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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.

What Do Patients Need From EMRs?

Posted on November 14, 2012 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 we’ve noted countless times in this space, EMRs aren’t going to get any better unless vendors and doctors communicate freely. But what about catering to the needs of patients.  But given that by Stage 3 of Meaningful Use, EMR data will need to be accessible to and available for comments by patients and caregivers, it’s time patient needs were taken into account.

In that spirit, here’s my list of a few EMR features that might benefit patients and their caregivers. Bear in mind that this is me speaking as a patient and family caregiver, but perhaps that’s a good thing.

Patient data needs

*  Multiple views of the data:  Doctors are used to standardized reports, but patients and their families will still be learning the game.  Patients should be able to do pull data by history, by current status, by lists of drugs, allergies and other key factors affecting current care, as well as by a simple overview similar to patient discharge papers.  It should be possble to pull down these reports into Word, PDF, Excel and other popular formats for re-use.

* Access to contextual data:  Being able to fit data into a larger context is very helpful. As a caregiver, I’d want to know if the pulse ox number my asthmatic son was low relative to other asthma patients, particularly pediatric asthma patients. I’d also want to compare his current number to numbers from the past, preferably in easy-to-read chart form.

* Links to medical information: If I’m reading a report on my care, and I run into medical terminology I don’t recognize, I should be able to pull up a pop-up window and search for the definition of that term. I should also have access to full-length reports on my condition — from validated sources such as WebMD — to give me a broad understanding of my care.

* Ability to comment on data and notes:   While I realize this could become very time-consuming for doctors, it might be worth the trouble to give patients the ability to comment on elements of the data or notes. (A Microsoft Word-style comment function would probably be sufficient.)  To contain the time doctors need to spend, comment functions could be constrained to medical notes and other areas where impressions could be clarified or corrected — rather than the entire EMR data set.

*  Portal:  Portals, of course, are on the way regardless. But I wanted to underscore, as the caregiver to two chronically-ill family members, that accessing data through an organized interface will be a welcome method for skimming key indicators and raising the questions I need to ask doctors.

* Mobile access:  Another obvious one. Patients are as likely to access data on the road as physicians are. Patients need an adequate mobile app which offers a reasonable amount of access to key EMR data on a real-time basis.

Readers, what other types of data access do you think patients and caregivers need to participate effectively in care?

Are iPads Good For Healthcare? A Few Video Viewpoints

Posted on April 17, 2012 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.

Within, say, six months of its introduction, bloggers were already waxing rhapsodic over the potential of the iPad to transform the practice of medicine.

Many industry observers still do see the iPad as one of the defining moments in health IT, and many clinicians couldn’t be parted from their iPad with a crowbar.

But these days, as news of iOS security issues become more widespread, hospitals struggle with integrating iPads into their infrastructure and doctors grow weary of the iPad’s awkward data entry format, the elegant device is making some enemies as well as friends. OK, not enemies, exactly, but for some clinicians and IT leaders that early thrill is gone.

Given how perceptions of the device are shifting, I thought it’d be interesting to take a look at three takes on the iPad today. The first is from a hospital CIO, the second an interview with a doctor an Israeli hospital, and the third with a US physician. Check them out; there’s an interesting range of perspectives here.

Apple Security Issues Linger, Raising iPad, iPhone Concerns For Hospitals

Posted on January 18, 2012 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.

To date, few hospital IT administrators have made a big investment in supporting Apple devices, though many facilities are testing them out. Most testers have found that neither the smartphone nor the tablet work well as clinical data entry devices, and some have actually ended i-whatever pilots when doctors refused to use them.

But it seems that this is far from the worst problem iPads and iPhones pose for your hospital. In fact, in a recent case, one application downloadable directly from the company’s App Store was compromised to such an extent that it completely exposed the device to attackers.  According to a recent story in Forbes magazine, former NSA analyst and high-profile Apple hacker Charlie Miller sneaked an app onto the Store which, among other things, allowed Miller to execute commands on an iPhone. The program, Instastock, appears only to list stock tickers. (It’s not hard to imagine an app like this popping up on physicians’ iPhones/iPads, is it?)

While this might be old news to some of you, I was surprised to learn that the mobile Safari browser used on iOS devices seems to have some serious security flaws, too.  In fact, Safari doesn’t seem that sound overall. A report published six months ago concluded that while Explorer 9 blocked 100 percent of malicious URLs (with Application-based filtering enabled), Safari 5 blocked just 13 percent.

I am a huge fan of Apple devices, mind you. I think that EMRs would be in place in every hospital in the U.S., more or less, if vendors produced an interface one-tenth as elegant and streamlined as that of Apple products.  And it’s easy to understand why hospital IT leaders might want to go with the times and support the devices physicians already use.

But given the extent of these vulnerabilities, and the fact that Apple seems surprisingly slow to patch them, I’m actually surprised that so many hospital IT departments are continuing to  consider (or even offer) EMR access via iOS devices.  Maybe they’re not being irresponsible — after all, any OS can be hacked in time — but they seem to have one heck of a security challenge on their hands. It would definitely make me nervous.

Big EMR Problems To Tackle in 2012

Posted on December 30, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Friends, Romans, countrymen, lend me your ears. I come to bury 2011 EMR assumptions, not to praise them. Here’s some of the critical problems we didn’t kick this year:

* Just about everything we’d like to see happen with EMRs takes longer, costs more, and involves more left turns than we’d originally expected. Sure, enterprise software is like that anyway, but EMR adoption brings a whole ‘nother level of pain.

* Getting EMR data into the right hands on the right platform — via mobile computing devices, point of care tech, smartphones, rolling workstations and more — may be even more important than how the data is presented.  But the industry is juuuust beginning to get its head around the idea.

* Maybe some hospital execs were hoping this would go away over time, but it isn’t. Doctors still don’t like most EMR interfaces, period.

* It’s pretty obvious, now, that EMRs aren’t going to meet most of their bigger goals until they’re linked up into a community HIE with heavy doctor buy-in.  So far, not so good: HIE penetration is on the uptick but it isn’t standard by any means.

* While there’s clearly been worthwhile progress in a few areas, few institutions have seen the big EMR process and clinical outcomes they’d hoped for yet, much less major returns on investment (admittedly, more of vision in that case).

So readers, I challenge you: which of these problems do you think the hospital industry, or your organization specifically, will begin to solve in this New Year? What will resources will it take to make these changes, and how long will the process last?

Are there other problems I haven’t mentioned that deserve a few words?

More Mobile Questions: Do Your Devices Play Nicely?

Posted on December 21, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Today I had a very interesting conversation with a health IT exec (full disclosure: a client) about the future of mobile devices in hospitals. His perspective, which sounded dead-on to me, was that while mobility is great, making sure your mobile and point of care devices work together is even more important.

Let’s look at the patterns emerging in clinical data access. Here’s some big pieces to consider:

* EMR: First, of course, the EMR. You’ve spent hundreds of thousands, or in some cases millions, to put your EMR in place (and in most if not cases, you’ll be spending big dollars on integration too). But having done that, you’re still not home. These days, you have to look at how doctors and nurses will access EMR data on the fly as well as in the office.  In other words, mobility is a must-have, not nice to have.

* Tablets: Clinicians are very excited about using tablets, especially the glamourous iPad. But sometimes, reality intervenes. In some cases, clinicians are satisfied with using them — take fellow contributor Dr. Michael West — even if their EMR might not have a native client available for the platform. But many other physicians and nurses have found them exasperating or even unusable given the volumes of data they’re managing.

* Smartphones:  Obviously, it’s great to let doctors access EMR data wherever they are, and in some cases, that works fine.  Smartphones are already in wide use by doctors,  70 to 85 percent of whom have one, according to various sources. Not only that, they’re light and portable. But given their small screens, smartphones aren’t the ideal vehicle with which to access detailed clinical data.

*Point of care devices:  The old faithful of portable data, point of care devices on carts were there long before newfangled smartphones and tablets made the scene.  You may have more confidence you can manage them, and depending on the specifics, you may save money on the front end. (Integration and support are a separate issue.)  The question is, are they going to meet the needs of doctors who don’t spend a lot of time on the hospital floor?

I’ve outlined these options as though they’re mutually exclusive, but the truth is, they’re all likely to pop up in your hospital, and more. Doctors and nurses carry smartphones and iPads of their own, you probably have COWs in place already, execs and clinicians tote laptops around and you probably have some wall-mounted computers or displays in place too. In other words, your real choice isn’t whether you mix and match mobile and point of care device, it’s how you manage them as a group.

Integrating this mix of device is a big technical challenge, a support headache, a security problem, and probably a Meaningful Use issue too. But you’re stuck with it. Now, how are you going to handle it?

Hospitals and Mobile Health: Time To Get Involved

Posted on October 7, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

You’re going to spend a boatload of money on your EMR/EHR this year. And the next year. And several years after that.  Agreed?

And at least for the time being, the only return you’ll see on the massive investment (MU payments) doesn’t come near to covering what you’re spending on that EMR. Hey, with the arguable exception of the defense business, nobody makes a fortune on government programs, right?

So, for the time being, if you’re going to get anything out of your EMR install other than frustration and expense, it’ll have to come from another direction.

As I see it, that direction is mHealth — and initiatives supporting not only doctors but patients as well. Mobile health approaches, which can include appointment reminders, chronic condition outreach and continuing care, have always been an intriguing possibility.

As they’re planning their EMR strategies, hospitals should include mobile channels. With an EMR in place, mHealth approaches becomes much more valuable, as it can deliver and capture information in a dynamic way by drawing on the patient’s own record.

I admit hospitals aren’t totally oblivious to mobile options. For example:

*  Happtique, an organization spun out from the Greater New York Hospital Association, is working with 11 healthcare organizations, is an app store presenting what it sees as the best enterprise healthcare apps.  The hospitals involved are developing (or have already developed) custom applications which will distributed through the store.

*  OhioHealth of Columbus, OH has developed a women’s health app allowing patients to easily connect with their OB/GYN providers.

* St. Christopher Hospital for Children has launched an app connecting the community with health information and data services, including ER wait times and a “my data” section.

The problem is, these type of approaches are just scratching the surface of what mHealth can do.  The big picture to think about in mHealth isn’t just keeping patients informed, or even giving them access to their data, but to use mobile devices to keep up a health dialogue.

Doctors need to monitor what patients are doing — whether they’re taking their meds, what their blood sugars or pulse-ox readings are — and your EMR needs to be able to collect and display this data.   Patients need reminders and feedback, especially chronically-ill patients, and they need those reminders wherever they are at the moment.

Ultimately, this kind of accessible, two-way communications are what both sides will need if they hope to accomplish the ambitious health goals policymakers expect you to meet.

In the mean time, if you want to begin showing some returns — even incrementally — on that giant pile of code you’ve just bought, doing some smart work with mobile health might be a good place to start.

Driven by EMRs, Hospital Mobile Use Gains Ground

Posted on August 22, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

For most U.S hospitals, giving staff mobile access to key apps is more a vision than a reality. But here and there, hospitals are adopting cutting-edge mobile applications – and their doctors seem pretty happy with the arrangement, according to a piece in the Green Bay Press-Gazette.

Despite the security and support issues that come with supporting mobile devices, hospitals have more reason than ever to get on board. After all, doctors are increasingly demanding mobile access to their EHRs, a trend that’s only likely to heat up in coming years.

At Texas Health Resources of Arlington, Tx., mobile devices have changed the way physician Ignacio Nunez handles emergencies.  Though Nunez, an OB/GYN, may make his rounds in the morning, he can still take phone calls at 2PM from the field and remain connected. For example, he can check an expectant  mother’s medical records or even watch the fetus’s heartbeat on his iPhone.

THR’s goal, according to associate CMIO Luis Saldana, goes well be yond just to expanding the reach of his EMR, the paper reports. Ultimately, he hopes to “extend the physician beyond the hospital.” (I love his turn of phrase, don’t you?)

Meanwhile, other hospitals are beginning to stick their toe in the water as clinicians begin to demand mobile access to their systems, the newspaper reports. Aurora Healthcare, for example, is getting a flood of requests for it to support iPads, handheld devices and smartphones, says Russ Hinz, who manages the system’s EHR.

To get more examples of hospitals’ mobile progress, I encourage you to check out the newspaper piece, which captured more case studies than most trade journals.  I didn’t want to summarize them all here, but you’ll find a lot to consider there.

If there’s any single theme I took away from the varied anecdotes, it’s that doctors aren’t just interested in mobile technology, they’re ready to stage a revolt if they don’t get it.  Given that hospitals have a desperate need to keep up with physicians, it seems like a win-win proposition.

That being said, doctors, there may be a flip side to all of this. Anyone want to guess how long it will be before hospitals insist that their physician use mobile technology?

Partners Brings EHR To Mobile Devices

Posted on August 4, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

This week, Partners HealthCare announced that it made its EHR available on mobile devices for the first time, a move which has already attracted 2,000 of its affiliated physicians to mobile use.  At first blush this seems like a true mobile support project, rather than slapping a crude mobile interface on a desktop-based product like some of Partners peers, but we’ll have to wait and see.

Partners, a Boston-based integrated delivery network, created an app for iOS and BlackBerry devices drawing on InterSystems CACHE object database.  According to mobihealthnews, it took Partners’ IT staff 90 days to implement mobile options. In the future, Partners IT leaders plan to support Android devices, as well as making it possible to view radiology images on iPads.

The event deserves notice given Partners’ huge scope, which includes teaching and community hospitals making 160,000 admissions per year, along with a network of more than 5,000 physicians. It will be interesting to see how much use doctors make of the “mEHR” over the long term, and even more intriguing if Partners can isolate specific clinical, financial or operational benefits from its mobile support effort.

That being said, it’s also worth noting just because it happened, given how few hospitals seem to have invested significant development dollars in mobilizing their EHRs. Sure, doctors can connect with hospitals using their iPads and Android phones, but sometimes that’s limited to using a somewhat limited mobile browser. The problem with browser-based interfaces, however, is that Firefox, Chrome or Internet Explorer developers control the experience. An app tied directly into the guts of Partners’ EHR makes a lot more sense in my book.

Yes, I realize hospitals have much more to do than enable mobile access. I also realize that if they’re frantically trying to support onsite access to their EHR system, meet Meaningful Use requirements, manage sprawling integration projects and more, native mobile access to the EHR may not seem like a priority.

I’m dying to see more mobile EHR applications emerge, though. Hey, they’re effective, convenient, useful in a crisis and, ok, I’ll admit it, pretty darned cool.  (You can’t beat bringing your EHR along in your pocket!) Besides, once doctors get used to having medical data at hand when they need it, they might be more comfortable with the EHR in their office. Who knows?

 

 

Three Reasons Hospital EMRs Are Bad Investments

Posted on August 1, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Yes, this blog covers hospital EMRs/EHRs. And have no doubt, I understand the many reasons hospitals continue to invest in such systems, sometimes accomplishing important clinical goals in the process.

Still, in many ways EMRs are still undiscovered country. After all, the hospital industry still hasn’t adjusted to EMR/EHR use, though a few early adopters are well on their way. And it never hurts to take a skeptical look at a trend barreling towards the industry at such speed. So here’s my “devil’s advocate” take on EMR/EHR adoption by hospitals, below. Honestly, I think we’ve paid too little attention to the rather basic argument below, so let’s dig in a bit.

____________________________________________________________________________________

So, you think it’s a given that hospitals need to roll out EMRs?  Well, I’m not so sure — and let’s admit it, you probably aren’t either. If you think I’m going overboard, fine. But I encourage you to read the following before you make up your mind. Here’s three reasons hospital EMRs are a bad investment, at least at the moment:

* They’re incredibly expensive,  yet offer no obvious short-term ROI.

Let’s start with the most obvious issue — cost. From the tens of millions laid out by mid-sized community hospitals to the alleged $4+ billion Kaiser Permanente spent on its giant Epic installation, hospitals are spending a huge chunk of their IT budgets on EMR rollouts. In most cases, they’re forcing the staff to work on overdrive to meet Meaningful Use goals, and pulling people off of other worthy projects. All this for systems which aren’t likely to mature for, oh, three to five years into their adoption cycle. And when will hospitals see the ROI on their investment? OK, everyone agrees EMRs will save money someday — someday! — but I’m still waiting to see a dollars-and-cents ROI estimate. Has anyone seen one?

* They’re taking the place of other efforts offering a more direct impact on patient care.

What else might hospital IT departments do with the gigabucks they’re spending on EMRs?  Where do I begin?  Advanced telemedicine and mobile care options. Improved devices for managing care at the bedside.  Better nurse to nurse communications options. Or even laying long-term plans for health information exchanges. If hospitals weren’t pushing so hard to digitize patient records, they might change care for the better right away. Certainly, EMRs can add something to all of these efforts, but the truth is that they’ll stay in 23rd place on the list as long as the IT department is focused on the EMR installation.

* Hospital EMRs are still clumsy to use and hated by many — if not most — physicians.

I admit, many industries are forced to adopt a key piece of software before it’s completely mature. Heaven knows many manufacturers were more or less forced to spend enormous sums on an ERP install, only to have to patch, adjust and integrate for years before they had a workable system in place. In this case, though, does the hospital industry really need to do this?  I know government officials and policy wonks are convinced that hospitals should just, in effect, suck it up and do the install. And I know that someday,we’ll need to put a fully-linked, national data network in place that links hospitals to other providers, something that won’t work without EMRs at its core. But isn’t this premature?  From what I’ve heard, most hospital EMRs are ungodly awkward to use, extremely difficult to integrate with other systems and counter-intuitive to use. (They’re pretty much a turnoff all around.) Why not wait until we have better standards in place for UIs, components, data networking and the like?  Plunging ahead with a massive national EMR push just doesn’t make sense yet.

Yes, I know nothing I’ve said here is terribly original — but that’s what surprises me. If everyone knows all of this, why hasn’t the big EMR march screeched to a halt?