Compared with some industries, mobile computing came late to healthcare. But now, the revolution is accelerating—both on the clinician end-user side, and in the arena of clinician-patient communications and care management. How are IT leaders engaging clinicians and helping clinicians engage patients, in the emerging healthcare?
Here is Part 2 of this Cover Story Package, The Promise of Mobile: Connecting to Underserved Populations.
What happens when the goals of workflow optimization and data security clash? CIOs and CMIOs are finding out.
Remember the time, back, say, about six or seven years ago, when the majority of physicians still had to be dragged kicking and screaming into the world of healthcare automation? That time now seems so…well, “last decade,” doesn’t it? Indeed, with a confluence of policy, payment, business, and technology trends pushing change forward, the time when CIOs, CMIOs and other healthcare IT leaders faced daunting resistance from doctors with regard to using clinical IT tools has morphed rapidly into a new phase in healthcare, one in which healthcare IT leaders can barely keep up with the demand for electronic connectivity on the part of their organizations’ physicians.
What’s happened to change the equation? Two sets of trends: first, the broad availability and affordability of mobile computing devices, particularly smartphones and smaller tablets, which has spawned the “BYOD” (bring your own device) phenomenon among physicians. Second, a raft of policy mandates coming out of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, is forcing physicians and hospitals to implement and use electronic health records (EHRs) on a tight schedule; and the Affordable Care Act (ACA) in 2010, is requiring hospitals and physicians to document their quality outcomes for mandatory programs such as the avoidable readmissions reduction program and the healthcare-acquired conditions reduction program, and encouraging participation in accountable care organizations and bundled-payment contracting.
In contrast to the situation several years ago, nowadays, one of the core challenges for healthcare IT leaders is figuring out how to get ahead of the avalanche of demands for connectivity on the part of physicians, as well as helping them understand and embrace needed data security protocols and processes. That challenge only became more pressing on Jan. 17 of this year, when the Office of Civil Rights of the Department of Health and Human Services released a new “Omnibus Rule” under the HIPAA (Health Insurance Portability and Accountability Act of 1996) Privacy and Security Rules linked to the HITECH Act. The development only cemented for healthcare IT leaders the need to get more strategic about the BYOD phenomenon. So, what are CIOs, and CMIOs and other healthcare IT leaders doing about it?
IN DETROIT, A BROADLY COMPREHENSIVE STRATEGY
At Henry Ford Health System, the Detroit-based integrated health system with five hospitals, 240 care sites, and 1,500 employed and 500 affiliated physicians, senior vice president and CIO Mary Alice Annecharico freely admits that developing a BYOD strategy continues to be a work in progress, despite the fact that she was deeply involved in helping to craft a comprehensive BYOD policy shortly after she arrived at the organization from the University Hospitals of Cleveland in December 2011, one whose development involved a tremendous amount of consensus-building among physician leaders at Henry Ford.
“It’s forever challenging; and as quickly as the platform developers develop a new product, we have to be ready to support a new device,” Annecharico reports. “We had a policy up to a year ago that the standard for device use was the Blackberry, and you know what happened to the Blackberry; but that gave us the opportunity to embrace the iPad and iPhone.” In addition, the broad set of BYOD policies at Henry Ford, she notes, is closely linked to the aggressive efforts to complete the rollout of the Epicare EHR solution (from the Verona, Wis.-based Epic Systems Corporation) across the entire Henry Ford organization.
Mary Alice Annecharico, R.N.
Most importantly, Annecharico says, “We are a culture of confidentiality, and we’re very, very cognizant of the exposure and risk to brand identity and to our exposure under the HITECH Act, with regard to our obligation to protect our patients’ privacy and security. So we have these products very embedded in a program that helps us manage at the device and network levels, for privacy and security. Every device has to be registered, and every device is encrypted through [the Atlanta-based] AirWatch; and there’s shared accountability and responsibility for the devices if anything happens to them.”
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.”