Several years ago, providers at Penn Medicine, based in Philadelphia, began using mobile apps for a variety of reasons, including: to support better interaction among care teams, conveniently manage and monitor multiple patients, prioritize needs, and make treatment decisions.
As officials from Penn Medicine noted in their project submission for the 2018 Healthcare Informatics Innovator Awards Program, “Having standardized mobile devices to convey real-time, medically relevant key information about patients promoted rapid clinical adoption and demand escalated to more consistently support ‘care on-the-go.’” Then, in January 2016, Penn Medicine met with Apple engineers to develop a full configuration standard clinical iPhone (SCiP) to work with the healthcare organization’s mobile device management tool, while leveraging Apple’s Device Enrollment Program (DEP) and Volume Purchasing Program (VPP)—two deployment programs for device setup and app provisioning.
The Penn Medicine project, “Standard Clinical iPhone Effectively Enhances Patient Care,” was recognized with semifinalist status in this year’s Innovator Awards Program. In a recent interview with Healthcare Informatics, Sean Sarles, director of clinical engineering at Penn Medicine, says that the initial beginnings of this initiative were centered on the medicine team at the hospital wanting a communication tool. So, an initial plan brought in 55 iPhones, and at first, pilots were developed around secure texting. Sarles says the idea was “to provide a means for the multi-disciplinary team to communicate about patients in real-time to promote patient progression—to get discharges completed on time, to understand when patients were coming into the unit, and when patients were coming from the ED and through the hospital.”
Providers and nurses were thrilled with the iPhones’ effectiveness early on, and it was at that point when a project was created to distribute a shared iPhone device to all the nursing units at the hospital, and then eventually throughout all Penn Medicine hospitals.
Vasee Sivasegaran, corporate director of information systems (IS) infrastructure at Penn Medicine, notes that Apple’s VPP program was in its infancy about three to four years ago, at which a point a strong request was made by several large enterprises to turn the consumer-focused iPhone device into one that would be enterprise ready—specifically for adopting workflows in which there is a lot of shared device usage. As Apple was working to automate the device enrollment program and make it consumer-focused, it was realized that there was no practical way to expand that to the scale that Penn Medicine was thinking of. But then, the phone carrier entered the picture, Sivasegaran explains.
The way it works, Sivasegaran says, is that a carrier that is part of the procurement process is able to tie in Penn Medicine’s organization ID with Apple’s VPP program, allowing an end user to take a device that was procured for them out of the box and turn it on, while also allowing for the carrier to detect the cellular signal and tell Apple that it belongs to the using organization, and that it’s time to evoke this organization’s VPP ID as part of the program.
Then Apple will contact the mobile device management vendor and can confirm which organization the device ID and VPP ID belongs to. “I can now send the image for that mobile device, and then a user can turn on that device and provision for them within just a few clicks,” explains Sivasegaran. “This is where our teams worked together—my architecture team with Sean’s team—to get the three vendors aligned with us. And then the clinician gets a free image device with all of the key clinical applications that fill into that form factor and that deployment mode right at the fingertips. And now we have over 1,600 devices across three hospitals,” he says.
There are several benefits gained from the result of all this technical work, Penn Medicine officials say. Sarles points to the newfound flexibility and being able to manage the device, and very quickly things, if necessary. “So if we decide to bring into a new app, something for medication administration, for instance, and if those were consumer devices, you would have to go to each individual phone and set them up accordingly. But with the device enrollment program you send out those required settings and applications, and it appears on 1,600 devices,” explains Sarles.
And Sivasegaran notes some of the clinical benefits as well. With Penn Medicine being scattered around more than 170 physical locations in two states, “providers are challenged to navigate that much territory, geographically, only to find out that the patient is not ready or something isn’t done for him or her. Now you are giving clinicians the information they need right at their fingertips to navigate the giant footprint we have,” Sivasegaran says. “The amount of time saved as well as the optimization of patient care are the real [clinical] benefits.”
Indeed, Penn Medicine officials have estimated that using this method has saved them 975 man hours in the organization’s initial deployment using DEP streamlined setup (15 minutes versus 1-hour for each iPhone). “Pushing additional apps to devices without needing an Apple ID and password for download or manual touch also made the implementation efficient. By implementing this project, it placed a vital tool into caregivers’ hands,” officials said.
What’s more, taking it a step further, Sarles says that this approach has allowed the organization to create a community of nurses, doctors, nurse practitioners, respiratory therapists, social workers, and others, bringing everyone into one virtual location to talk about patient’s discharge, treatment plan or repository status.
One specific example of this, officials offered, involved the cardiac surgery team on a thread with the patient’s current caregivers. The nurse took a picture of the surgical site and sent it securely—every device is encrypted—with a description, concerned about swelling around the surgical site. The surgical team was able to provide immediate feedback and resolve the issue remotely.
“That’s unique—it’s really tough, almost impossible, to get everyone together physically,” says Sarles. “So this allows them to not only talk about the patient securely over text messaging, but you are also all looking at the same information. That’s invaluable.”