Challenges and benefits in a mobile medical world
Institutions should create a set of BYOD guidelines that foster mobile device usage.
By Anne Meneghetti, M.D., February 2013
Bring your own device (BYOD) is a growing trend in healthcare as multiple device usage becomes more popular. How many mobile devices do healthcare professionals need at the point of care? Today’s answer: at least two. Before the late 1990s, the devices clinicians relied upon to stay connected rarely made an appearance inside an exam room. Now, modern practitioners access information, record clinical data and communicate with patients using mobile devices, which are increasingly integrated into the flow of the patient encounter. In recent years, juggling smartphones with large tablets or laptops in front of patients led to a demand for the optimally sized point-of-care device. The recent introduction of the iPad Mini represents a long-awaited form-factor – a happy medium in terms of portability, and an optimal swivel device for point-of-care patient education.
While some healthcare organizations assign mobile devices to their clinicians and staff, a great number of healthcare workers use their own smartphones and tablets, combining work and personal activity. All personal mobile devices bring with them security, privacy and compatibility challenges, such as keeping patient data safe. To overcome the obstacles of this BYOD phenomenon, it is important for hospital CIOs and practice managers to understand why fostering mobile device preference benefits the physician, patient and institution.
Multi-platform device adoption
Physicians are on the forefront of mobile innovation. At least 80 percent of U.S. physicians use a smartphone, tablet, laptop or combination of devices at the point of care, with some studies estimating usage by more than 90 percent. But preferences vary. A majority of these physicians prefer Apple iOS products, with Android as a distant second and other platforms trailing. Nearly 30 percent of physicians who use a mobile device are using more than one, reaching for the form factor that makes the most sense for each point-of-care task. Supporting this is a critical challenge – physicians expect their devices to seamlessly work with multiple hospital and private practice systems, as well as serve their personal needs for communications and media. Employing multiple devices for personal and business use can cause logistical problems for healthcare system-wide programs.
Some of us are old enough to remember what it is like to have three or four beepers hanging off the waist of your scrub pants while on call. While clinicians today may have multiple different devices, they are less likely to tolerate the burden of duplicates of the same device for work and personal use. Personal mobile device preferences are unique to the practitioner and clinical situation; healthcare professionals will save time and optimize results with the ability to choose the form factor that works best for them without having to conform to one institutional standard.
Each mobile device brings its own unique benefits and drawbacks.
Smartphones at the point of care
Nothing bests a smartphone for quickly looking up a drug dose, checking a drug interaction or getting a quick differential diagnosis list. If it’s quick and easy, it is more likely to get done. A recent survey by a leading clinical app developer (Epocrates Specialty Survey 2012: http://www.epocrates.com/who/media/mediaresources/statistics) stated that 60 percent of physicians reported avoiding at least one adverse drug error per week by using information found in its application. That equals thousands, if not millions, of errors avoided annually by physicians all over the United States. In the same survey, physicians also reported saving time by using smartphone medical apps, with one in two stating they save 20 minutes or more daily. For a busy primary care physician, that could mean the ability to see two to four more patients per day.
The smaller screen of a smartphone may be fine for texts between clinicians or e-prescribing, when properly optimized. However, when it comes to data entry, all but the simplest point-and-click functionality is tedious at best on a phone.
Benefits of the big screen
Once tablets were readily available, tasks that previously required stepping out of the exam room became part of the patient encounter. Many clinicians prefer to complete tasks – such as ordering labs, e-prescribing and light data entry – right in front of the patient to maximize face time. Patients appreciate it when their doctor looks up information relevant to their care. They report feeling secure knowing that their clinicians are using modern technology to make sure they are receiving the best care.
Tablets allow clinicians to show interested patients their information. The graphic capabilities of tablets lend themselves beautifully to swiveling the tablet to face the patient to share test results, internal anatomy diagrams, imaging findings, or patient education materials and brief videos. However, clinicians have to consider how many minutes of a brief visit are worth dedicating to this type of experience; most patients are eager to interact directly with the clinician.
The iPad Mini is a device to watch
The iPad Mini lies somewhere between a tablet and iPhone, at 7.87 inches tall by 5.3 inches wide – the perfect size for a lab coat – and runs all a physician’s favorite apps. The device has benefits that are enticing to the healthcare community, including a medium screen for basic data entry, lightweight portability and the easy readability that all iOS model devices offer. The size is still small enough to prevent unwanted snooping of sensitive data on the screen, but like its larger counterparts, it is an excellent device to swivel and share information with patients. The iPad mini also allows physicians to carry a tablet and a smartphone simultaneously, an option I believe more physicians will increasingly favor over the next year.
Mobile is essential
As recently as five years ago, many hospitals and other institutions had a blanket ban on cell phone usage. Those regulations have been abandoned as the many benefits became recognized and clinician usage exponentially expanded. Now clinicians use their personal devices, both smartphones and tablets, as workplace tools, expecting them to access lab results or patient charts seamlessly. Today, institutions have a new set of concerns surrounding security and HIPAA compliance. Each physician having their own device, or multiple devices, also causes logistical problems for internal systems that may not be mobile optimized, requires individual passwords and times out a user after a few minutes of inactivity. Productivity is impaired by these hassles and should be addressed.
As mobile device innovation and app development continue to boom, it becomes more important for practice managers and healthcare professionals to find a balance between security and platform standardization inclinations. To maintain the higher level of care that medical apps have helped establish, institutions small and large should create and enforce a set of BYOD guidelines that foster mobile device usage while anticipating new technological developments. Following are suggestions for 2013:
- Work to expand mobile. Be prepared for an increasingly ambulatory work force. Any time services are being renewed or upgraded, make sure you are taking native apps and mobile optimization into account for BYOD plans.
- Standardize registration. Require that mobile devices are registered to access the practice network and standardize a company-approved, two-layer authentication system to be downloaded as part of the process.
- Set boundaries. State clear and concise rules for when a mobile device can and cannot be used. For example, mobile device use may be limited during a surgical procedure unless it is cleared beforehand.
- Conform to HIPAA guidelines. Have a policy for mobile device usage to align with HIPAA guidelines surrounding patient privacy, including patient imaging data and secure messaging.
- Encrypt data. Make sure that data transmitted from one device to another is encrypted.
- Limit data storage time. Limit the amount of time data is stored on a mobile device before it is automatically erased.
- Start a conversation. Coach physicians on how to have an open dialogue with patients regarding the information they are looking up; patients will be more informed and physicians may gather additional insights. Remind clinicians to maintain patient eye contact as much as possible.
- Encourage usage. Keep a list of recommended apps and update them quarterly.
In healthcare, barriers to practicing safe, efficient medicine are high for physicians. By choosing their own devices and apps and using them securely, clinicians will save time, reduce errors and increase patient satisfaction by improving face time. Through the implementation of clear and concise BYOD rules, practice managers and healthcare professionals are able to foster an open dialogue between practice needs and realities. HMT
About the Author
Anne Meneghetti, M.D., is director of clinical communications, Epocrates. For more on Epocrates: www.rsleads.com/302ht-202
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