By Jennifer Prestigiacomo
Will form factor issues be resolved as clinicians move forward to embrace the use of mobile devices for a growing list of patient care delivery tasks?
As the mobile healthcare market is still in its infancy compared to other markets, there seems to be no consensus exactly what to do with the mobile devices -smartphones, tablets, and every other type of device-that are flooding into healthcare. Although everyone agrees that mobile devices will be a centerpiece of healthcare delivery-in some cases devices being brought into hospitals and medical office settings by clinicians themselves, while in other cases, being provided to them by their organizations-it's still early for IT leadership to agree on whether to employ a tethered or untethered approach or how best to access and enter information on a smaller screen.
ONE THING THAT IS IMPORTANT TO ACKNOWLEDGE IS WHETHER WE'RE TALKING ABOUT A SMARTPHONE OR TABLET THAT IS REALLY OPTIMIZED FOR MOBILE DATA ACCESS, RATHER THAN DATA ENTRY.-CHRIS LONGHURST, M.D.
Evidence for clinician readiness to embrace such devices is everywhere. To take just one example, 85 percent of hospitals have launched wireless networks, notes Gregg Malkary, managing director of the Menlo Park, Calif.-based Spyglass Consulting Group. The challenge, though, remains that mobile devices in the healthcare setting are still seen as data access points, rather than data entry devices, and many organizations are taking divergent approaches in how to support these clinical tools.
Those interviewed for this article agree that smartphones are ideal for engaging in such tasks as viewing patient records, test results, and medical content on the go. Fran Turisco, research principal in the emerging practices division at CSC, says the smartphone is a perfect device for accessing training tools. She cites that vendors are creating iPhone apps that prepare nurses for competency exams, provide information and tutorials on medical procedures, and offer continuing education.
Meanwhile, core clinical IT vendors are moving forward to address the clinician mobility needs of hospital organizations as well. For example, Leland Babitch, M.D., chief medical information officer at Detroit Medical Center, notes that the Kansas City-based Cerner Corp. has created a mobile version of its inpatient EHR (with Cerner's innovation being just one of many such new vendor adaptations for the new mobility). “There are limitations based on the size and the way in which data is input into the device,” he says. “It won't be that people will be using this for heavy ordering or for complete review of a record, but if someone calls and I'm at Costco with my kids, and they have a question about a patient, I can quickly open the app and see what's going on.” Chris Longhurst, M.D., CMIO at Lucile Packard Children's Hospital, Stanford University (Palo Alto, Calif.), adds: “One thing that is important to acknowledge is whether we're talking about a smartphone or tablet that is really optimized for mobile data access, rather than data entry.”
As for the preferred smartphone among clinicians, most believe it to be the iPhone, with its cool cache, coupled with built-in GPS and easy user interface. But many in the industry feel the Android operating system is gaining mind and market share, with its availability on multiple carriers. (However, now that the iPhone has come out on the Verizon network that point might be a moot.)
The iPad will most likely prove to be a game-changer in the healthcare setting, according to Longhurst, who believes this form of tablets is here to stay. Where tablets failed in the past due to inefficient light pens and short battery life, the iPad has improved with a touch interface and enviable battery life, he says. “In fact we're seeing a lot of Android tablets coming out locally here in the Valley,” Longhurst says. “I think they'll become an important part of physician workflow. In order to see electronic health records at the tablet level, the 7- to 9-inch range, we're going to have to see a fairly dramatic rewrite of software interfaces.”
Michael Restuccia, vice president and CIO of the Philadelphia-based University of Pennsylvania Health System, forecasts that for data entry to be possible on a mobile device, speech recognition will have to fill the void of touchpad difficulties. Longhurst adds that natural language processing could likely be used, in situations in which servers have been programmed to recognize systematized terminologies to make voice recognition more accurate. Turisco, however, finds voice recognition to be problematic for the mobile environment, which can be accompanied by lots of peripheral noise. Babitch also finds the prospect dubious, as Dragon (Nuance, Burlington, Mass.) software requires hefty processing, which may be too taxing for mobile devices. Spyglass Consulting's Malkary finds a good in between technology to be Bluetooth-enabled keyboards to make data entry on a tablet easier.
As Healthcare Informatics' August 2010 cover story noted, hospitals have been taking many different approaches to secure mobile devices on their networks, and most have been taking a technologically agnostic approach to which devices they are now supporting. Turisco and Longhurst both agree that the safest way to support mobile computing is to implement a Web-based platform. “For physicians, most of the solutions are Internet access, so nothing lives on the device except for the browser,” Turisco says.
Longhurst adds that a more sustainable way to plan for mobile is to not create specific apps for mobile devices, but create “a Web platform that can support all of those, so it's broader and more sustainable and doesn't store data on the end user's device.”
On the other end of the spectrum, Restuccia says that many organizations, including his, are moving to a more tethered approach that provides a reliable connection to the hospital's clinical information systems. He is putting Lenovo (Morrisville, N.C.) workstations in every exam room, as there is too much competition for wireless connection, including huge image files passing through the system, as well as hospital construction. “[In our] experience the adoption of new technology and applications is in part driven by the reliability and the consistency of that connection to the system,” Restuccia says. “And in the hospitals there are too many potential conflicts that could impede that wireless connection.” To that point, Malkary recommends that the leaders of facilities that go down the wireless path should do a comprehensive survey to understand the radio frequency propagation in the building.
Turisco, though, believes that wireless is eventually going to win out. Babitch agrees, adding, “It is a good strategy for physicians to take something they can use in the office, car, and hospital, something that he can take back and forth, and it helps relieve some of the budgetary restraints.”
The mobile future seems very bright, with the current explosion of tablets in the market. In fact, says Longhurst, “I think we're going to see a lot more competition at the tablet level. The iPad was relatively groundbreaking when it entered the market, but it's a very expensive model.” Turisco believes the Samsung tablets will be the next form factor to watch, especially with a new, more tech-savvy generation of young doctors graduating from medical schools like Harvard and Stanford that have been using tablets in their programs.
Healthcare Informatics 2011 March;28(3):34-36