In Patients' Hands: Smartphones as Medical Infrastructure.

This article examines the ways in which smartphones have emerged as essential pieces of medical infrastructure that increasingly connect patients to their health-care providers, directly interface with medical devices, and bear responsibility for care delivery. While clinical care increasingly depends on smartphones as continuously available platforms for monitoring and communication, smartphones themselves are not regulated as components of health-care infrastructure. The authors examine the historical and cultural context for the rise of smartphones into this role and consider the policy and ethical implications, including potential hazards, of this subtle but consequential shift. Recognizing smartphones as infrastructure reframes a range of issues that might otherwise appear to be isolated or app-level problems, including the transfer of technological, financial, and privacy-related burdens onto patients themselves. The authors explore how smartphones complicate existing frameworks for medical device regulation, patient autonomy, surveillance, and health equity, while also considering potential ethical and regulatory responses to these emerging challenges.