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The Various Approaches to Mobility in Healthcare

Posted on September 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

I’m about to head down to the CTIA Super Mobility Week conference. I try to attend a few conferences each year that aren’t directly related to healthcare and health IT in order to get a broader perspective on what’s happening in the rest of the world. I think this will be one such case (although, they do have some mHealth sessions and exhibitors as well).

As I started to think about mobility and where it’s headed, the industry is all about the smart phone and smart mobile devices. I think it’s an incredibly powerful concept and one that will only become more important. However, I think that many people are taking it too far. While I love my smartphone and its capabilities, I still love the productivity that’s possible with a great desktop setup with dual monitors, a mouse and a keyboard. I’m not sure we’ll replicate that in a mobile world and I’m not sure we should.

In fact, it’s one of the trends I hate most about many of the website designs that are coming out lately. They are going all in on mobile and in the process they’re killing the productivity of the desktop experience. It’s a travesty and continues to annoy me with many of the applications I use on a daily basis.

We can apply this same principle to healthcare IT. Often we need to step back and ask ourselves if something really needs to be mobile or not. Plus, if we decide to make something mobile, we need to ensure that those who still use the same application in a non-mobile environment have their workflow optimized as well.

At the end of the day, we need to create a much more sophisticated approach to mobile computing. There are many times when a doctor or nurse really need whatever they’re working on to be mobile. There are extreme benefits to having a point of care device which allows the nurse or doctor to document at the point of care. However, there are just as many times when mobility is actually a hindrance to the required workflow.

What are you doing in your organization to leverage the amazing mobile technologies that are out there while still maintaining the optimized workflow?

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.

Pennsylvania Hospital Sees Data Breach

Posted on June 16, 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.

No matter how careful you are with patient data, there’s always a way for it to slip out the door or be accessed illegitimately. That’s why a Pennsylvania-based hospital has been forced this to notify almost 2,000 patients that an employee had committed a HIPAA breach.

The 551-bed Penn State Milton S. Hershey hospital learned, after conducting an internal investigation, that an employee accessed and transmitted protected health data outside of the hospital’s secure information network. The hospital was forced to inform 1,801 patients that their names, medical record numbers, lab tests and results and visit dates could conceivably have been accessed by unauthorized persons or entities due to an employee mistake.

The HIPAA breach was due to a mistake by a Penn State Hershey clinical laboratory technician, who was authorized to work with PHI but did so insecurely. The lab tech accessed patient data via an insecure USB devices through his home network rather than the hospital network, as well as sending patient data via his personal email address to two hospital physicians.

To date, Penn State Hershey has had a respectable track record for security. As HealthcareITNews notes, this is the first large HIPAA breach the facility has reported to HHS.

But there’s clearly an education gap here if an otherwise well-behaved lab tech didn’t know that he be compromising data if he accessed and sent it this way.

To prevent breaches like this from becoming common, hospitals need to keep up an ongoing education program which continually re-emphasizes the dangers of outside-network communication, unencrypted communications, data storage on easily stolen laptops and phones and more. But few hospitals offer the level of education required to fend off everyday accidents like this one.

But education isn’t the only security challenge facing hospital IT departments. There’s also an issue that remains in hospital security which, as we discuss HIPAA breaches, is worth a quick note. While it’s critical to educate staffers  on what they can do to avoid HIPAA breaches, health IT departments themselves may need a refresher from time to time,  notes my colleague John Lynn.

John notes that while hospital IT staffers may have strong antivirus software protecting their facility, their malware protections are often weak, as software that locks staff computers down too much often makes users angry.

As he sees it, the next wave of security breaches may not be due to human error (or malicious content) but unseen malware quietly feeding data to health data thieves. Not only that, he expects to see personal mobile phones get compromised and infect the hospital network. All scary stuff.

The CIO’s Guide to HIPAA Compliant Text Messaging

Posted on January 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Yesterday I wrote a piece on EMR and EHR where I talk about why Secure Text Messaging is Better Than SMS. I think it makes a solid case for why every organization should be using some sort of secure text messaging solution. Plus, I do so without trying to use fear of HIPAA violations to make the case.

However, you can certainly make the case for a secure text messaging solution in healthcare based on HIPAA compliance. In fact, the people at Imprivata have essentially made that case really well in their CIO Guide to HIPAA Compliant Text Messaging. This is well worth a read if you’re in a healthcare organization that could be at risk for insecure texting (yes, that’s every organization).

They break down the path to compliance into 3 steps:

  1. Policy – Establish an organizational policy
  2. Product – Identify and appropriate text messaging solution
  3. Practice – Implement and actively managing the text messaging solution.

Texting is a reality in hospitals today and the best solution isn’t suppression, but enabling users with a secure solution. The checklists in the CIO Guide to HIPAA Compliant Text Messaging provide a great foundation for making sure your organization is enabling your users in a HIPAA compliant manner.

ICUs Can Improve Survival, Speed Discharges Using Telehealth

Posted on December 10, 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.

ICUs can boost patient survival rates and speed ICU and hospital discharge rates if they use tele-ICU technologies, a study published  in CHEST Journal concludes, according to a report in iHealthBeat.

The study involved researching the impact of tele-ICU technologies in 56 ICUs that were part of 32 hospitals and 19 health systems, tracking them over a five-year period, according to iHealthBeat. The project, which was led by Craig Lilly, director of UMass Memorial Medical Center’s eICU Program, involved more than 110,000 patients.

The hospitals involved in the study used the Phillips Healthcare eICU technology, a comprehensive set-up which included bidirectional audio and video equipment, population management tools and real-time and retrospective reporting tools.

The study looked at how ICU doctors created treatments based on best practices, and responded to patient alerts and alarms, iHealthBeat notes.

Researchers found that patients who received care in hospitals using telemedicine were 26 percent more likely to survive in the ICU than patients in units that didn’t use tele-ICU technologies. It also found that patients were 16 percent more likely to survive their hospitalization than their counterparts who didn’t receive tele-ICU services.

What’s more, researchers found that patients in ICUs using telemedicine saw 20 percent faster discharges in the ICU and 15 percent faster hospital discharges.

This research strongly suggests that tele-ICU is maturing, and should be taken seriously as part of a hospital’s treatment arsenal.  In fact, your hospital might want to take a look at a new set of best practices created by the New England Healthcare Institute designed to make tele-ICU more scalable and accessible to hospitals.

Ultimately, the ideal is to connect telemedicine — and other remote sources of data — to hospital EMRs, allowing a new level of collaboration between far-flung clinicians. But in the mean time, it seems that tele-ICU can offer great benefits even if it creates a data silo for the time being.

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.

Beth Israel Deaconess Uses Lessons Learned To Protect Bombing Patient Data

Posted on August 23, 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.

When terrorists exploded bombs at the Boston Marathon, Beth Israel Deaconess Medical Center was one of the hospitals that received patients injured in the attack. With world attention focused on the event and its aftermath, it wouldn’t have been surprising if someone managed to breach the patients’ medical information.

But as it turns out, BIDMC was able to keep private not only injured victims’ data, but also information on the condition of bombing suspect Dzhokhar Tsarnaev, reports iHealthBeat.  BIDMC CIO John Halamka told a conference this week that his facility was able to keep sure in part due to lessons learned from a data breach involving a stolen laptop.

During his presentation at the meeting, Halamka explained how the facility tightened up security after a July 2012 incident where a physician’s personal laptop.

The incident, which required  the hospital to notify about 3,900 patients about the data breach, led the hospital to immediately change its encryption policies for any device hospital personnel used that could contain protected health data, iHealthBeat reports. BIDMC also improved security in office buildings and launched a campaign to increase awareness regarding data security.

What’s more, after a second data privacy issue came up, BIDMC retained Deloitte to audit how employees use computers and personal devices.  Deloitte ended up recommending adding messages to portals to remind employees to take care with data; creating 26 new staff positions; deciding which records were the most restricted; and updating doctors’ record access permission when they were given new job titles, iHealthBeat says.

When the Boston Marathon event took place, Halamka was able to build on these precautions. Specifically, he took steps to make sure doctors working in the emergency department weren’t able to access patient records out of curiousity. IT leaders restricted access to the victims’ and Tsarnaev’s data, making employees who did seek access to explain why they did so, iHealthBeat said.

Health data security measures like those at BIDMC are too seldom implemented in full, as the countless reports of data breaches at hospitals demonstrate. But they’re increasingly necessary, particularly as mobile devices bring new layers of risk and health data grows more of a target for criminals. Unfortunately, given the desirability of health data as a target, this is a problem that can only get worse before it gets better.