HIStalk Advisory Panel: Use of Mobile Devices

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This month’s question: What interesting uses of mobile devices are you seeing by hospital employees and physicians?

We have very limited use of mobile devices in our organization due to security-driven policies. We are hoping that once we complete a virtual desktop infrastructure install we’ll be able to be more flexible.

Jordan Hospital in Plymouth, MA has a terrific mobility approach. They had a serious noise problem on the patient floors. They decided to implement a "quiet hospital" program. They banned the use of the PA system for any reason on penalty of being fired. They bought a large number of iPhone 4s (at a great discount since the 5s have debuted).  They disabled their cellular functionality, making them usable only on a WiFi network (the hospital’s). At the beginning of each shift, the nursing staff picks up a phone from a large charging bay. He or she types in a code and that phone automatically rings to his or her personal extension during the shift. In addition, when the nurse logs in, he or she has immediate access to all of the patient EHRs (Meditech) that have been assigned to him or her for that shift. The charge nurses can assign patients individually or take a single nurse’s entire patient load and assign it to another nurse on the next shift with only a few keystrokes. Patient calls to the nursing station are automatically forwarded to the iPhone of that patient’s nurse. If the nurse doesn’t respond in 15 seconds, the call is automatically forwarded to the charge nurse. Doctors affiliated with the hospital also get iPhones, but theirs have their cellular functionality left intact, so he or she can be reached whether or not they are in the hospital. Individual extensions never change, and the on-call physicians in each specialty can be dialed or texted with a single keystroke. Jordan has not lost a single iPhone since the nurses’ units don’t work outside the four walls of the hospital. They were very surprised when they analyzed what functionality was being used by the nurses most frequently. It turned out to be texting, which was not expected since the average nurse’s age is 54. Within two weeks of implementation of the program, patient satisfaction scores went from the low 70s to the mid 90s.

We are using Clinical Expert to do some clinical surveillance relative to sepsis. These alerts are sent to response team via iTouch and iPad app.

[from a vendor employee] We’re definitely seeing increased uses of mobile devices by the people we connect with in revenue cycle, finance, and department heads. They’re relying on their mobile devices to have up-to-date information, dashboards, and reports on the overall financial status of their facility or system. These reports range from AR, productivity, and charge capture for revenue cycle. Department heads are moving toward utilizing mobile devices for up-to-date reports on physician performance and relative ranking within their department. Upper management likes to have this information "at their fingertips" during meetings or ad-hoc discussions. Properly designing these reports and dashboards for viewing and interaction on mobile devices hits the spot.

On the positive side, many hospital employees and clinicians continue to use their mobile devices as a reference tool to assure they properly understand diagnoses, medications, etc. We continue to see good use of these devices for continuing education and various other apps in that regard. One tremendous use of mobile devices done by our IT staff recently was to utilize FaceTime to allow a seriously ill patient to virtual attend their daughter’s wedding. On the dark side, hopefully everyone in the industry is aware that unsecure, unencrypted texting between staff and clinicians continues to be a risk that will not be eliminated without a secure texting solution. The lure of convenient, asynchronous communication is considerable and individuals will disregard policy and use available means to do so if we are not providing them with an appropriate and approved tool.

Nothing out of the ordinary. They are proving to be great for quick communications and coordination. Many providers are very HIPAA security aware and asking that we provide secure messaging apps. We do see responsiveness and coordination to be better than using pagers or other means for contacting individuals.

[from a vendor employee] At a recent visit to see a family member in the hospital, I noticed that all of the staff had a phone that they had clipped to their pockets. It wasn’t the size of a cell phone, but was a little smaller than cordless phone you would have at home (back when people had home phones). I asked one of the nurses what they used them for and she said, "I don’t know, but I hate it." Another nurse said that she loved it because it gave her all of the "notifications" she needed without having them broadcast over the intercom. She did say however, that it was very heavy and that it pulls on the her clothes (scrubs aren’t stiff enough to hold it). I noticed the staff checking theses phone constantly – like my teenager does when he’s texting his girlfriend.

Nothing good. Right now I’m fighting the battle of nurses using their personal cell phones to take pictures of EKG strips (PHI is blacked out) and sending them via unencrypted text to the physician. Evaluating our options right now.

Secure e-mail/calendar access. Texting between providers.

[from a vendor employee] I talk a lot about how the market niche we serve (enterprise clinical content management) has become much more than about how data is managed through its lifetime but rather now how data is accessed within a patient context. I believe the unprecedented demand for clinical data drives a greater need for data liquidity across healthcare IT applications. That said, as we continue to achieve a higher level of data liquidity, we will see clinical content accessed through many mobile devices. Heck, I’d argue that the platform becomes unimportant, data should just be available. Therefore we should be able to access the internal EMR, external EHR, even the HIE, though any device. On top of this, these devices are becoming the portal to multiple types of high definition content – be it pictures, movies, or other Internet-elivered content – why can’t clinical content be just as rich. As we move towards what I like to refer to as the High Definition EMR, I believe all clinical content will be accessed through any device, including mobile devices – especially by hospital employees and physicians.

We have rolled out Epic’s Haiku and Canto for our clinicians using iPhones/droids and iPads. The early response has been very positive. It’s read-only, but we will be adding Dragon functionality soon. We also have over 300 wireless mobile carts roaming the units using virtual desktop (VDI), thin clients, and Imprivata single sign-on with proximity access. Also a big satisfier.

Airstrip OB for fetal heart monitoring. Residents and younger attendings are using lots of apps for providing care instead of textbooks.

Communication! They are doing it now with all sorts of devices, so we are exploring a way to make it (1) integrated with the EMR (e.g. choose from a patient list), (2) more secure, but easy to use, and (3) widely adopted, but we recognize there may be more than one use case scenario (e.g. one use case might be about confirming orders, another about relaying a lab value, another about sending a photo, and another about getting a quick consult). We’ll see if one solution can solve all, or if more than one is needed.

Naturally, mobile devices on the public WiFi (as opposed to the hospital firewall) are not censored like the hospital intranet. So when you can’t get to the breast cancer walk site (because the hospital thinks it might be porn), you whip out your portable device. Same for ESPN.

While we use UpToDate Mobile and Epic’s Haiku and Canto, the cool thing we use today we developed and patients use is called WebAhead. Allows access to our urgent care locations and clinics and you can pick your appointment time on the fly… we call it WebAhead. There may be others being used by staff, but we don’t control the mobile aps nor are we pushing any right now as we are coming our Epic install.

Not seeing a lot. We are throwing new laptops and Dragon with PowerMics at our docs and for most of them that is plenty of technology at one time. We have also upgraded their desktops if they were very old. We have had a couple of request for the iPhone app for our EMR, but since interest is low key, we will add it later.