Forward movement

Mobile technology is changing the game, on both sides of the doctor/patient divide
By Mike Miliard
12:00 AM

At the 2013 HIMSS Annual Conference & Exhibition in New Orleans this past March, one attendee tweeted something to the effect of: "Attending a session on mobile healthcare - or, as we call it: healthcare."
Yes, in just a few years, mobile devices have become ubiquitous in clinical settings, fundamentally transforming the way care is delivered.
But that's not to say they're without their drawbacks. Hospitals are availing themselves of the efficiency and convenience offered by smartphones and tablets, but they're also still grappling with the thorny security issues they represent.
The numbers from the 2nd Annual HIMSS Mobile Technology Survey, published in late 2012, tell the story. The good news? A large majority of respondents (80 percent) reported that physicians use mobile technology in direct service of patient care. That said, most respondents said mobile devices facilitate less than 25 percent of patient care.
When using apps, clinicians use them to view patient information such as lab results and CT scans (65 percent) and access clinical decision support (64.4 percent). But when it came to analysis of patient data, such as EKG readings, or monitoring data from medical devices, usage numbers were lower, with percentages in the mid-30s.
The vast majority of respondents (98 percent) reported their organizations supply clinicians with devices to provide this care - mostly referring to laptop computers (89 percent) and workstations on wheels (87 percent).
But more than half (53 percent) said they give their clinicians smartphones, and nearly half said they gave them tablets, either those custom-designed for healthcare (47 percent) or consumer-focused (43 percent).
Keeping control of the devices a doctor uses, of course, is one way to keep control of the data on those devices. Indeed, privacy and security was the top concern for health organizations deploying mobile technology, according to respondents.
But bring-your-own-device policies are increasingly looking to be the way forward for most facilities. Physicians want to be able to use their own smartphones - whether their tech teams like it or not.
"BYOD, that's the challenge to the CIO," says John Hoyt, executive vice president of HIMSS Analytics/directory/analytics" target="_blank" class="directory-item-link">Analytics. "It makes them shudder."
Still, he says, "the opposite is that, if you don't want that, Mr. CIO, then you supply the devices." The problem with that is the risk of investing in soon-to-be-obsolete technology. "That is a very fluid market. Eight months old, and it's already out of date."

Providers' security precautions vary. Ninety-seven percent of respondents to the HIMSS survey use passwords; 87 percent reported using data encryption measures; nearly three-quarters (71 percent) use remote wipe technology.
However it happens, "Clearly this is the future," says Hoyt. "It's arriving. It has arrived. So we'd better be ready. CIOs had better be ready - and able, and willing - to secure BYOD."
The most fail-safe way of protection, of course, is to keep protected health information off the device entirely.
"You don't want patient information on the device; you just want the device to access patient information, and to view it," says Hoyt. "When you walk out of the building, there should not be anything on that device. If you left it at Starbucks, no one should see patient data.
The good news is that the majority of respondents (83 percent) to the HIMSS Mobile Technology Survey said the devices in use by clinicians do not retain patient-specific personal health information.
And speaking of patients, let us not forget it is they who stand to benefit from mobility the most - whether physicians are using the devices or the patients themselves are.
"The name of the game going forward is patient engagement and improving chronic disease management," says Hoyt.
"These organizations that are signing up as an ACO are basically committing to improving health of a population," he says. "You can't do that without some sort of patient involvement in their own healthcare. That's one of the roles of mobility."
"Let's pretend we've got this big clinic: 70 or 100 doctors. They are signed onto an ACO contract with the big-momma hospital down the road. They have got to improve a patient's diabetes management. They've got to improve their cholesterol levels; they've got to improve their weight.
"Engagement of the patient is enabled through mobile devices. I can send results to the patient through their mobile device, and I can get them to communicate back to the office that way."
Caregivers, especially in the ambulatory world, "better have a strategy about engaging patients through their mobile devices," says Hoyt.
No question, there's no shortage of devices or apps these days.
"Apps are definitely the Wild West in terms of the number being developed," says David Collins, senior director, mHIMSS at HIMSS. "The iTunes store alone has more than 97,000."
Still, it seems clear that soon enough, "the market will consolidate," says Hoyt. "Think how many PC makers there were 20 years ago."
It's probable, however, that we'll see an increase before there's a decrease. There are so many being developed because it's so easy to develop them. Whether or not they're used for achievable and consistent health results, of course, is another story.
But there's no question that people are making use of their devices, their apps, and putting them to work in better understanding their care.
Hoyt says the situation is "not dissimilar to the middle and late '90s, when the patients were walking into the doctor's office with stuff they printed off the Internet, and saying, 'Hey doc, it says here that I should be doing such and such. How come you haven't ordered it?'
"The physicians were floored that the patients were becoming more aggressive with their desire to become more knowledgeable about their healthcare," he says. "It's no longer this wise old man telling you what to do. It's beginning to be shared. And that was a bit of an affront, to be honest, to a lot of medical staff."
Mobile devices, says Hoyt, represent "an acceleration of that. We have patients who are doing some self-monitoring and maybe doing something that the physician a) wasn't aware they were doing or b) hadn't advised them to, but they learned about it and they're saying, 'Hey, I've been learning about my blood sugar because I bought this cute little app. How come you haven't asked me about that?"
It's a "new affront" to physician authority, he says, but one that "physicians better get used to, or go find another job."