and issued draft guidance in 2011. But final regulations -- and clarification of which apps would be subject to them -- are still forthcoming.
"There is a little bit of disconnect between the community developing these technologies and the actual health-care system," said Blum. But it's a gap both UCSF and Rock Health are working to bridge.
The key, doctors say, is in developing mobile technologies that are more than just fun gadgets for self-tracking enthusiasts. To be useful to the medical community, mobile technologies need to be at least as effective as traditional tools and pass rigorous standards and scientific evaluations for medical devices.
The smartphone could contribute hugely to making medicine less costly, more efficient and accurate, they say.
For example, a patient with heart palpitations could use the AliveCor Heart Monitor, which requires a prescription, to screen rhythm abnormalities, transmit them to a doctor and determine whether to go to the hospital. Such devices could cut down on the time and money patients spend in doctors' offices and emergency rooms.
Or they could one day replace expensive medical equipment with devices that cost just a few hundred dollars.
"With the smartphone, the opportunity to expand care more broadly is tremendous," said Dr. Aenor Sawyer, an associate director of UCSF's digital health center.
Just the beginning
In the end, a smartphone or tablet is just one piece of medicine's digital revolution.
In Abramson's San Francisco practice, the use of mobile technology and tracking is an ongoing experiment, one he is constantly honing to make more time- and cost-effective.
For starters, he found that spending his own, high-priced time analyzing patient data was not cost-effective. That's why he added a "quant coach," a combination personal trainer/data analyst who works with patient data.
Eventually his goal is to develop a model that other doctors will use that combines the right amount of technology, tracking and medical expertise to deliver outcomes faster while also not eating up unnecessary resources or patient dollars.
Already, the "experiment" has changed the way Abramson views medicine.
"It's made me focus on the fact that medical care is more of a process," he said. "It's more than just a result."
Kristen V. Brown is a San Francisco Chronicle staff writer. E-mail: [email protected] Twitter: @kristenvbrown ___