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Dialing Into Physician Smartphone Usage

August 4, 2010
by Jennifer Prestigiacomo
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Web-Exclusive Interview: Gregg Malkary, Managing Director, Spyglass Consulting Group

The Menlo Park, Calif.-based Spyglass Consulting Group recently released a study showing significant growth in physician adoption of smartphones—94 percent of physicians reported using smartphones, compared to a 59 percent usage rate in November 2006. The study also reported that clinicians were often overwhelmed with the volume of incoming communications and found it difficult to connect with colleagues during office hours. Spyglass’ managing director Gregg Malkary spoke with HCI associate editor Jennifer Prestigiacomo about why physicians are loving their smartphones, and why those devices won’t be fully integrated into clinical workflow anytime soon.

Healthcare Informatics: What were some of the major findings that came out of this study?

Malkary: I think one was the predominance of the use of the smartphone by docs as a communication device for managing their personal workflow—it’s really becoming an all-encompassing device. And that they see as a requirement for managing daily personal and business activities. They’re also utilizing all the capabilities of the device, primarily as a standalone system. So in other words, it’s not integrated into any other systems. Healthcare IT is shunning that and the reason is that [it’s hard to] deal with the complexity and the cost to support those devices; healthcare IT doesn’t want to network up to those devices.

HCI: The percentage of physicians using smartphones seems awfully high; were you surprised by this figure?

Malkary: For reference-based tools it’s probably about 85 percent. As soon as you go to any clinical applications, like lab results viewing, chart capture, viewing of EKGs, and electronic prescribing, it’s less than four percent. And there is a reason for that. Terminals are so widely available that if you’re working at a hospital or clinic, you’re never more than 10 minutes away from accessing a terminal. Why would you want to look up clinical information on a really small [screen] that is hard to see? And that’s actually the most common response we heard.

Now, when we started doing this study back in 2002, we started hearing that in some of the more wired hospitals, like Partners Health [Partners HealthCare, based in Boston] and Mass General [the Boston-based Massachusetts General Hospital, a Partners organization], that clinical information systems were really starting to gain traction. Now that they’re starting to gain traction across the country, doctors are now particular on where they want to spend their time. If I continue to have to scroll in order to see information, it’s really a waste of time. That’s really the most common response. With that said, we really need the vendors to step up to the plate, because what they’re trying to do is force clinical applications designed for a 19-inch monitor onto a small form factor. What we really need to do is look at the user interfaces and see what information is really needed. And there is a small genre of applications that is suited for a smartphone. This includes chart capture, electronic prescribing, census management, and reviewing lab results. But clearly not looking at a patient’s complete medical record, which is ludicrous on a device this small.

HCI: Did anyone talk about security issues surrounding using their smartphones at their practices?

Malkary: There’s a huge security issue, especially around the iPhone [made by the Cupertino, Calif.-based Apple]. There’s a huge perception that the iPhone is less secure than the RIM [Waterloo, Canada-based Research in Motion] Blackberry. I think the iPhone has a lot of built-in security mechanisms to make it as secure. But there is a perception that it is a toy, so therefore, healthcare IT is highly resistant to integrate it within the infrastructure including e-mail—even the Microsoft Exchange implementation option is very robust. So if you put these other devices on the network, what are the cost issues involved, how many devices can you support? There’s a lot of resistance, because as soon as you open the kimono up to every RIM Blackberry, you have all this infrastructure that needs to be in place, and you open the network up to vulnerability.

HCI: Why do you think there is a preference for the iPhone over the Blackberry?