Care providers are an incredibly mobile workforce,” says Stephanie Reel, CIO and vice president of IS at Baltimore-based Johns Hopkins Medicine. She has a point: Clinicians roam from patient room, to the OR, to the ICU, and to the lab to teaching rooms. In community hospitals, they're frequently running off to their private practice and back, and, these days, even making house calls. All this, in addition to having personal lives outside work.
“I think when you look at the convergence of quality of life, a mobile workforce and expectations of our customers, there's no way we're going to be able to do it the old-fashioned way,” Reel says. Today, that means increasing a clinician's mobile access to information.
Real-time access to the latest patient information significantly impacts quality of care. “Having information at your fingertips is key to the whole process of patient care,” says Ruth MacCallum, a consultant at Minneapolis-based Healthia Consulting. “Knowing the most current and up-to-date status of your patient is the number one need for clinicians.” That means seeing a patient's latest lab results or entering an order in real time, whether the physician is in the patient's room, on rounds, waiting for the elevator, or at a ball game.
An increased focus on mobile computing is making it possible for clinicians to perform a wide variety of functions on the go. Mobile applications range from charge capture, to results reporting, ordering tests and e-prescribing. And of course, viewing results, like labs or radiology images.
The tried, true and new
In the hospital, there are tried and true solutions: mobile workstations that go room to room were the first wave. And they have staying power. “Obviously computers on wheels, or a laptop on a cart seem to be used the most because you've got typing capability, and a larger real estate for the screen,” says Jason Hess of Orem, Utah-based KLAS.
Hess believes tablets haven't taken off due to the same issues. The obvious reasons are screen real estate — and it depends on the task. “Are you entering orders? How easy is that to do on a tablet or a handheld?” he says. “That's pretty challenging.”
Reel agrees that in spite of the prevalence of handheld devices, computers on wheels are still popular. Her sense is that IT as we have known it, as a fixed device in someone's office or hallway, isn't going away because of the high comfort level.
But a variety of handheld devices — mostly those selected by physicians that can integrate back into a core EMR — are gaining in popularity. Hess says devices that provide access to the EMR through Web-based portals are rapidly becoming the mobile solutions of choice. According to KLAS scoring, Patientkeeper (Newton, Mass.) and Toronto-based Thomson Healthcare are the lead products in the space. Both vendors provide applications that clinicians can use on handhelds, smartphones and other mobile devices that allow bi-directional access to the EMR either wirelessly or through synching stations in the hospital, Hess says.
Devices by the dozen
And there are many, many devices. “We call it the invasion of the handhelds,” Reel says and laughs. She says that where doctors get the devices is a mixed bag. Some of these physicians may be piloting devices given to them by a vendor. Some of them may have made a decision within their department to allow physicians who are house officers to use a certain device. Others may have bought them because they use them for other things. At Hopkins, as at many other hospitals, Reel says the organization has not made the decision to provide the doctors with any specific device.
Hess says when it comes to which device works best, it's about physician preference. “One problem is you have a lot of very intelligent physicians out there who don't know how to type. It's generational. If you grew up with iPods and PalmPilots, you're often more comfortable than the older crowd.”
With such a range of devices and technologies for mobile access, doesn't a CIO need to lay down some restrictions? Not necessarily. Hess says there is no one clear solution for all.
Reel agrees that the lead strategy is hard to identify with such a mixed bag of who's embracing what, noting most CIOs are cobbling together solutions. She says the mobile solutions that aren't so good will wither and die, while the winners will become more broadly adopted. “Let 1,000 flowers bloom and some of the best ones will survive,” Reel says. “Those will probably become enterprise-wide offerings. But I doubt that we'd ever say you can't use anything else.”
According to Reel, it's important to remember that going mobile can mean adding a layer of complexity for users, who may not even be comfortable using the application on a full screen.
Same problems, smaller screen
Part of the problem for mobile solutions is that it's just as overwhelming as when you're at your desk, Reel says — except now the navigation is in a much smaller space. “It's information overload, so we're going to have to have smarter devices that say, ‘I know I'm in the hospital, or I know I'm in Stephanie Reel's room, so just give me the knowledge that I need about her.’” Reel says next-generation devices should be smart enough to do that filtering.
Hess says that people will use devices in different ways. He recently visited a hospital where nurses were using tablets for nursing documentation. “I watched one nurse go to the med dispensing cabinet, load all of her pills onto the back of the tablet and bring them to the patient's bedside. It was essentially a $4,000 tray,” he says and laughs. When the nurse was finished dispensing, he says, she flipped it over and did her documentation.
Some physicians used tablets in the same way, while others chose not to use them at all. “The CIO raised his eyes and said, ‘Well, it fits into the workflow,’” Hess says. That's essentially the message. “There is no one size fits all,” he says. “You just need to find something that's going to work for the majority of your docs and go for it.”