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This is part one of a two-part series that explores how health care organizations are meeting physician demand for EHR access on their iPads, and how the devices are being rolled out. Part two looks at the role of virtualization vendors in bringing EHRs to the iPad.
Few health IT leaders outside Beth Israel Deaconess Medical Center CIO John Halamka, M.D., or his peers saw the iPad as a health care game-changer upon its release two years ago. Now however, CIOs increasingly view iPad EHR implementations as a way to promote meaningful use compliance among physicians, who love the device. Meanwhile, virtualization vendors are making those implementations more workable.
The increase in iPad EHR use also pushes some facilities closer to joining the "bring your own device" -- or BYOD -- movement, which brings its own security and compliance challenges. On the plus side, adopting a BYOD policy shifts the cost of purchasing the tablet to the employee, as well as the hassles of administering hardware upgrades.
More iPad EHR resources
Ten iPad EHR security strategies for HIPAA compliance
Debating the merits of virtualized vs. native iPad EHR implementations
Learn more about the iPad in health care at Health IT Exchange
If you're an IT pro working for a health care provider and not already involved in an iPad EHR implementation, chances are you will be, soon: The iPad represents a significant slice of a mobile connectivity pie that will reshape health care, according to Deloitte's 2011-12 Open Mobile survey, which calls health care the sector most likely to benefit from 4G technology in the coming years.
"Mobile is going to be a big part of health care," said Harry Greenspun, M.D., senior advisor at Deloitte Center for Health Solutions, who noted that health care lags a bit behind other market sectors. "People always ask me, 'What does the future of health care look like?' About like the present of every other industry. When you look at how mobile has transformed retail and finance and travel and every other aspect of our lives -- health care is going through the same transformation."
The biggest interoperability problem health care software vendors must solve, Greenspun said, is making data ubiquitous despite the wild variation in screen sizes and operating systems. That, while taking into account workflow issues. "Tablets are great for consuming information, but for a lot of folks [tablets are] challenging to generate a lot of information," he said.
The pluses and minuses of iPad EHR virtualization
While some EHR vendors offer their own iPad apps, and a few health care providers have developed their own customized iOS EHR apps, virtualizing PC desktops to the iPad via VMware or Citrix seems to be the fastest, most popular route to get physicians and nurses their iPad EHR clients. This is despite the complexities in network architecture and troubleshooting involved in managing virtualization.
At present, virtualized EHRs might not always work as fast or navigate as intuitively as custom-built apps, but CIOs cite virtualization's security advantages -- i.e. ease of logging out a user if a device is lost, with no patient data stored on the device to steal -- as an appealing tradeoff.
Tisa Murdock, healthcare product line manager for VMware View, said her customers indicate security as one of the leading drivers toward virtualization, because CIOs see iPads as, potentially, "a big storage device" and therefore a HIPAA compliance risk. That sways CIOs toward starting on virtualization setups instead of native apps. Improved performance and better touch-screen navigation with each new version keeps them interested.
At no time is there any patient data -- or any data, for that matter -- on the device.
Kirk Larson, CIO, Children's Hospital of Central California
Other customers choose virtualization over native EHR apps, Murdock said, because some vendors offer feature-limited or even read-only apps -- but in some cases providers need access to an EHR's full functionality. Virtualization gives iPad users that access.
How iPad EHR is paving the way to meaningful use, BYOD
It's natural that the iPad ascended to its position of preferred tablet, Murdock said. As an iPhone user herself, picking up an iPad was quick and intuitive. Handling an Android tablet after getting used to the iOS-driven iPhone isn't, she added.
Kirk Larson, CIO of Children’s Hospital of Central California, said that nurses involved in last summer's switchover from paper to a Meditech EHR virtualized to the iPad and other devices already had basic iPad skills, having either used them or watched other people use the touch-screen nav. The switchover -- done "big bang" style, all at once -- included a phased-in approach to a new virtualized-to-iPad computerized physician order entry (CPOE) system.
In advance of the rollout, his staff did presentations they called "device roadshows" to the different nursing groups in the 348-bed hospital to demonstrate the EHR and CPOE systems on laptops, iPads and a number of other devices.
"Not all of the clinical applications were touch-friendly," Larson said, when discussing some of the training challenges that came with virtualizing an EHR to iPads. "It was really a matter of ensuring that those groups that selected the iPad understood what that meant in terms of data entry and the user interface…it's not a knock on VMWare at all, it's just a reality of using some of these applications on a touch-screen device."
Difficulty in data entry on the iPad's virtual keyboard means that care providers in specialties whose jobs require keying in more data will probably prefer traditional PCs. Larson said that, for now, iPads seem more suited to the practitioners who don't have much data entry and instead mostly look up or monitor data in the course of care.
The success of the nursing iPad EHR rollout, despite very little support of the technology from Meditech, has led to the next phase: A pilot BYOD program for physicians, in which Children's Hospital will run VDI sessions -- and the EHR application -- to whatever the docs choose. "It will be very telling," Larson said about how physicians perceive their own workflows, "to see what types of devices physicians choose. It will literally be 100% self-selection as far as what they use for BYOD. They might bring their iPad, their laptop, I've even heard someone who might bring their Mac from home and put it on their desk."
The iPad rollout "was a great segue" to the BYOD pilot, he concluded, because it created a network infrastructure to support a BYOD policy -- including separate, secure wireless network for the devices. "At no time is there any patient data -- or any data, for that matter -- on the device. We feel very comfortable with that and we feel it's going to be a real win for our end-users."