Everything in medicine is going mobile (HIMSS meeting)

Promoted as technology that can change behavior in both patients and physicians, mobile technology dominated the annual Healthcare Information and Management Systems Society meeting.

By Pamela Lewis Dolan — Posted March 26, 2012

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Cardiologist Eric J. Topol, MD, was on a cross-country flight when an attendant made an announcement asking if there was a doctor on board.

Dr. Topol, chief academic officer for Scripps Health, responded and was brought to a man who was in obvious trouble. Only a year or two ago, Dr. Topol would have had to make an educated guess and hope he could take care of the patient until the plane landed.

This time, though, he pulled out his iPhone, and with an app that produces an electrocardiogram, he determined that the patient was having a heart attack. The plane made an emergency landing while paramedics waited on the ground to take the patient directly to surgery to open the blocked arteries causing the attack.

Though the story is an extreme example, it illustrates why mobile technology was such a big focus of the 2012 annual meeting of the Healthcare Information and Management Systems Society, where Dr. Topol shared the story. With each passing day, mobile technology is giving physicians more opportunities to practice medicine from anywhere, at any time.

Mobile technology has become such an important part of health information technology that HIMSS launched its mHIMSS initiative just a few months before the annual conference, held in late February in Las Vegas. The effort is intended to provide educational resources and guidance to health IT professionals trying to meet demands of physicians they support. Within three months, it had more than 3,600 members.

The HIMSS conference was full of examples and stories of the hundreds of ways mobile technology is changing health care. On display were products and apps that not only had the capacity to replace the old doctor bag full of tools such as stethoscopes and blood pressure cuffs, but add to it hundreds of other tools a physician could access with literally the touch of a finger.

Shawn Jackman, principal and product manager of Kaiser Permanente's wireless portfolio, said he was amazed by all the wireless technologies he saw at HIMSS. “It's really becoming the access layer of preference,” he said.

And it's not just doctors who are demanding mobile health care. Patients are as well.

Chris Wasden, global health care innovation leader for PwC, said mobile apps “will be core in the practice of medicine” because of their ability to change behaviors in both patients and physicians like no other technology has been able to do.

Doctoring anytime, from anywhere

Just a few years ago, physicians with patients in hospitals either had to be at the patient's bedside to get a complete view of what was going on or rely on a floor nurse's interpretation of what the patient's monitoring devices showed.

Mobile technology has made it possible to bring the patient's bedside to the physician's smartphone or tablet.

Applications can send a physician real-time updates on a patient's condition regardless of where the physician is. A doctor can monitor the wave-forms of cardiac monitors, contraction and fetal monitors, ventilators, and a host of other bedside monitors. A dashboard displays a patient's vitals and lab values, and all the information from the patient's electronic health record can be accessed from a device small enough to fit in a pants pocket.

If there was any question as to how important the mobile market has become, HIMSS attendees needed only to walk through the conference exhibit hall. If the product being pitched had to do with data capture or exchange, chances were good there was an accompanying mobile component.

“The biggest wow that I have seen in health care since I have been involved with it has been in work flow and how we do care,” Jackman said. “Mobile devices and applications and their ability to know where people are at and to send data to them is literally changing the way we practice medicine.”

Patient engagement

Portals that allow patients to access their health records are not new, but many argue that health care organizations are going to have to make it easier for patients to access the portals from a mobile device in order to stay competitive.

Eric Mueller, president of WPC Services, the consulting arm of Washington Publishing Group, said the industry is learning that if you have a patient portal and want patients to actually use it, “you have to provide a mobile app.”

Today patients expect to have the ability to make an appointment, pay a bill and send their physician a message from a mobile device. Patients can capture data from their smartphones that can be sent to their doctors.

One of the mobile tools explored at HIMSS can monitor chronic disease sufferers and assist in transition gap periods, such as ages 13 to 21, when a patient has a disease that was diagnosed by a pediatrician but needs to be treated and addressed in adulthood. Connecting a patient to the right mobile device is being pitched as having the potential to significantly reduce the time he or she needs to spend at doctor appointments.

Before the smartphone, if a physician wanted to track a patient's hypertension over several weeks, the doctor would send the patient home with a blood pressure cuff and a notepad to manually create a log. Now there is an app for that.

There are even apps to monitor things patients are unable to track on their own, such as REM sleep, lung capacity and vision.

There are wireless devices that are more convenient than carrying a smartphone. Enter stealth monitoring.

In a room filled to capacity, Todd Stokes, PhD, a postdoctoral fellow at Georgia Tech and Emory University, presented a session in which he displayed various technologies to collect vitals and other measures with remote devices that the patient can forget are even there. These include a bracelet to measure pain produced by sickle cell disease, a teddy bear that detects dust levels for asthmatic children and a contact lens that monitors blood glucose levels.

These devices will have the ability not only to track data but also to transmit it to the physician and send a red flag if an intervention is needed.

Linda Travis Macomber, RN, assistant professor at the Center for Technology and Health Sciences at National University in San Diego, who demonstrated several monitoring apps, had a personal story of how smartphone apps are changing the patient dynamic.

Her 86-year-old father, who lives across the country from her, had a serious fall recently. She said a hand-me-down iPod she had given him months before to use for weekly video chats had kept him out of the hospital after his accident. Through the iPod, she was able to maintain regular contact with him, see the color in his face and watch him take his blood pressure and medications.

“It was not just a telephone call with him telling me he was OK,” she said. “It was me seeing that he was OK.” She realized the implications this could have on Medicare costs. “The whole hospital admission was alleviated, and I felt closer to Dad.”

Dr. Topol likes to compare what is going on with wireless in medicine to the radical belief of Joseph Schumpeter, an Austrian-Hungarian-American economist and political scientist who coined the phrase “creative destruction” to describe his belief that innovation will drive the economy.

Dr. Topol coined his own phrase for what mobile devices and apps are doing to health care. He said it is being “Schumpetered.”

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Staffing needs are biggest barrier to health IT adoption

Although organizations used to be most concerned about financial support, groups taking the 23rd Annual HIMSS Leadership Survey are now most apprehensive about not having adequate IT staff. About 22% listed it as the No. 1 barrier to IT adoption.

22%: Lack of staffing resources

14%: Lack of adequate financial support

12%: Vendor's inability to deliver products/services to satisfaction

Fewer than 1%: Lack of effective project management

Fewer than 1%: Laws prohibiting technology sharing with referring physicians

0%: Ability to secure data

Source: 23rd Annual HIMSS Leadership Survey, February

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How wireless is being used

A 2011 HIMSS online survey of 237 information technology professionals from hospitals and hospital systems showed the various areas of medicine that have gone wireless. Respondents were asked what types of wireless applications they use, and nearly three-quarters said they used an electronic health record system.

70.6%: Electronic health records

62.6%: Nursing clinical point-of-care

51.4%: Standard office applications

48.6%: Computerized physician order entry

46.7%: Physician clinical point-of-care

45.8%: Ancillaries

10.7%: Other

Source: HIMSS Wireless Benchmark Survey, December 2011

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Challenges with going mobile

One of the biggest things driving mobile use among physicians is the “cool factor,” said Phil Chuang, director of information services for Sutter Health in California.

“They've seen the power of them in their personal lives, and they want to see that same power in their clinical lives,” he said during a session on mobile electronic health record deployment at the 2012 annual meeting of the Healthcare Information and Management Systems Society.

But just because mobile devices work well in their personal lives doesn't mean they will work in a clinical setting. Being proficient at playing Angry Birds on an iPad doesn't mean using an EHR on the iPad will be as easy, Chuang said.

If the EHR wasn't designed for use on a tablet, the user will not gain the same efficiencies that they would have on a desktop computer. For example, an EHR that uses a lot of small checkboxes for a clinical exam won't work very efficiently for someone with adult-sized fingers trying to check the boxes.

“Many apps were written for a 19-inch computer screen, and we're shoving them on a 7-inch mobile screen,” Chuang said.

Choosing the device also can be a challenge, said Andrew Willett, senior vice president of sales and marketing for NetMotion Wireless, a mobile device management software vendor based in Seattle. Organizations not only have to ensure they deploy devices that will be used securely, but the security can't make them too onerous to use. They also must ensure that the devices have a good wireless or cellular connection in the places employees will use them and enough battery life to last an entire shift. Without these, the devices will be useless.

Willett advises organizations to pilot-test any devices before large deployments. They should be tested in the places, ways and time spans they would be used after deployment so that issues can be identified before a large investment is made.

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