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Is Apple HealthKit Headed For Hospital Dominance?

Posted on February 12, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Even for a company with the cash and reach of Apple, crashing the healthcare party is quite an undertaking.  Not only does healthcare come with unique technical challenges, it’s quite the conservative business, in many cases clinging to old technologies and approaches longer than other data-driven industries.

Of late, however, Apple’s HealthKit has attracted the attention of some high-profile healthcare institutions, such as New Orleans-based Ochsner Medical Center and Stanford Healthcare. All told, a total of fourteen major U.S. hospitals are running trials of HealthKit. What’s more, more than 600 developers are integrating HealthKit tech into their own health and fitness apps.

What’s particularly interesting is that some of these healthcare organizations are integrating Apple’s new patient-facing, iOS HealthKit app with Epic EMRs and the HealthKit enterprise platform.  If this works out, it could vault Apple into a much more lucrative position in the industry, as bringing together health app, platform and EMR accomplishes one of the major steps in leveraging mobile health.

According to MobiHealthNews, the new app allows patients to check out test results, manage prescriptions, set appointments, hold video visits with Stanford doctors, review medical bills — and perhaps most significantly, upload their vital signs remotely and have the data added to their Epic chart. This is a big step forward for hospitals, but even more so for doctors, many of whom have warned that they have no time to manage a separate stream of mobile patient data as part of patient care.

For Apple leaders, the next step will be to roll out the upcoming Apple Watch and integrate it into its expanding Internet of Apple Healthcare Things. CEO Tim Cook is pitching the Apple Watch as a key component in promoting consumer health. While the iPhone gathers data, the smart watch will proactively remind consumers to move. “If I sit for too long, it will actually tap me on the wrist to remind me to get up and move, because a lot of doctors think sitting is the new cancer,” Cook told an audience at an investor conference recently.

All that being said, it’s not as though Apple is marching through healthcare corridor’s unopposed. For example, Samsung is very focused on becoming the mobile healthcare  technology provider of choice. For example, in November, Samsung announced relationships with 24 health IT partners, including Aetna, the Cleveland Clinic and Cigna.

At its second annual developer conference last December, Samsung introduced an array of software tools designed to support the buildout of a digital health ecosystem, including the Samsung Digital Health SDK and Gear S SDK, which lets app makers create software compatible with Samsung’s smart watches. Also, Samsung is already on the second generation of its Simband reference design for wearable device design, as well as the cloud-based Samsung Architecture for Multimodal Interactions, which collects sensor data.

And Microsoft, of course, is not going to sit and watch idly as a multibillion-dollar market goes to competitors. For example, late last year the tech giant launched a fitness tracking wristband and mobile health app. It’s also kicked off a HealthKit-like platform, imaginatively dubbed Microsoft Health, which among other things, allows fitness band users to store data and transfer it to the Microsoft Health app. Microsoft isn’t winning the PR war as of yet — Apple still has a gift for doing that — but have no doubt that it’s lurking in the swamps like an alligator, ready to close its powerful jaws on the next right opportunity to expand its healthcare presence.

Bottom line, Apple has captured some big-name pilot testers for its HealthKit platform and related products, but the game is just beginning. Having users in place is a good start, but Apple is miles away from being able to declare itself the leader in the emerging hospital mobile health market.

UPMC Kicks Off Mobility Program

Posted on July 1, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

If you’re going to look at how physicians use health IT in hospitals, it doesn’t hurt to go to doctors at the University of Pittsburgh Medical Center, a $10 billion collosus with a history of HIT innovation. UPMC spans 21 hospitals and employs more than 3,500 physicians, and it’s smack in the middle of a mobile rollout.

Recently, Intel Health & Life Sciences blogger Ben Wilson reached to three UPMC doctors responsible for substantial health IT work, including Dr. Rasu Shrestha, Vice President of Medical Information for all of UPMC, Dr. Oscar Marroquin, a cardiologist responsible for clinical analytics and new care model initiatives, and Dr. Shivdev Rao, an academic cardiologist.

We don’t have space to recap all of the stuff Wilson captured in his interview, but here’s a few ideas worth taking away from the doctors’ responses:

Healthcare organizations are “data rich and information poor”: UPMC, for its part, has 5.4 petabytes of data on hand, and that store of data is doubling every 18 months. According to Dr. Shrestha, hospitals must find ways to find patterns and condense data in a useful, intelligent, actionable manner, such as figuring out whether there are specific times you must alert clinicians, and determine whether there are specific sensors tracking to specific types of metrics that are important from a HIM perspective.

Mobility has had a positive impact on patient care:  These doctors are enthusiastic about the benefits of mobility.  Dr. Marroquin notes that not only do mobile devices put patient care information at his finger tips and allow for intelligent solutions, it also allows him to share information with patients, making it easier to explain why he’s doing a give test or treatment.

BYOD can work if sensitive information is protected:  UPMC has been supporting varied mobile devices that physicians bring into its facilities, but has struggled with security and access. Dr. Shrestha notes that he and his colleagues have been very careful to evaluate all of the devices and different operating systems, making sure data doesn’t reside on a mobile device without some form of security.

On the self-promotion front, Wilson asks the doctors about a pilot  project (an Intel and Microsoft effort dubbed Convergence) in which clinicians use Surface tablets powered by Windows 8. Given that this is an Intel blog, you won’t be surprised to read that Dr. Shrestha is quite happy with the Surface tablet, particularly the form factor which allows doctors to flip the screen over and actually show patients trends.

Regardless, it’s interesting to hear from doctors who are gradually changing how they practice due to mobile tech. Clearly, UPMC has solved neither its big data problems nor phone/tablet security issues completely, but it seems that its management is deeply engaged in addressing these issues.

Meanwhile, it will be interesting to see how far Convergence gets. Right now, Convergence just involves giving heart doctors at UPMC’s Presbyterian Hospital a couple dozen Microsoft Surface Pro 3 tablets, but HIT leaders plan to eventually roll out 2,000 of the tablets.

Hospitals Using Tablets to Improve EMR Access

Posted on February 18, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Some high profile hospitals are turning to tablets as a way to give physicians better access to EMRs when they’re walking the halls.  Using tablets is seen as a way of working around desktops’ limitations in making better use of EMRs’ capabilities, according to MedPageToday.

For example, back in 2010, the University of Chicago School of Medicine issued tablets to all hundred 15 internal medicine residents. After a year, three quarters of residents reported tablets help them finish tasks more quickly and spend more time on direct patient care.

In another example, the Cleveland Clinic is pilot testing the use of tablets with a few sectors of its workforce, such as its rapid response teams. Using tablets, clinicians can look up patient data on the way to the patient was crashing and be better prepared when they arrive.

In yet another instance, the University Of Pittsburgh Medical Center is testing the use of Windows tablets with cardiologists. The medical center has developed special software allowing physicians to jump between different mobile apps without having to reenter patient information to do their work.

These are just examples of how hospitals can turn mobile devices into effective extensions of the EMR, said David Collins, senior director of mHIMSS, the mobile wing of HIMSS. “If you can spend $300 on a tablet and issue these to providers so that they’re more mobile, it’s really a minimal cost for the payoff,” Collins told MedPageToday. Although, John Lynn makes a pretty good counter argument for why IT admins prefer the more expensive Windows 8 tablets over iPads or Android tablets.

These are just a few early examples of how hospitals can use tablets to make access to patient data simpler. Over the next year or two expect to see far more examples of tablet use in hospitals, as it’s become increasingly clear that they can help enhance the use of clinical data, on the spot when clinicians need it.

Deploying WiFi For Clinicians, Hospital Guests A Complex Problem

Posted on December 3, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

These days, offering WiFi for both hospital visitors and clinicians is pretty much de rigeur. The problem is, clinicians need different things from their Wi-Fi connection than consumers do. And as a recent story in Healthcare IT News notes, that can make it difficult to keep up with everyone’s demands.

According to Ali Youssef, senior clinical mobile solutions architect at Detroit-based Henry Ford Health System, maintaining a wireless network that suits everyone’s needs is “moving target.”

Youssef was responsible for planning and implementing the HFHS wireless network, which included expanding coverage from 4 million to 8 million square feet. What’s more, the network rollout had to take into account the needs of the HFHS enterprise EMR system, according to the HIN piece.

For Youssef, one of the most difficult problems health IT managers face in this situation is provisioning bandwidth appropriately to all the different types of devices that will share the bandwidth.

Not surprisingly, Youssef believes that one of the most important ways to see that everyone has enough bandwidth is regular contact with the system’s clinicians.

In some situations, clinicians may need far more bandwidth then the IT department had anticipated, for example, where clinician is launching a new project fueled by grant money, notes the Healthcare IT News piece. (We’re also increasingly see a growing list of wireless medical devices, such as wireless glucometers, edge into mainstream clinical care.)

To cope with these rapidly changing demands, Youssef recommends planning for a high level of wireless system redundancy and conducting site surveys.

And in what may be a more difficult challenge, he recommends that network architects keep continuous tabs on what types of devices are going to be used, and testing them see how they behave on their health system’s network.

Youssef didn’t offer any detailed advice on how to accommodate hospital visitors in this story, but clearly, they will pose a significant challenge to any hospital network architect as well.

Particularly as apps become part of patients’ health system experience, network architects will need to bear consumer experience of the network in mind as well. It will be interesting to see, over the next few years, whether consumer wireless health use demands a fresh approach to network architecture generally.

Hospital Residents Question Value of iPad For Clinical Rounding

Posted on November 13, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Though the iPad has a sexy reputation — the Apple mystique is alive and well — it may not not necessarily the best tool to use for clinical rounding or education, according to a new study published in the Journal of Mobile Technology in Medicine. That being said, there’s a lot of issues with the study, as you’ll see below.

First, the study design. During the 2011-2012 academic year, researchers gave iPads to 102 medical and surgical residents at Riverside Methodist Hospital in Ohio. The tablets were 16 GB iPad2 models with wireless Internet capabilities, reports iHealthBeat. The iPads had Wi-Fi but no cellular network connectivity, which left many residents complaining about hit-or-miss connectivity.

At the end of the academic year, researchers surveyed the residents to learn how iPad use had worked for them. What they found out was that while the residents largely liked the iPads, they didn’t find them useful for clinical rounding. On the other hand, though the study doesn’t address this directly, they had reason to be uncomfortable.

Of the 102 residents, only 14.7 percent used the iPad on rounds, and a scant 7.8 percent said the tablet helped them document care more efficiently. But it should be noted that the iPads were running only VMware View, not an iPad-native care system, forcing the residents to cope with an interface designed for seated users on keyboards.

Meanwhile, almost 58 percent of respondents said that the iPad was useful for sourcing articles outside of the hospital and 52 percent said the iPad was valuable for research.

The medical residents also valued the iPad for making recommendations to a colleague (58.3 percent), facilitating patient care (45.8 percent), as an educational tool (41.7 percent) and to view results and use as a guide for evidence-based practice (38.9 percent). (Surgical residents were much less impressed, with, for example, only 6.7 percent agreeing that the tablet was a valuable educational tool.)

Despite its flaws, the study does make one important point — that it’s well past time for EMR vendors to create iPad-usable interfaces, rather than forcing residents to use some awkwardly hacked version of their desktop/laptop product. If this study is any indication, large numbers of residents like the iPad a great deal, but they’re not going to use it for documentation unless they have a good user experience.  Vendors, your move.

P.S. By the way, if you want to read about a case in which iPads are being used in daily rounds, check out this piece from drChrono that was highlighted on the Apple iPad website.

Patient’s Take On Making Hospital IT Patient-Friendly

Posted on September 4, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today I was talking with my mother about her experiences with hospitals and IT. My mother, you should know, is so computer averse that she won’t send or receive e-mails — she leaves that to Dad.  But despite her fear of home computing, she’s got some interesting opinions about how hospitals should use health IT to involve patients in the care process:

* If possible, she suggests, hospitals should assess a patient’s “electronic IQ” to see how comfortable they are with using technology. I liked this because it could apply not only to in-hospital info sharing but also the patient’s ability to participate in remote monitoring or other mHealth modalities.

*Give patients access to a schedule (via an app on a tablet, perhaps) which tells them when various tests, procedures and clinician visits are likely to happen. This not only calms the patient, it helps keep the family in synch with the patient’s routine, she notes.

* Display results of key tests — or if clinicians are concerned that patients won’t understand them, at least register when the results have been received, so  patients know their care process is progressing. She’d be happy with a note that said: “Dr. X will be in to discuss the results of your CT scan shortly.”

* Allow the patient and their family/caregivers to make notes within the system of what they want to discuss with clinicians.  Otherwise, as she rightly points out, they’re likely to forget what they wanted to say when the nurse or doctor swoops into the room with their own agenda.

Actually, my mother’s vision is already largely in place in at least one facility. As I reported last year, the Mayo Clinic has already begun a program using content- and app-loaded iPads to move the patient through their inpatient stay. Not only does the Mayo implementation do everything on my mother’s wish list, it also allows patients to report on pain levels and exchange messages with doctors.

Let’s hope more hospitals find a way to use IT to make the care process more transparent for patients. While it calls for a not-inconsiderable investment in time and resources, it seems like an excellent way to keep patients engaged in their care.

Personality Traits Predict Nurse Acceptance of Mobile EMRs

Posted on August 27, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As HIT leaders know well, clinical personnel have a wide range of responses to EMRs, ranging from enthusiastic adoption to outright panic. In most cases, hospitals can’t predict which doctors and nurses will need extra support and which will be power users until they roll out their EMR.

However, a new study suggests that by examining nurse attitudes, the HIT team can get some idea ahead of time which will jump on board with mobile EMRs and which will hang back.

Key personality traits can predict which nurses are more likely to accept and adopt EMRs, according to a new study appearing in a FierceEMR piece.

The study, which appeared in BMC Medical Informatics & Decision Making, analyzed a questionnaire filled out by 665 nurses to compute a “Technology Readiness Index.”  In so doing the researchers broke out a series of personality traits that impact on whether nurses see mobile EMRs as easy to use and useful.

Researchers concluded that four traits in particular — optimistic, innovative, secure and uncomfortable with technology — had a meaningful impact on their acceptance of technology, according to Fierce EMR:

* Optimistic nurses were more likely to see mobile EMRs as useful and easy to use
* Innovative nurses saw EMRs as being easy to use, but not necessarily useful
* Those who were insecure or technology-challenged saw the EMR negatively

According to the study write-up, researchers concluded that continuous educational programs aimed at increasing IT literacy should be provided for nurses. It also recommends that hospitals recruit, either internally or externally, more optimistic nurses as product champions for the mobile EMR.

Of course, figuring out the personality types of  nurses en masse isn’t practical in most situation. After all, most hospital IT administrators don’t have the time to do a scientific study prior to their launch, especially if they’re doing a multi-layered mobile launch using new tools and introducing new requirements. But it doesn’t hurt to know, informally at least, which types of nurses are likely to be able to lead the mobile EMR charge.

Building A Successful Hospital Mobile Strategy

Posted on August 20, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Hospital leaders know that having a mobile strategy in place has become a necessity. Doing so not only accommodates physicians’ and nurses’ mobile workstyles, it leverages tablets and smartphones in a manner which makes hospital communication and EMR use more effective.

The thing is, making a mobile strategy work is far more complicated than simply giving caregivers with mobile devices and wishing them luck, notes Trey Lauderdale, founder and president of mobile communications firm Voalte. In a recent piece for the HIT Consultant blog, Lauderdale argues that there are a few key steps hospital CIOs need to take if their mobile initiatives are going to be successful. These include:

Assess and  prepare your infrastructure

Before you roll out a major mobile initiative, it’s critical to make sure both your physical and digital infrastructure can handle a new flood of mobile device traffic, Lauderdale says. Bear in mind that your Wi-Fi network will need to handle data, text and voice transmission on a level it hasn’t before, and what’s more, that this demand is likely to change and grow. You’re also going to need to figure out how to integrate mobile devices with alarms management middleware.

*Plan for deploying your smartphones

As you think through the nuts and bolts of handing out smartphones, be aware than you’ll need to see to their day-to-day functioning, Lauderdale points out. For example, you’ll need battery cases to protect the phones and keep them charged shift-long, and screen shields to  protect against accidents, and possibly a custom holster to help nurses work comfortably with phones. You’ll also need to decide whether smartphones will be shared or assigned to specific caregivers, and how you’ll store and charge them when they’re not being used.

Manage and update smartphones

With caregivers using smartphones as an official work device, you’ll then need to implement a mobile device management strategy, an approach which allows you to download apps to phones, update operating systems and make repairs when necessary. You will also want to include mobile devices in your security strategy, for functions such as password protection, lockout protocols and provisioning access, Lauderdale says.

Not every healthcare organization is ready to invest in its own stock of smartphones or tablets. Many are still struggling to implement a BYOD strategy that meets the institution’s needs without asking doctors and nurses to check their personal device at the door. But if you’re ready to supply and control mobile devices, Lauderdale’s suggestions make sense.

CA Hospital Jettisons Nurse Communications Gear For iPhones

Posted on July 22, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

At Keck Medical Center of USC, nurses will no longer use standard hospital communications gear.  In an effort to simplify and improve communications, the academic medical center is rolling out an initiative placing specialized adapted iPhones in the hands of each nurse.

According to an article in USC’s The Weekly, Keck’s IT leaders  have ordered 300 “specialty” iPhones for  use by the nursing staff. “The idea is to give them one device to do everything,” Keith  Paul, chief technology officer for USC Health Sciences, told The Weekly.

Paul chose to go with the iPhones when the firm installing its EMR said that they could link it with the smartphones. (The EMR is in the process of being rolled out, the paper reports.)

When the devices are completely functional, nurses will be able to receive secure messages from patients and other nurses, as well as emergency alerts, the article notes. The devices, which come with enhanced batteries and a tough casing, will also be able to show when a specific nurse is available.

Nurses are not going to be given their own phones, but instead, will pick up a phone at the start of their shift, entering their user ID and password to activate the device.  At the end of their shift, they’ll be asked to return the phones to a charging station.

One way in which the phones are unique is that they won’t have cellular capabilities. The modified iPhones will function only on the Keck campus, with calls made over the facility’s secure Internet infrastructure.

This is the first time I’ve heard about a smartphone or tablet rollout which crippled the cellular communications functions of the device, but it probably won’t be the last.

As we’ve previously reported, few smartphones are secure enough to meet even half of Meaningful Use or HIPAA requirements, according to ONCHIT. So it makes sense to run voice communications through a hospital-controlled voice-grade Internet network if you have the option (which Keck obviously did). But to date few hospitals (that I know of) have taken the plunge.

What’s equally interesting here is the extent to which the new iPhone rollout superceded investment in standard nurse communication platforms such as, say, Vocera phones. I wonder if vendors of such equipment will see iPhones or other smartphones begin to eat into their market share. What do you think?

Howard University Hospital Rolls Out Mobile PHR for Pre-Diabetic Young Adults

Posted on June 26, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Howard University Hospital has kicked off a research study, using wireless technology, to help at-risk young adults in the District of Columbia change their behavior to prevent their developing diabetes.

The program involves giving African-American adults aged 18 to 24 who are diagnosed with pre-diabetes access to a mobile PHR and activity tracker which are synchronized wirelessly with the Web-based PHR.

Howard is giving young adults in the program free access to the NoMoreClipboard PHR for their smartphones, along with a FitBit Zip wireless activity tracker which counts the number of steps taken, distance covered and calories burned per user. The study also includes a separate “lifestyle group” which will not receive the technology, but will attend group meetings addressing their condition.

Once synched up with the Web-based PHR, the technology group’s data will be available to clinicians with Howard’s Diabetes Treatment Center, who will use the data to provide coaching to program participants.  Data from the Center’s EMR will also populate the PHR, creating a patient health record participants can bring with them to other providers.

The program will also include sending a variety of text messages to the young adults in the technology group, including reminders to interact with the PHR and 75 health and behavioral tips which will be dispatched over the course of a year.

To examine results of this intervention, the program will study changes in Patient Activation Measure scores — a validated 13-item measure used to assess patients’ ability to self-manage their chronic disease — at three months and one year.  Researchers also plan to look at changes in BMI and hemoglobin A1c levels at the same intervals.