Swedish Healthcare System, Seattle: CIO Janice Newell and CMIO Thomas Wood, M.D., have made their four-hospital system one of two hospital organizations in the country to deploy Haiku on the iPhone. About 500 iPhones have been distributed to physicians, Newell reports, while numerous other doctors are bringing their own in and obtaining approval to import Haiku onto their devices. Newell says security protocols built into the system, include system configuration to disconnect the device from Epic within five minutes and password protection. Given such provisions, Newell says, she feels confident in the security of the situation.
Kaweah Delta Health Care District in Visalia, Calif.: Dave Gravender, vice president and CIO and Roger Haley, M.D., medical director of information systems, have embraced the “bring-your-own-device” philosophy, based on strategic, infrastructure, and economic concerns. In terms of the economics, Kaweah is an integrated health system with one 529-bed inpatient facility. It is partly publicly funded and partly private, with relatively limited IT resources. Strategically and in terms of infrastructure, Gravender explains that they rely on the Citrix Receiver solution in order to ensure the security of all the devices physicians bring into the hospital. That solution enforces PIN entry, automatically wipes any device clean after 10 unsuccessful PIN entries, and prevents any data storage on the device. And rather than focusing on device-specific EMR applications from vendors, Gravender believes that the optimal approach is to optimize server access and encourage physicians to bring in their own devices.
Alegent Health, Omaha: At this eight-hospital system, Chief Clinical Information Officer Susan Lorkovic, R.N., and her colleagues are treading cautiously, even as their organization has had a long history of working with early versions of handheld mobile devices. While testing out the iPad for possible activation, they have provided respiratory therapists and laboratory phlebotomists with Motorola Symbol pocket PCs for charting (respiratory therapists) and positive patient identification for blood tests (phlebotomists). And they are allowing physicians and other clinicians to bring their own devices into the organization and allowing them to access the Wi-Fi network.
The Voalté/iPhone rollout will continue until it is enterprise-wide at Sarasota Memorial, Baker says. Of course, what he and his colleagues are rolling out at their hospital is only one of an astonishingly wide range of initiatives taking place nationwide around handheld mobile devices. Indeed, not only are hospital organizations and medical groups deploying handheld mobile technology (iPhones, BlackBerrys, and now iPads and even Androids) for clinicians; many clinicians are bringing their own devices into patient care organizations. This is forcing CIOs and clinical informatics to move very quickly to respond to clinician demands and preferences. In other words, the revolution of handheld mobile computing is already upon us.
PRESSING QUESTIONS ON STRATEGY, SECURITY
Nationwide, the landscape around handheld mobile device policy and process is extremely diverse, with CIOs and clinical informaticists at patient care organizations taking wildly different approaches to the proposition (sidebar, p.12). Among the key questions clinical IT leaders are trying to answer for their organizations:
Should the organization purchase and deploy handheld mobile devices? Allow clinicians to bring in their own? Do both? Neither?
How does the potential use of handheld mobile devices intersect with whatever existing clinical information systems, and messaging, paging, and other communication systems the organization has? What about server configurations?
Even more broadly, what do the organization and its clinicians want to accomplish? If the ultimate goal is to allow physicians and nurses to do extensive clinical documentation on a computing device; that's one thing. But in most cases, the handheld mobile devices are being used for far more limited, time-sensitive purposes, such as messaging, checking e-mails, looking up tests and other results, and in many cases, inputting limited clinical information, such as vital signs.
Anticipating the future is a particularly tricky proposition. The devices themselves keep changing as new ones keep coming onto the market. At the same time clinical IT vendors are beginning to push out applications meant to run on specific devices. For example, Apple's iPad, still a technological infant in the broader scheme of things, already has dozens of apps developed for it.
Meanwhile, because clinicians, particularly physicians, are beginning to bring their own devices into hospitals and clinics, the “normal” historical process of clinical IT strategic planning is being turned upside down. As a result, clinical IT leaders are being forced to react to that phenomenon long before they might otherwise move ahead with IT deployments.
Above all, data security concerns loom large in this “Wild West” computing landscape. Organizations' responses to the security risks are as varied as are their overall approaches in this area; but all those interviewed for this article agree that security will remain a preeminent concern for the foreseeable future.
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