Growing pains for mobile devices

 

The proliferation of mobile devices in healthcare has been a boon for medical professionals as the portability of smart phones, tablets and laptops keep them connected from wherever they might be at any given time. This convenience has allowed clinicians to correspond, check patient statuses and review vital data to make critical decisions while at home, in transit or at a remote site.

Yet for all the ways mobile devices make individuals' lives easier, the movement affectionately known as BYOD (Bring Your Own Device) is causing complications for healthcare organizations – specifically the unchecked growth of mobile apps and concerns about the security, privacy and manageability risks they pose.

The issue served as a predominant topic of conversation at the recent IHE North American Connectathon in Chicago. Mohammad Arif Ali, MD, chairman of the mHIMSS Roadmap Task Force wondered aloud about "who owns the patents for all the cloud-based apps out there" and reckoned "we'll be trying to sort that out for the next five years."

Even if healthcare workers are restrictive about the apps they use for their devices, consumers represent a major challenge, said Keith Boone, lead interoperability systems designer for GE Healthcare in Boston.

"If you look at Meaningful Use Stage 2, it pushes providers to make data accessible to patients," he said. "HIPAA says they have the right to that data via e-mail. The only thing physicians can do is advise their patients on the risk."

The influence of mobile devices will only grow more pervasive in coming years. Nick Adams, co-founder and COO of Providence, R.I.-based Care Thread, estimates that there will be 6 billion mHealth devices by 2016, while PriceWaterhouseCoopers projects 10.5 billion by 2017.

Adams acknowledges the conflict that exists between clinicians' desire to use their mobile devices and hospital management's worries about security.

"Eighty percent of physicians have smart phones and want to use them in the same way they do in other aspects of their lives," he said. "At the same time, texting on smart phones scares the heck out of administrators."

This fear has led to some hospitals continuing to use antiquated paging systems, which are not only inefficient, but end up hurting the bottom line, Adams said.

"Approximately $12 billion is being lost due to communications inefficiencies and half of that cost is nurses and discharge planners not knowing whom to contact, wasting valuable time trying to find that contact and then waiting to make contact," he said. "If someone has to sit in a hospital room for extra hours because the care team can't coordinate the discharge plan with inefficient tools, that is adding up to serious costs. Look at the per patient, per bed, per day cost in a suite. It could mean thousands."

With razor-thin margins on the operations side, hospitals need to get creative, Adams said, by supporting existing technologies with the various mobile devices in use and evaluating how the communications and collaboration can be done.

"As a mobile technology provider, if we can coordinate the way people communicate, it could shorten the time for discharge," he said. "Workflow efficiencies are not something hospitals have studied to any great degree. They've charted clinical activities, but what about wasted time spent trying to contact the doctor?"

Adams added that pagers provide a false sense of security because ham radio operators can intercept their transmissions.

 

Broken records

Dale Sanders, senior vice president for strategy at Salt Lake City-based Health Catalyst, observes that the mobile technology avalanche "has fragmented the notion of the medical record." It's not unusual for a care team using mobile devices to have "lots of communication that never makes it into the medical record," he said.

This communications fissure could draw the interest of the legal community, he said.

"I haven't seen litigation on fragmented medical records, but we could conceivably see them trying to subpoena a wave form from an EKG that has been accessed by a mobile device," he said. "What we define as a medical record has been completely blown apart and we have to really think about it."

Conversely, EMR vendors need to do a better job of ensuring transaction integrity and notifying caregivers about any problems that occur on transactions, Sanders said.

"Clinicians don't see it and it is a problem that is a lot bigger than people realize," he said. "There is an effort going on at the National Library of Medicine to study the safety of EMRs as they relate to mobile devices. The goal is to put together a framework on risk and safety assessment."

Sanders also called for a stronger validation process in software safety engineering related to mobile apps so that there is some assurance that patient data isn't put at risk.

 

App control

Despite the challenges that exist with mobile technology, Gautam Gulati, MD, chief medical and innovation officer for Marlborough, Mass.-based Physicians Interactive says the healthcare industry must work to "make the whole greater than the sum of the parts and ensure that healthcare professionals have a digital future."

In examining the different needs that exist, he recommends that the healthcare brain trust look for ways to leverage channels that engage healthcare professionals.

"Healthcare doesn't happen in a particular location – it happens in between office visits," he said. "Patient care experiences must be delivered within that workflow, whether it is via the web, mobile channels, within electronic health records or at the point of care. Digital solutions must come through those channels."

To be sure, the overwhelming abundance of apps "has created a complex and confusing environment on how to use mobile technology in the clinical context," Gulati said. Therefore, he said a consolidation of these apps must occur.

"In order to make the mobile proliferation digestible, we need to put the different apps together and working in conjunction with each other," he said. "That is the future."

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