The Doctor Is In (and Wants to Get Online)

Meanwhile, at the University of Pennsylvania Health System in Philadelphia, John Donohue, associate chief information officer, enterprise infrastructure services, and Brian Wells, associate vice president of health technology and academic computing, have been working through similar large-scale issues with regard to BYOD in their organization. “From a mobile perspective,” Donohue notes, “we’ve got about 4,800 mobile phones that we’ve provisioned to 20,000 employees—so, about 5,000 Penn-owned, Penn-managed devices, with security. [Technology] allows us to encrypt those devices, to manage to some degree what is on those devices; if they’re stolen or lost, it allows us to wipe them clean. We also have close to 1,000 BYOD devices that our employees are using to access everything from clinical to other systems. We insist that those devices also use our mobile device system. And frankly, that’s the trend.”

Still, Wells notes, the rigors of physician documentation mean that most documentation will continue to prove challenging on smartphones and tablets; as a result, he says, most physicians will continue to document either on desktop computers or on notebooks, and in that regard, Penn is deploying a mature notebook strategy involving the dissemination of Lenovo notebooks.

PHYSICIAN PRACTICE PERSPECTIVES

Perhaps not surprisingly, those healthcare IT leaders working in physician groups have very different perspectives on the BYOD phenomenon from those working in senior executive positions in large integrated hospital-based health systems—as is the case across so many issues. Chief among the challenges is the fact that in most physician groups, physician executives have little power to “order” their fellow doctors to use mobile devices, or to tell them how to use them. As Jeffrey Woo, M.D., a practicing family physician and the chief technology officer of Grand Valley Medical Specialists, a 15-physician practice, located in Grand Rapids, Mich., encompassing family medicine, internal medicine, and gastroenterology, puts it, “We’re technically a PLC, a professional or private limited corporation, and the more I protocol-ize things, the more pushback I get. In the ideal world, we could make certain things mandatory, but that’s not possible in a group practice setting like this.”

Still, Woo has had success in a few key areas, particularly in leveraging technology to support better physician documentation within physician workflow. Brought into the group to help its physician members more efficiently use their EHR, from the Chicago-based Allscripts, he helped them implement the Allscripts Wand application, which uses the Siri interface to allow physicians to dictate by voice into the documentation text field in the Allscripts solution, on the iPad.

Such advances are absolutely crucial, Woo emphasizes. “Now, with PQRS and NCQA and everything else,” he says, referring to participation in the outcomes reporting program Physician Quality Reporting System (under Medicare), and in the patient-centered medical home certification program from the National Committee on Quality Assurance, “I don’t know how we could stay in practice without an EHR.”

Things continue to evolve forward, too, at the 15-physician, three-location Vanguard Medical Group, based in Verona, N.J., where Thomas McCarrick, M.D. is chief medical officer and CMIO. Vanguard’s participation in a groundbreaking patient-centered medical home (PCMH) program with Horizon Blue Cross Blue Shield of New Jersey ultimately required Vanguard to become certified as a PCMH; and that necessitated better connectivity. Of course, that led to McCarrick’s developing an increasingly comprehensive strategy and policy around deployment of mobile devices and their securitization. It’s all rather subtle and complex, he notes, because a balance must be struck between the ideal and the practical, with regard to how physicians really practice, and what kinds of policies they can realistically adhere to.

Thomas McCarrick, M.D.

TOWARDS THE FUTURE

Looking towards the future, all those interviewed for this article agree: working out the mobility, security, and process issues in this whole area will take years. Still, says Mike Carr, a Sarasota, Fla.-based director at the Denver-based Aspen Advisors consulting firm, what’s clear is that “The accountable care future is really going to require that clinicians and patients engage, in order to improve patients’ health. The mobile devices that patients can use will be key to this, as well as connectivity with monitoring devices, but mobile computing will be a critical success factor in population health management.”