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Full Speed Ahead? For Mobile EHR Adoption, Not Yet

July 9, 2014
by Gabriel Perna
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While consumer-based mobile health applications explode in growth, clinical apps for tablets and smartphones are still maturing

Dr. Lee Peter Bee, D.O. is one of those people who just can’t run at half-speed.

Bee, an internal medicine doctor in Sesser, Ill., runs a six-employee independent medical clinic, Southern Illinois Medical Specialists. He is also a fellow with the American College of Osteopathic Internists, a trained chiropractor, who specializes in intervention pain management, and has a Masters degree in nutrition. He teaches students and second-year residents and works at an emergency room on the weekends.

“You can’t be everywhere and anywhere at the same time,” says Bee, who seems to try anyway.

Having worked at Fortune 500 companies including Apple and Canon before entering the medical field, Bee is fanatical about technology. He is a firm believer in the mobile revolution. Every single one of his employees was given a Windows 8 Surface RT tablet. Personally, he uses an iPad and has trained Siri, Apple’s homegrown voice-assistant application, to speak and understand medical terminology so he can verbally document on a patient. The Windows tablets have voice assistants as well.

Dr. Lee Peter Bee, D.O.

Bee says he has also become adept at using Practice Fusion’s (San Francisco) mobile electronic health record (EHR) app, and as his clinic switches over to a Kareo (Irvine, Calif.) system, its mobile EHR app as well. Moreover, he has set up intricate templates that help him complete detailed documentation notes on the app, and has it set up so it seamlessly and wirelessly integrates with the desktop application as well other clinical applications. To top it off, each room in his practice is equipped with dual-screens—mobile and desktop—so he can document and educate the patient simultaneously.

In other words, he doesn’t run his mobile EHR strategy at half-speed. “If you don’t do it well, it’s very dangerous,” warns Bee about mobile EHRs.


In a way, Bee’s experience reflects where healthcare stands with mobile EHR applications. While consumer mobile health (mHealth) revenue has exploded in growth, driven by consumer demand in wearable technologies as well as entries from multitudes of small and large players, clinical EHR applications on mobile devices remain a still-maturing segment. Those who are using EHRs on a mobile device are typically doing so with software that has limitations (something that even a tech super user like Bee admits) and doing so to compliment a desktop application.

Catholic Health Partners, a large health system with 23 acute-care facilities and 1,500 ambulatory providers in Ohio and Kentucky, certainly fits that profile. Stephen Beck, M.D., CMIO of the health system, says the organization has made investments into mobile EHR technology, but the applications are only used as viewers to compliment the desktop application.

“I’ve worked with several EHRs in the past, and the challenge around EHRs is that there is so much information to compile and to organize, it’s difficult to get all that information onto a small work space. If you look at a chart on a smartphone or a tablet, there is limited real estate to show the pertinent information on a single screen,” he says.

At Catholic Health Partners, clinicians can use the mobile app to review clinical information quickly and in front of the patient. However, a law in the State of Ohio requires two-factor authentication when electronic prescribing. This, Beck says, has required the organization to take a more cautious approach with the mobile EHR application. He says the health system plans on figuring out efficient ways to have the app move beyond its limitations.

The mobile EHR application market is so immature that the segment has not yet been reported on by KLAS Research, a well-known industry vendor research firm in Orem, Utah. Colin Buckley, strategic operations direct at KLAS, says this is because provider experience has been very thin in this area.

Colin Buckley

“We did a study last year on EHR usability, both on the hospital and ambulatory side. We talked with CMIO types and had them rate levels of functionality,” Buckley reports. “Most of what we asked about were meaningful use related functions, but we threw in mobile. We asked how they would rate EHR vendor support for mobile, and only half could even answer the question,” he notes. Those who would answer spoke of an immature form factor and only a few vendors stood out, he adds.


Other research efforts confirm that those like Beck and Bee, who are using mobile EHR applications, are clearly among a select group. The New York City-based research firm Black Book Rankings recently surveyed more than 20,000 EHR users. Of those, only 11 percent of the respondents were mobile EHR users.

Even then, respondents who reported using an app were sharply divided in user satisfaction. Large multispecialty clinics and group practices, hospital-based practice staffs, and other large healthcare organizations were more content with their mobile EHR apps, while most independent practices and solo physicians did not have as positive of an experience.

Doug Brown, managing partner and president of Black Book, surmises that because larger healthcare provider organizations can provide technical support staff for both software and hardware issues, there is more satisfaction. “The luxury of live, local support improves user satisfaction tremendously. Training, updates and retraining/refreshers is also conveniently provided and causes little disruption in productivity at hospital networked practices,” he says.

At one large provider organization, the University of Pittsburgh Medical Center (UPMC), large investments are being made into mobile platforms around the idea of clinical data integration. UPMC has teamed up with the GE Healthcare/Microsoft creation, Caradigm, a Bellevue, Wash.-based healthcare analytics and population health vendor, and developed Convergence, a Windows 8.1 tablet-based platform.

According to Rasu Shrestha, M.D., vice president, medical information technology at UPMC, the platform sits on top of the EHR. It gives providers a longitudinal patient record of vital information from multiple systems that can be used in multiple settings. Furthermore, it is integrated with the organization’s clinical care pathways application, which guides providers to UPMC-approved treatments for specific treatments. In terms of security, the problems that Beck has encountered at Catholic Health do not apply here, as this platform uses single-sign technology and multifactor authentication, he says.

To Shrestha and others at UPMC, it comes down to embracing the mobile form factor and taking advantage of its potential. They’re not just investing in mobile for the sake of mobile. It’s about integrating it into the workflow, he says.

Rasu Shrestha, M.D.

“Our focus is not just on data and interoperability. With Convergence it’s on user experience interoperability. You’re on your mobile [device], [the app has a] beautiful visual, it’s not on just an EMR, there dozens of clinical information systems. You need to place an order to change a medication and it’s just a swipe away,” Shrestha says. The focus on workflow, he adds, is why UPMC went with Microsoft as its partner. The operating system fit into the providers’ workflow seamlessly because the clinical desktop operates on Windows as well.


While Black Blook’s research shows a divide in mobile EHR user satisfaction, in a sense the efforts at a large healthcare system like UPMC mirror the mobile strategy of Dr. Bee, at an independently run clinic. Both small and large providers are utilizing bits and pieces of how Dr. Stephen Beck at Catholic Health Parts envisions mobile clinical applications evolving over the next few years.

“Mobile technology will eventually evolve and make it easier for clinicians to see smart trend lines and other intuitive tools, and allow [doctors] to get a good sense of a patient’s information without having to go to multiple screens,” Beck says.

The idea of clinical integration is why Bee is an advocate of HTML5. He says the standard allows developers to application data that can cross different platforms. Connectivity as well as usability and intuitiveness are the elements to success in mobile EHR applications, he says.

For most though, this kind pertinent mobile EHR adoption is still two to three years away.  As KLAS’ Buckley says, the providers on forefront of mobile EHR adoption are “techies at heart.” CIOs at provider organizations as well as the doctors themselves and even the vendors are too focused on meaningful use regulations to push forward of mobility, he says.

Recent research from athenahealth, a Watertown, Mass.-based provider of a cloud-based EHR system, and Epocrates, an athenahealth service, confirms that sentiment. Last year, athenahealth found there was a decrease in the number of clinicians using tablets, smartphones, and desktop computers in their workflow because of the push to meet meaningful use standards.

Eventually, observers like Buckley see that changing. Perhaps, it will come sooner rather than later. Ninety-one percent of physicians who responded to the Black Book Rankings survey said they plan on accessing their EHR through a mobile device by the end of this year. Whether that timeframe is optimistic or not, is to be determined. Either way, widespread adoption of mobile clinical applications seems to be inevitable.

“As meaningful use dies down and as people get used to the EHR, vendors are going to be searching for more and more differentiation. There are a lot of opportunities to improve EHRs, but from an image point-of-view, they will put time and attention into mobility,” envisions Buckley.

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