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MOBILE COMPUTING GAME CHANGERS
Nonetheless, the winds of change are clearly blowing in the direction of smaller, lighter, and more mobile. One of the proponents of this view is Podesta, who says that mobile computing in its various forms is on the rise. He sees the iPad, and to a lesser extent, the iPhone, as game changers. He says that vendors have begun to take notice, by launching applications for mobile devices. Fletcher Allen, for example, is getting ready to implement Canto, a read-only EMR developed by Verona, Wis.-based Epic Corp. for the iPad. (Haiku, a counterpart program for the iPhone, has also been developed by Epic.)
UPMC's Venturella notes that the rapid expansion of mobile computing devices in the consumer market has begun to be felt in hospitals. How well the devices have taken hold largely depends on how well the devices meet the needs of the particular user, he says. The iPad, for example, has been embraced by some physicians, although less so by nurses. “Physicians are there for a shorter period of time, in the general med-surg area. They are in and out, just doing their rounds.”
PEOPLE HAVE BECOME FAR MORE RELIANT ON THESE DEVICES, AND WHAT YOU BUILT FIVE OR SIX YEARS AGO DOESN'T NECESSARILY HAVE THE RIGHT COVERAGE OR STRENGTH TO SUPPORT THE NUMBER OF DEVICES YOU HAVE TYING IN NOW. -JIM VENTURELLA
He adds that UPMC has tested many tablets with physicians, and many times they have handed them back, because they didn't meet their needs. “They need to be able to go in, sit down with the patient and walk back out and around,” he says. “But they still want a full keyboard and a desktop, and to be able to sit in front of a larger screen while they are viewing PACS images.” He believes that iPads and like devices will have a place in physician workflow, but will probably not replace more conventional devices.
Venturella says there is a mix of hospital-owned and personal mobile devices in use at the hospital. UPMC supplies small numbers of iPads and smartphones. As the hospital moves into the next phase, it has had discussions focused on controlling or managing the devices. During the last nine months, UPMC has been reviewing the infrastructure for mobile device management, and security and privacy teams have been evaluating whether the right tools are in place to manage that. In addition, the IT support team has to expand its skills as devices from a variety of manufacturers are introduced, he says.
The key, he says, is to have applications that are built for particular devices. Venturella says UPMC is beginning to build an infrastructure to pilot a set of mobile applications from Kansas City-based Cerner Corp., the provider's EMR vendor. The initial stage will be to review laboratory, medications, orders, and documents.
In addition, UPMC is in the process of upgrading its wireless infrastructure. “People have become far more reliant on these devices, and what you built five or six years ago doesn't necessarily have the right coverage or strength to support the number of devices you have tying in now,” Venturella says. UPMC has its wireless network segmented into one for patients and the other for clinicians. It is considering creating a separate wireless network for personal wireless devices brought in by physicians.
While acknowledging the impact of mobile devices in the healthcare setting, Kwak of Providence expresses some skepticism. “I don't see them as enterprise-wide ready, because they are a consumer product versus an enterprise product,” he says. “From an IT perspective of someone who has worked in enterprise, they are just not there.” The caveats, in his view, are that they cannot be encrypted like traditional laptops and tablets, and they are fragile. Traditional PCs and laptops have the necessary infrastructure for support in an enterprise environment, can be encrypted, and are physically rugged, he adds.
Podesta also says that maintenance and security of an increasingly diverse set of products is significant, adding that the Department of Health and Human Services Office of the Inspector General and the Office of Civil Rights “are focused on starting security audits this year, and the first thing I heard they are going to start auditing are mobile devices, including laptops.” He notes that some vendors are offering solutions that can manage a mixed mobile environment from a security standpoint, which he sees as a growing need in the future.
Despite the significant challenges, Kwak says he understands the appeal of small mobile devices: they are sleek, relatively inexpensive, and easy to use. In a nod to the preferences of some of the hospital's clinicians, Providence is testing small mobile devices such as iPhones and Blackberrys for Microsoft Office type applications; it has not yet tested them in clinical applications.
RISE OF THE THIN CLIENT
The virtual desktop is becoming a more important factor in the healthcare environment as CIOs seek to offset hardware costs. Potential cost savings are significant, Podesta says: “Virtual desktops are going to be a game changer, because it allows you to go with a thin client into your nursing areas and your clinical areas. It gives you the ability to buy a $300 device with no C drive, lock it down and manage an image from the profile in the server, versus the PC.”
