Jeffrey Woo, M.D., internal medicine specialist at the 16-practitioner, multi-specialty group, Grand Valley Medical Specialists, knew that making the case for mobile documentation to his colleagues wasn’t going to be an easy task. As Woo explains, West Michigan, where the group is located in Grand Rapids, is an “anachronistic” area of the country where people like things to be old school.
Woo, who was brought on by the group to help physicians utilize their Allscripts (Chicago) EHR [Electronic Health Records] more efficiently, was able to sell mobile documentation via iPads through one singular feature: voice dictation. The Allscripts Wand application uses the Siri interface to allow physicians to dictate words into the documentation text field. As long as physicians are slow and articulate, he says, using this application is a lot easier than typing a whole summary into the iPad.
“We’re seeing 50-to-60-year old physicians who are suddenly getting excited to do their documentation again,” says Woo, who adds getting these guys to use an iPad for anything is “amazing.”
According to Woo, his first experience with mobile documentation was originally through remote access. He used an app, also from Allscripts, that was designed for the iPhone and could be used at home. The app allowed him to securely message other physicians, send prescriptions through, and notify the ER when a patient had to go in.
Woo’s previous work with the vendor had allowed for an easy transition over to the Wand app when it was developed. The app is not only useful as an on-call device, he says, but for documentation in both an office and even in a hospital setting. This is helpful because the two settings use different EHRs.
“If I have to do a direct admission in the hospital, I can access the whole file on the iPad. If I have to do a med reconciliation, or if I need to discharge medications, [he can do it on the iPad]. Cerner [the hospital’s EHR] sort of has a cumbersome interface, and since I need to import the new meds into the EHR anyway, I actually do the discharge medications through Wand when I’m rounding at the hospital,” Woo says.
In addition, Woo points out that the clinical elements on the patient’s face sheet are there when the app is loaded. Plus, he says, navigation of this interface and viewing items such as EKGs and colonoscopy reports or switching from a medication list to a lab report involve swiping a finger up, down, left, or right.
What Woo appreciates most, however, is the positive reaction he has gotten from patients, who love it for technological reasons and friendlier communication. With the computer, he says he’s at a 60 degree tangent, facing the computer and the screen. With the iPad, he can maintain face-to-face eye contact with the patient. “They get to have a dialogue with the physician, rather than a Q&A where I’m documenting and typing the information they give me. It’s a more personal interaction,” Woo says.
Layers of Security
Naturally, there are drawbacks and concerns to the mobile documentation approach. Woo says growing up with technology, he never thought about durability concerns in regards to the iPad. However, he did acknowledge having concerns over the device’s security in terms of making sure it wasn’t hacked or breached. The solution to the Health Insurance Portability and Accountability Act (HIPAA) ensuring the devices could only be connected through Grand Valley’s network.
“Once you leave our office, you can’t access the internet or our program. It simply won’t work,” Woo says. To get it to work remotely, either at home or at the hospital, he says physicians must sign in through a virtual private network (VPN) and have an application ID and password. He also says everything on the password-protected iPad is stored through cloud computing, and thus if the hard drive is hacked, there won’t be any patient data there.
In addition, Woo admits that the app isn’t a huge time-saver. While it does allow him to document more comprehensively, he says it doesn’t allow a practitioner to see five more patients or speed them up. However, he says that’s not a bad thing.
“This app enables us to do documentation the way it’s supposed to be done,” Woo says. “We notoriously under-document a lot of what we do in our jobs. When it comes time to transition care, or communicate what has been done to another physician, our documentation doesn’t look like what we’ve actually done. What I tell the doctors here is, ‘Take time to document better and spent a lot of time building the templates that allow you to standardize your practice and once you’ve standardized how you do your documentation, that’s when efficiency is improved.”