For the past few months, IT executives at the University of Pittsburgh Medical Center closely watched a pilot test of BlackBerry smartphones for doctors and other employees at its UPMC Mercy hospital. The recently completed test of BlackBerrys as health care workstations was clearly successful, said Mercy’s CIO, Bruce Haviland.
Workers transporting people, specimens and medical records saw a 45% boost in productivity because they no longer had to find a phone to accept or report the completion of a job or to call in an order. One of the key BlackBerry benefits is asynchronous communication, Haviland noted; instead of playing telephone tag, doctors and nurses could leave each other emails or text messages when they were too busy to answer the phone or pager.
Now, at least a hundred users at UPMC Mercy want BlackBerrys of their own, and Haviland plans to recommend to the hospital’s president the purchase of a large quantity of the smartphones for doctors and caregivers throughout the organization.
However, UPMC as a whole is very much in the evaluative stage when it comes to BlackBerrys, said Dr. William Fera, the center’s vice president of medical technologies. UPMC Mercy was a bit of a special case -- when UMPC acquired it, the hospital had nothing but landlines and pagers, CIO Haviland explained, so the cost of BlackBerrys and the requisite Wi-Fi network was less of an issue. UPMC’s other hospitals, in contrast, would have had to write off fairly expensive legacy cell phone installations, not to mention upgrading and securing the network for the new devices.
Fera said he hopes BlackBerrys eventually will become an all-purpose “work engine” that enables caregivers to look up patient records, order lab tests, enter notes, access the Web or text a colleague, whether they are at a patient’s bedside, making the rounds, or at home on call.
But this is definitely a long-term goal, Fera emphasized. He is far from alone.
Smartphones useful for doctors but problematic for IT
More and more health-care IT organizations are deploying intelligent mobile devices and wireless services to “address the challenges and opportunities associated with increased care quality, patient safety, customer convenience and satisfaction, and lower costs,” said Barry Runyon, a research vice president at Gartner Inc.
A recent survey from New York-based Manhattan Research LLC on physician smartphones found that 64% of U.S. physicians own smartphones. By 2012 that number will increase to 81%, and there will be very few professional activities that physicians won’t be doing on their handhelds, the firm predicted.
Still, rolling out smartphones for doctors poses something of a dilemma to health care IT executives: They recognize the devices’ potential for boosting user productivity and improving patient care. However, they are concerned about the cost, not only of smartphones but also of the additional network, server and administrative resources needed to support a large-scale deployment.
Furthermore, smartphones still have serious limitations that make them less than perfect health care work engines, industry sources agreed. One of the biggest limitations is in the area of data input, Runyon said.
“It’s pretty common right now for physicians to use their smartphones to view patient charts, lab results and diagnostic results,” but they continue to use laptops, tablets and rolling workstations to type in notes and other types of text, Runyon said.
Andrew Pizzimenti, senior director of voice and data services at Mount Sinai Medical Center in New York, said he would love to replace his organization’s current beepers, pagers and computers on wheels with smartphones. “Physicians will make eye contact with the patient instead of constantly staring at a screen, and they’ll stop having to wear a utility belt like Batman to carry all those different devices.”
However, Pizzimenti said he's still waiting for the right device to come along -- but he knows exactly what he wants. “Something like a Kindle, that physicians can put in a pocket, that has handwriting recognition and close to 48 hours of battery life, because physicians forget to charge things. And it needs to work with most [electronic medical record] EMR systems,” he said.
Using EMR applications on smartphones a challenge
Most major EMR application vendors now offer some form of smartphone access to their systems, often via the Web. What’s starting to emerge now are client applications that give users direct access to these systems and that are designed specifically to work within the smartphone’s limitations, Gartner’s Runyon said.
Unfortunately, that often means limiting functions compared with full PC versions. Siemens’ smartphone client for its Soarian clinical information system, for example, provides a summary if an alert is too complicated to display on the screen, said Dan Huber, product manager for the Siemens Healthcare group in Malvern, Pa. Users currently can access radiology text reports, but not images.
All that is changing as smartphone vendors continue to boost capacity, improve screen resolution and so on. However, delivering information means little if users have trouble accessing it. Client interfaces must provide ease-of-use features that work around devices’ screen and keyboard limitations. There should be a minimum of hunting and clicking and scrolling, said Paul Brient, CEO of PatientKeeper Inc., a Newton, Mass.-based maker of physician information systems. Functions should be automated, with dropdowns and touch-and-get features used as much as possible.
Physicians will make eye contact with the patient instead of constantly staring at a screen, and they’ll stop having to wear a utility belt like Batman to carry all those different devices.
Andrew Pizzimenti, senior director of voice and data services, Mount Sinai Medical Center
Ideally, a smartphone will be even easier to use than a PC-based EMR application -- which physicians are notoriously lax about using. A PatientKeeper survey found that about 20% of doctors in patient-admitting departments bother to log on to an EMR system on their PCs. In contrast, 70% to 90% of doctors using PatientKeeper as a front end were accessing information on EMR systems, saving from 30 minutes to 60 minutes a day, the survey found.
Users should have the information they need literally at their fingertips even when, as is often the case with health care organizations, it is distributed across multiple systems. PatientKeeper, Pittsburgh-based dbMotion Inc., and Thomson Reuters Corp. in New York are among the vendors that aggregate information from various EMR applications, then present it to a client, such as a PC or a smartphone, in a unified format.
UPMC is using dbMotion’s software to aggregate data from a wide variety of systems. The vendor recently introduced an interface for BlackBerrys, which UPMC Mercy has installed so users can access information on the hospital’s EMR application from Cerner Corp., in Kansas City, Mo., and outpatient system from Verona, Wis.-based Epic Systems Corp. Emergency room caregivers can call up all the key information about a patient, including past treatment history, by entering his name, the hospital’s Haviland said. In addition, doctors on call or on the road can access patient data when a computer isn’t handy, and nurses can receive alerts telling them they need to prep a patient or that a laboratory result has come in.
Security, compliance hinder deployment
Two chief concerns among IT executives about deploying smartphones for doctors are security and compliance. For starters, most devices are easy to hack. In addition, one of their main purposes is to provide doctors with information when they are on call -- and outside the corporate firewall.
Some vendors, such as Siemens and McKesson Corp., address security by providing stateless, view-only smartphone clients. Users can call up a patient record on an EMR application, but as soon as they stop looking at it, it’s gone.
Citrix Systems recently introduced the Citrix Receiver for iPhone, which enables the Apple mobile device to act as a virtual client, viewing information from Citrix’s Windows-based XenApp servers. Cerner, Oracle, McKesson and Microsoft are among the vendors whose health care applications run on XenApp.
PatientKeeper, meanwhile, provides key-based authentication and encryption for data both in transit and at rest on devices, Brient, the vendor’s CEO, says. So does BlackBerry-maker Research In Motion Ltd., which is one main reason UPMC doctors chose BlackBerrys, the center’s Fera said. However, UPMC Mercy’s BlackBerrys currently support only data viewing. “Physicians are OK with that for now,” Fera said, but they will want to be more interactive in the future. That could complicate things, from both the security and ease-of-use standpoint, he added: “Right now, it’s easy. To get a view, you just point and click.”
Fera’s group will continue to monitor UPMC’s progress as it builds various applications and make its own evaluation in time. “Fortunately, we’re in no hurry, he said.”
Mount Sinai’s Pizzimenti also feels it’s best to take things slow. The right mobile device for health care “isn’t here yet, but it’s coming,” he said. Maybe it’ll be Apple’s new iPad.
Elisabeth Horwitt is a contributing writer based in Waban, Mass. Let us know what you think about the story; email firstname.lastname@example.org.