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South African Journal of Surgery

On-line version ISSN 2078-5151
Print version ISSN 0038-2361

S. Afr. j. surg. vol.54 n.2 Cape Town Jun. 2016




Smartphone, Smart Surgeon, what about a 'Smart Logbook'?



A AdamI, II, III; K SpencerI, II, III; P SivsankarI, II, III; S Moon I JacubIV

IDepartment of Urology, Helen Joseph Hospital
IIDepartment of Paediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital
IIIDivision of Urology, Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
IVDeveloper, MIP Holdings (Pty) Ltd





BACKGROUND: Mobile phone applications (Apps) have become a vital assistant to medical personnel in today's technologically advanced era. The utility of Apps with case logbook capabilities has not yet been explored. : To assess and evaluate all currently available surgical and procedural case logbook Apps.
METHODS: A comprehensive search was conducted in April 2015 on the Android Play Store, iTunes (Apple App Store, iOS), and BlackBerry World for surgical and/or procedural logbooks. The search terms'surgical logbook', 'logbook', 'procedure logbook' and 'surgical log' were used. Apps which could not be utilized as a surgical/procedural logbook were excluded. Each App was individually assessed and rated using preset criteria, by the unit consultant, registrars, and medical officer.
RESULTS: In total, 2 740 Apps were assessed. After applying our exclusion criteria, only 16 Apps were relevant, and 11 suitable for critical review. Data sizes ranged from 510Kb to 12.2Mb. Costing of the Apps ranged from ZAR 0.00 to ZAR 105.32. The overall study scores revealed the following top five rated Apps: Surgical Logbook by Surgilog; Surgeon Logbook Pro; Surgery Notebook, Surgical Logbook, and Universal Logbook.
CONCLUSION: The current mobile Apps available are efficient in replacing traditional case logbooks. The use of the 'Smart Logbook' may become common practice in the life of the modern-day surgeon.



The recent expansion in technological advancements has had an impact on all spheres of modern day society. The same has been observed with the impact of the Smartphone.1 By definition, a Smartphone is a computer system within a mobile device that is able to perform various tasks, which include the running of third-party software and the possibility to download mobile applications (Apps).2,3 Apps have a wide range of functions in medical education, drug calculation and interactions and can be downloaded free or at a cost.4 These Apps run easily utilising the inbuilt Smartphone hardware.5

Previous surveys revealed that over 80% of residents use a smartphone and approximately 38% of physicians have admitted to using medically-related Apps on a daily basis.1,6,7

The presentation of a systematic case record or surgical case logbook has been a mandatory requirement to complete and stratify specialisation/registrar training in many countries, including South Africa. This logbook also has implications for consultants who need their case series logged for record keeping, follow-up and billing purposes. Since the modern-day registrar and consultant may not always have access to a desktop or pen and paper logbook, various mobile phone Apps ('Smart Logbooks') have been programmed to adequately serve this purpose.

We aimed, therefore, to assess, critically appraise and rank, all currently available surgical and procedural logbook mobile Apps ('Smart Logbooks') that are applicable to the surgical consultant or trainee, within the fields of general surgery and all the surgical sub-specialties.



A comprehensive search was conducted on the Android Play Store, iTunes, and BlackBerry World for surgical and/ or procedural logbooks available in the public domain. The search terms 'surgical logbook', 'logbook', 'procedure logbook', and 'surgical log' were used within these search platforms using an iPhone, BlackBerry device and an Android (Google Play Store) compatible mobile phone. This comprehensive search was conducted on 02-04 April 2015. Apps which could not be utilised as a surgical/procedural logbook were excluded from this study.

To avoid any antecedent account of bias, each App was individually evaluated and rated by the respective reviewer in isolation from other members of the unit. Rating was performed using tailor-made, standardised, preset criteria that included key features needed to serve the purpose of a 'Smart Logbook' (Table 1). This review was individually performed by the unit consultant, two registrars, and the attending medical officer. The preset criteria utilised were specifically selected and structured to assess various important components of the individual App, including: appeal of design, space for patient demographics, App security, ability to monitor trends, number of operative photos attached, description of surgeon's role, accommodation to sub-specialties, record of patient's billing and payment, ability to export records to the iCloud (if applicable), personal computer or printing capabilities and an overall impression (subjective) score.

Scores within each of the above sub-categories were added up for each App per reviewer. The tally of all the reviewers' scores for each respective App was then added together and an average was taken as the overall assessment score for this study.



In total, 2 740 Apps were assessed. After applying our exclusion criteria, 2 724 Apps were excluded. The remaining 16 relevant Apps matched the study criteria (Figure 1. Flow Diagram).



A further 5/16 could not be adequately assessed since 2 were non-English [Op log, Op log lite], 1 required a restricted access college membership [ACS SSR], 1 could not be utilised due to a technical error [iDoctor], 1 duplicated with no difference other than unlimited data storage [Surgeon Logbook free]. A breakdown of the 3 platforms utilised by the Apps that were suitable for the purpose of this study revealed 12 Apple, 7 Android, and 0 Blackberry. The overall rating and individual specifications of the individual Apps assessed within the study have been tabulated (Table 2).

Only 3 Apps were available on multiple platforms. Data sizes of the reviewed Apps, ranged from 510Kb to 12.2Mb. The pricing of the Apps/Surgical Logbooks ranged from cost-free to R105.32.

The frequency of updates within Apps assessed on the Apple platform has been listed (Table 2). The frequency and history of previous updates on the Android platform were not available in the public domain. This update frequency gives users an idea of the progress and potential for improvement within an App. We have observed that both Mobile E logbook and Universal Logbook had undergone at least 20 updates in the time frame assessed.

Our overall scores revealed the following top five rated Apps in order of performance: Surgical Logbook by Surgilog; Surgeon Logbook Pro; Surgery Notebook, Surgical Logbook, Universal Logbook (Figure 2).

A closer look at the TOP-5 performing 'Smart Logbook' Apps':

Surgical logbook scored an overall rating of 88% and was thus rated as the best performing 'Smart Logbook' App in this study. It was created by Surgilog, an IT and medical team specialising in medical case logging. The Apple Store user rating had rated it as 3/5 (at the time of writing). This App only takes up 2.3Mb (Android) or 5.5Mb (Apple) of space and is offered free with regular updates. The password protection within this App allows easy syncing to the iCloud or email. The user is also able to monitor stats and identify trends of cases inserted. Furthermore, this App creates a professional record for the surgeon including a much needed track record of academic activities, a feature very useful for the trainee or academic surgeon. The patient data insertion page, 'new procedure', is clear and easy to negotiate through (Figure 3). These above-listed features, along with the fact that it is currently freely available for download, made this the overall top-rated App within this study.

Surgeon Logbook Pro scored 84% in the overall rating, and was created by AppLand in India. No listed user ratings or reviews were listed in the Android Playstore at the time of writing. This App cost R105.32 and uses 1.75Mb of space. The application is password protected and allows for export of records. The App has a comprehensive patient record system and an additional payment record function. The designer also promotes unlimited data storage which makes it different from its free version, Surgeon Logbook Free.

Surgery Notebook was created by Universal Computer Consultants Pty Ltd. The reviewers of this study rated it as 81%. At the time of writing, there were no official reviewer ratings listed in the iTunes Store. It is only used on Apple iPhones, cost R59.99 and uses 2.8Mb of space. Surgery Notebook is secure and allows for comprehensive record keeping with the capability to export. Reviewers of the current study found it to be user friendly but did also note some technical errors (the App freezes occasionally). A point of note, the registered name Surgery Notebook and the screen cover image (Surgery Notepad) do not match.

Surgical logbook - Medicus is also restricted to the Apple platform. It is password protected, has limited space for patient demographics but has an easy export function. The demographic details on the insertion page, such as the surgeon's name, hospital details and common surgical procedure names or complications can be tailored to the user. After manually inserting these details, these options become saved within the App, allowing easy selection from the 'drop down' menu in the App once it has been inserted. This feature is very useful as it saves users significant time during the data capture process.

Universal Logbook was created by Raj Burgul. The App is not secure, since access is not password protected. This App does not allow for the insertion of detailed demographic data and there is no space allocation to record a surgical assistant's role. However, it does have an export option and a very useful search function. This logbook is adaptable and can also be used for the storage of other non-medical data.

Another important feature present in all the top five listed Apps is that they allow for the attachment of intraoperative photographs to the patient's record. This feature is very useful for future reference, case reports, research, presentations and patient follow-up.

Certain features available within all the Apps assessed are favourable and noteworthy and may be more important to some users. For example, a back-up with a 'Drop Box' feature (CT Case Log), individualised menu drop downs (Surgical Logbook), synchronization with a calendar (Surgeon Logbook), an option to add on colleagues (SurgiChart), and an option for both pre- and postoperative images to be incorporated under the same patient profile (Ortho logbook) are amongst other noteworthy features observed during this review.



Various service providers offer similar smartphone devices; therefore, as a point of reference, smartphones are at times classified according to the mobile operating system that they run.8 The most commonly used smartphones worldwide are Apple's iPhone and Samsung's Galaxy, and the largest application stores include Apple's App Store (iOS), Google Play (Android) and BlackBerry World.9 For the purpose of this study, we thus aimed to focus on the above three platforms.

The South African mobile phone retail sector noticed an increase in sales, since more affordable versions of smartphones have entered the market. With the ongoing decrease in data and internet costs, the competition between mobile phone operators will continue to intensify.10 These factors have made the growth of the smartphone market sector in South Africa amongst the fastest in the world.11

The impact of mobile phone Apps on Clinical Medicine and its practice has been immediate and its extent far reaching, with beneficial Apps in many diverse fields, such as Dermatology, ENT, Adult Surgical Specialties and even in the modern domain of Paediatric Urology.3,4,12,13

The following 3 Apps were available on multiple platforms: Surgical Logbook by Surgilog, Mobile E Logbook and CT Case Log. This makes the use of these Apps a more versatile option, since users will not have concerns if they intend to upgrade or switch to another platform or mobile device at a later stage.

The cost factor was also a significant variable that needed consideration in this study. We observed that a higher purchase cost was not always associated with a better performing App. The top rated App, Surgical Logbook by Surgilog was available freely on both the Google Play Store (Android) and Apple App store (iOS) platforms.

App 'freezing' was a problem encountered with two Apps (Surgery Notebook and Surgichart). This was of concern since the demographics entered could not always be completed prior to the 'freeze', which sometimes resulted in the loss of valuable patient data.

An obvious limitation encountered within all peer-reviewed publications reviewing studies of this nature is the discrepancy between the App updates and the lag time from first submission to the article publication date. Thus, this study may not be up to date on the date of publication, since updated Apps may have been available after this manuscript was written and subsequently accepted for publication.

The other often overlooked aspect is the concern of patient privacy and confidentiality, a matter which practitioners need to proactively maintain in the current era of technology and easy accessibility to social media.14 These factors need special consideration when entering patient details and operative photographs into the 'Smart logbook'.

A recent assessment of the current surgical Logbook requirements for the General Surgical and Surgical Sub-specialty final examinations from the local Colleges of Medicine of South Africa (CMSA) was reviewed; accessed from on 20th May 2016.

The differences between the various surgical colleges have been tabulated (Table 3). Some specialties prefer different descriptions of the actual surgeon's role within the logbook and certain parameters were not always specified. Although the majority of the requirements assessed (Table 3) are present within the top five Apps reviewed, there is room for App developers, examination boards and the relevant academic surgeons to review these requirements and tailor-make Apps to fulfill each specialty's requirement. This would lead to a more thorough Logbook review process and avoid the 'precious' time interruptions from candidates, during the weeks preceding their final examinations.

Although the file transporting capabilities have not been explored across different file formats within this study, it would prove useful if Apps allowed importing and exporting of the comma-separated values (.csv) file formats as well. This facility would make tabulation data easier to interpret and evaluate while using the 'Smart Logbook'.

A logbook may also need verification against another format to ascertain that it has been captured correctly, and is indeed the correct reflection of a surgeon's actual experience. This is especially relevant when one's logbook is needed for verification processes with a professional body, or if medicolegal issues are queried. The current verification processes in South Africa may be done manually, but, as is the international trend, this may soon become matched to electronic records and data from the attending hospital or associated recording facility.

Furthermore, the concept of securing the accessibility and transfer of this confidential data also requires a security login verification to attain access to this information. Within this review, this factor was used as a scoring point (Table 1): 'Are passwords and codes in place to ensure patient confidentiality?', as this feature holds importance within the framework of any secure 'Smart Logbook'.



After reviewing all currently available 'Smart Logbook' Apps that could substitute the traditional case logbook, we have observed a vast gradient in performance.

The obvious benefit of utilizing Apps available on multiple platforms is that the surgeon has the freedom to change platforms at a later stage, without missing out on the App they had just become so accustomed to using.

The current Logbook practices, requirements and submission methods used within a South African context could be improved to become a more regulated, secure, simplified and accessible method of data collection, by adequately utilizing a 'Smart Logbook'.

The top five performing Apps, in order of performance were independently ranked as: Surgical Logbook by Surgilog, Surgeon Logbook Pro, Surgery Notebook, Surgical Logbook, and Universal Logbook.

Surgeons in today's modern era need to embrace the technological advancements at their disposal. The 'Smart Logbook' will make case record-keeping more convenient than ever before, since the mobile phone is always 'close at hand' to the ever-busy surgical trainee or consultant.


Conflict of Interest




The authors are grateful to Mrs Anna Welman, Department of Surgery, Helen Joseph Hospital, University of the Witwatersrand, for her secretarial support in the drafting of this manuscript.



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Ahmed Adam

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