How mHealth technology can enable meaningful use compliance

Physicians are leveraging mobile health technology to tackle e-prescribing, CPOE, patient education and other key meaningful use requirements.

CAMBRIDGE, Mass. -- Up to now, the buzz around mobile health (mHealth) technology seems to have been about its potential to make health care cheaper and more efficient while perhaps improving outcomes.

But potential doesn't pay the bills. In a panel at the World Congress 3rd Annual Leadership Summit on mHealth, health care providers shared how mHealth technology is beginning to enable meaningful use compliance in their workflows.

The panelists -- Hennepin County (Minn.) Medical Center CMIO Kevin L. Larsen, M.D., Physicians Interactive President Sanjay Pingle and U.S. Navy Bureau of Medicine and Surgery Clinical Informatics Deputy Director Peter Park, M.D. -- described how mobile apps can address specific meaningful use criteria.

Smile, your wound's on Candid Camera

Larsen outlined his facility's expansion of its Epic Systems Inc. electronic health record (EHR) into mobile apps, including in ambulances with patients en route. He said tablets and phones have made their way closer to the bedside, enriching communications and efficiency of care.

Practitioners are finding new ways to interact using features such as still cameras and webcams built into mobile devices. One example he cited was a nurse dressing a patient's wound and sending a physician a picture to document how it's healing; previously, the nurse would describe the healing in words or have the physician come to the bedside, take off the bandage, and inspect it himself.

Physicians, too, are using the cameras built into mobile devices for documentation of patient progress. Even though docs learn in medical school how to describe things well in their charts, it's not a precise science. Taking a picture of a patient's rash at one visit and then taking another a week later yields a much more precise document for comparison.

Hennepin County Medical Center virtualized its EHR system, e-prescribing system and reference library, making all available on phones and tablets. The facility purchased tablets for its residents. Now, in addition to simply using EHR systems, residents can fulfill meaningful use criteria such as e-prescribing and looking up drug interactions.

Larsen said speech recognition software is proving to be effective for navigating the EHR system as well as adding more detailed care documentation when manual data-entry isn't as quick. In the future, as accuracy improves and software vendors integrate speech recognition with EHRs, he feels it will be an even more effective tool.

Docs might like their Dictaphones now, Larsen said, but a smartphone running the EHR -- with access to patient lists that don't take forever to load -- recording those same notes and converting them to text on the spot is faster and more efficient. Over time, he added, it also will be more effective for care, as natural-language processors will make those voice notes more searchable and the data within them more accessible.

EHR, smartphone use complementary

While the smartphone EHR virtualization is "not fun" to use, Larsen said nurses prefer it -- it's a smaller device and, besides, they use fewer EHR functions than doctors. Both doctors and nurses use other software tools on their smartphones, too, including Google (for looking up medical data needed in the course of administering care) as well as calculators (for medication dosing).

"A dirty little secret -- doctors in the room probably know this -- Google is one of our best friends for finding information for patients," Larsen said. "Its search engine I find much easier to use than medical search engines that require complex medical terminology."

Tablet, laptop and smartphone use are all a focus of the hospital's mobile program to support physicians and nurse practitioners in nursing homes and homeless shelters. While these facilities aren't part of the hospital, it has deployed IT staff there to address problems such as wireless dead spots so health care providers working with patients on-site can still access the Hennepin County Medical Center EHR system.

Health care providers say mHealth technology is beginning to enable meaningful use compliance in their workflows.

Giving practitioners a look at patients' records -- especially for nursing-home visits -- provides much more background on a patient's case than ever before, Larsen said, and it lets them make more enlightened care decisions. Not only that, but there's what he termed "a huge amount of care coordination" back and forth between nursing homes and the hospital. Online access to the EHR gives practitioners at nursing homes full access to labs, care summaries and other vital data.

Achieving meaningful use compliance with mobile patient interaction

Engaging patients -- and giving them access to their health data -- is a major tenet of meaningful use. That's why Hennepin County Medical Center is porting its patient portal to smartphones. This lets patients see data as well as interact in some ways, such as booking appointments, messaging providers, receiving notifications for preventive care visits due, accessing after-visit summaries and viewing lab test results.

"Many of these components are part of stage 1, and some are part of stage 2," Larsen said, adding that the features aren't just available, they work. "I have a number of patients who are leveraging this quite effectively."

Park outlined the Navy's use of mCare to message sailors and Marines recovering at home from head trauma injuries. The system -- which is compatible with most phones, smartphones or not, and uses a secure cell phone connection -- dispatches appointment reminders, health bulletins and unit announcements (which apply to a group of recovering soldiers).

The mCare program started as a mHealth technology pilot and has expanded into its present research stage. "Having demonstrated the proof of concept, we're now moving into a clinical outcomes study," Park said. This will see whether mCare can actually help military members recover more quickly and completely from their injuries.

Future's bright for mHealth technology, experts say

Of course, mHealth technology remains in that mostly-potential phase of adoption. Professionals believe such tools could enable meaningful use compliance in several areas, from computerized physician order entry (CPOE) to clinical decision support.

That includes e-prescribing, Physician Interactive's Pingle later said. "One of the challenges to further adoption is that you'd think a majority of [prescriptions] would be done via mobile…but the vast majority that we see are written via desktop and the Web," said Pingle, citing Allscripts research showing that 25% of prescriptions were filed electronically in 2010. Though low, this represents a "huge increase" over 2008 and 2009. Physicians love new technology, he said, but only when it works well.

Vendors will have to overcome usability issues plaguing many current applications. These include poor data-entry mechanisms and slow list-loading on mobile devices, he said. Once that happens, robust data systems such as e-prescribing can work well on smartphones. 

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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