The Landscape: Physician use of handhelds is by no means a new concept. But as the devices - particularly the RIM BlackBerry, Apple iPhone and Google Android - become more sophisticated and more applications become available, the game is changing, quickly. And with so many hospitals upgrading their infrastructures to offer ubiquitous wireless coverage, clinicians are using smartphones in the hospital setting to access online tools such as drug references, and communicate with colleagues. For CIOs, it's a no-brainer - physicians and nurses are already carrying these devices, so why not capitalize on the trend by enabling users to access clinical information and link to patient records. A number of organizations have adopted this thinking and are on the road to enabling EMR access via mobile devices. And while there are certainly sticking points, it's an area that many say is poised for significant growth in the next few years.
The Future: Many innovative organizations are looking to provide access to electronic records and other clinical data through smartphones. Plans are already being formulated to leverage the devices to facilitate patient handoff and sign-out, as well as to link charge capture with quality measures. Cutting-edge organizations are looking to create actionable information for clinicians through software that can analyze data, track patients' progress, and send out alerts when conditions worsen.
When it comes to cutting-edge technology, sometimes the implementations that fail are the ones that end up having the greatest impact.
A few years ago, Children's Hospital Boston launched an initiative to plug clinical data into smartphones - the result was disappointing. According to Daniel Nigrin, M.D., CIO and senior vice president of information services, the IT team at the 396-bed hospital linked smartphones to the Cerner (Kansas City, Mo.) EMR system, enabling physicians to view patient information online. But the project never quite took off, says Nigrin, who believes it was primarily because the technology “wasn't quite up to the degree that it is now. In order to secure the devices to the degree that we thought was required, clinicians had to enter a clunky password each time they logged on,” he says. “It was enough of an obstacle that it led to providers just not bothering to log in. That was one of the places we stumbled.”
Making it too difficult for users to access electronic records was a critical mistake, he says, but it was one that Children's certainly learned from. And with the organization now looking to get back into the smartphone space, Nigrin says he feels he and his team are at a distinct advantage. “As we consider redeploying similar types of things, we know what we really have to focus on,” he says. “Things like, how are we going to secure the information to the degree that we need to, while also making it streamlined and easy enough for the clinicians that they'll log in and use the tool.”
Presently, clinicians at CHB are using smartphones for tasks like searching for drug information through applications like Epocrates, and are accessing Web-based tools through the hospital's Intranet. But in the next few years, Nigrin's team is looking to leverage the technology to facilitate patient handoff and sign-out by creating an application that extracts data from the Cerner EMR system and feeds it into the handheld device.
Children's is also working to link charge capture with quality measures. “We've got a significant effort underway to try to collect clinical quality outcomes from the providers at the time of care,” says Nigrin. The function will be available both through the EMR system and via the handheld, he adds, letting clinicians choose the method most convenient for them.
For many, that option is the handheld. “I think there is more and more of an interest” in accessing patient data via smartphones, he says. “Clinicians aren't banging down my doors asking for it, but there are enough comments being made that I think as we start to roll these things out, the uptick will be better than the last time around.”
Craig Brandis, a principal at mHealth Consulting based in Portland, Ore., says this reflects what he is noticing across the industry. “I've seen an enormous surge of interest in smartphones,” he adds, estimating that 70 percent of physicians carry the devices. “The amount of reference information available is constantly going up, and people are looking for more integrated, more actionable information.”
Perhaps the biggest appeal of smartphones, he says, is the fact that clinicians are already using them as personal communication devices. “That's the number one thing - it's a ubiquitous platform. And I think the expectation is that if your regular data is available on your smartphone, then why isn't the clinical data there?”
According to Brandis, the two areas CIOs are looking to improve by rolling out smartphones are patient safety and communications.