For all the incentivizing, prompting and pleading to get physicians to adopt health IT, perhaps no one could have predicted 20 years ago that the cell phone would have the biggest impact on adoption rates. Evidence comes in a recent report, "Taking the Pulse v9.0," issued by Manhattan Research. It found that 64% of doctors, more than double the number eight years ago, are using smartphones -- iPhones, BlackBerrys, Treos and other hand-held devices with phone, wireless Internet access and robust applications that bring formerly desktop solutions to the palm. "You have to make it very easy for the average doctor," said Denis Harris, MD, a solo orthopedic surgeon from Washington, D.C., who runs most of his practice from his iPhone. Dr. Harris, 63, said that by having the technology mobile, many physicians who avoided IT adoption because they thought it would be obtrusive are now taking a second look. According to Manhattan's research, some of the most widely used mobile applications by physicians are drug and clinical references, as well as clinical tools such as dosage calculators. But many believe this is just the launching pad for a technology-driven health care system that will revolve around the smartphone. Monique Levy, senior director of research for Manhattan Research, said she is starting to see the line between the tasks done by physicians on desktop computers and on mobile devices "start to blur." 64% of doctors use smartphones. "You prefer to do things where you need bigger visuals on your PC, but if it's useful to you because you are on the train or between patients, whatever it is, it seems to be good enough to do it on your mobile phone, which mirrors the consumer world," Levy said. Alex Kasten, a consulting analyst for The Diffusion Group who conducted a study two years ago on physician use of smartphone technology, said mobile devices and applications will never replace desktop systems entirely. They will, however, help physicians become more efficient by bringing those applications to the point of care, which may persuade more doctors to adopt health IT. "Primarily, the work flow you are going to enter into as a provider at the point of care, in front of the patient, will be done on a device like an iPhone. [A] desktop, laptop, keyboard is pretty much not going to work if you want to do things quickly and do things at the point of care," said Tom Giannulli, MD, an internist from Westlake Village, Calif., who developed the first stand-alone EMR for the iPhone. It was launched in September 2008. Interface problems The problem with some applications has been the interface, Dr. Harris said. There's only so much you can do on a small screen. But the developers are tweaking applications to fit physicians' needs. For example, Dr. Giannulli's iChart application has a Web site to which the mobile devices can sync to make viewing easier and to accomplish tasks that are beyond a mobile device, such as printing reports or reviewing full-size x-rays. The first stand-alone EMR for the iPhone was launched in September 2008. Dr. Harris, an iChart user, believes the next generation of iPhone EMRs will have voice recognition that automatically will fill in the appropriate fields on the desktop system. While Dr. Giannulli and Dr. Harris envision a health care system that ties desktop systems to physicians' palms, C. Peter Waegemann's vision goes one step further. Waegemann spent 30 years advocating for electronic medical records as executive director and founder of the Boston-based Medical Records Institute. The institute quietly shut its doors earlier this year to make way for the mHealth Initiative, a new organization focused on the advancement of mobile technology in health care. "We really believe that if the Obama administration will now put $10 billion or $20 billion just to make sure everyone gets an electronic medical record system, it would not bring much for our [health care] system. It would not bring savings or make physicians happier or make hospitals happier," Waegemann said. "But if you spent $5 billion on [mobile technology] and you get a system which is participatory where you involve everyone else, and it's simple and easy-to-use solutions, physicians will be happier, hospitals will be happier, patients and consumers will be happier." Waegemann believes that the hundreds of mobile applications being developed each week both for physicians and patients will affect health care more than any of the health IT systems the government is pushing. Waegemann says mobile devices will change the physician-patient relationship. He predicts widespread use of mobile monitoring devices, cell phone-based personal health records and applications that keep patients connected with their physicians at all times. This will change the reimbursement system as well, he said. The traditional reimbursement structure has meant that innovative systems are pushed out of the market, Waegemann said. But today's mobile applications are creating a participatory health care system that not only physicians but also consumers are starting to demand. Payers eventually will have to respond to these demands as well, he said. While Kasten believes that mobile technology can make life easier for physicians, he does worry about one potential consequence -- too much information. "The downsides are you don't have as much freedom," said Dr. Harris, who added that having work on his iPhone means he always has his work with him. According to Waegemann, the mHealth Initiative is working to secure federal stimulus funds to launch pilot programs that will show the cost savings and advantages of mobile applications for physicians and patients. "I am almost certain the stimulus money will be spent in different ways from what the politicians have been thinking," Waegemann said.