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Mobilizing Electronic Healthcare Records
 

Mobilizing Electronic Healthcare Records

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This Webinar by Endeavour - The Mobility Company provides insights into the changing paradigm of EHR Systems & their mobile enablement.

This Webinar by Endeavour - The Mobility Company provides insights into the changing paradigm of EHR Systems & their mobile enablement.

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  • AB – Lifecycle?
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  • These are the best practices evolved over the period of time though our experience of building enterprise grade EHR applications. We look for security everywhere in the solution!Educating all team members about security requirements is an important step. The security architecture of the solution may use one or many mechanisms illustrated in the diagram. Name few.
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Mobilizing Electronic Healthcare Records Mobilizing Electronic Healthcare Records Presentation Transcript

  • Agenda Mobile EHR Trends 1 Phasing EHR Functionality to Mobile Platforms Formulating a Development Strategy 2 Building the Right Team UX Considerations Security Challenges/Best Practices 3 Representative Case Studies 4 Q&A
  • Trends – Mobile EHRs1 Phasing EHR Functionality to Mobile Platforms Formulating a Development Strategy2 Building the Right Team UX Considerations Security Challenges/Best Practices3 Representative Case Studies4 Q&A
  • Trends - Mobile EHRsSeveral leading EHR vendors have developed mobile solutions for their products:Vendor iPhone iPad Android Other NotesEpic – Haiku, Canto Partnered with AppleAllscripts RemoteNextGen MobileGreenway - PrimeMOBILE Third Party PartnerPractice FusionGE Healthcare CAMobileCerner - MPages Web-based access -1-
  • Trends - Mobile EHRsVarious technical/OS approaches are being used by vendors/developers:Type Examples1. Native Mobile EMRs Apps – Mobile applications developed using native Greenway PrimeMobile SDK and utilize devices specific features, touch UI, etc. Native apps may Dr. Chrono use web services also. PracticeFusion Allscripts Wand2. Web-based Mobile EMRs – These systems utilize a web brower. Webchart3. Hybrid Mobile App – app that utilizes some native and some web-based (many) functions4. Remote Access EMRs – Most client/server, on-premise EMRs can be Citrix accessed from a remote system through thin-client utilities like Citrix. Users can use their laptops or iPads to access systems. Similar to web-based apps the UX may not be as rich as a native app -2-
  • Trends - Mobile EHRsAllscripts Mobile Solution has a variety of functions:Patient Summary Medication Favorites Patient Timeline Images Appointments Results Patient Review -3-
  • Trends - Mobile EHRsThe Practice Fusion Mobile solution has a broad range of functions: Scheduling e- prescribing Patient Records -4-
  • Trends - Mobile EHRsEpic’s Haiku mobile application: Patient List Activities Results – Visual Display Voice Dictation Schedule Problem List -5-
  • Trends - Mobile EHRs -5-
  • Trends - Mobile EHRsSeveral key trends are noteworthy: Continued Growth in Use of iPad within Health Care Enterprises – the Apple iPad continues to have appeal with physician community Native Apps Development by Large Vendors Continues– Large EHR vendors continue to develop native apps e.g., recent release of Allscripts Wand Embedded Speech Recognition and NLP Software– Vendors are embedding speech recognition and NLP software into their solutions Patients Accessing EHR Using Mobile Device – Large providers (IDNs) are providing patients with mobile access to EHR (e.g., Kaiser Android App) Integration of Specialized Patient Facing Apps – several specialized mobile apps (e.g., Airstrip, WellDoc) have been integrated into mobile EHR platforms – patient data collection into EHR -5-
  • Trends - Mobile EHRsSeveral key trends are noteworthy (cont’d): Open APIs – Some vendors (e.g., PracticeFusion) are opening their system to developers to connect patient data collection solutions Non Traditional Vendors Building Smart Mobile Layer – solutions that act as ‘mobile smart layer’ are being developed by vendors from outside tranditional EHR space (e.g., SAP Electronic Medical Record Mobile App) Mobile for Stage 2 Meaningful Use – mobile technologies are being used as way to achieve Meaningful Use goals (e.g., point of care data capture, coordination of care, etc.) -5-
  • Mobile EHR Trends1 Phasing EHR Functionality to Mobile Platforms Formulating a Development Strategy2 Building the Right Team UX Considerations Security Challenges/Best Practices3 Representative Case Studies4 Q&A
  • Phasing of EHR Functionality to MobileCommon functions established on mobile EHRs, phasing of functions/roadmap varies:Functions Basic Advanced FuturePatient Lists/Search – Ability to see list of patients, appointmentsResults – Ability to view lab results, etc.Work Lists – view, process, add, assign tasksePrescribing – ability to place electronic prescription ordersImages and Scanned Documents– access to images, documentsDictation – use of speech recognition and embedded NLP softwareVisual Display – Results, Timelines -6-
  • Mobile EHR Trends1 Phasing EHR Functionality to Mobile Platforms Formulating a Development Strategy2 Building the Right Team UX Considerations Security Challenges/Best Practices3 Representative Case Studies4 Q&A
  • Formulating Development Strategy 1. Development Approach 2. Technology Plan 3. Functional Approach  Phases- organize build in  Platform agnostic, Multi platform/ Single platform?  Core functions first - bells and phases (by function, platform, whistles later etc)  Tablet/ Smartphones?  Must Haves vs. Nice to Have  Connected/ Offline Support?  Iterative Approach - Build  Early stakeholder validation working prototypes; clarify use  Frameworks vs. Custom patterns Development  Regulatory Requirements  Build foundations first –  Life Cycle - Define a forward Security framework, Patient looking product life cycle that list, Access control, Storage, supports ongoing improvement etc. of app -7-
  • Mobile EHR Trends1 Phasing EHR Functionality to Mobile Platforms Formulating a Development Strategy2 Building the Right Team UX Considerations Security Challenges, Best Practices3 Representative Case Studies4 Q&A
  • Building the Right TeamThe following teams play a vital role on the project: Product Development Engineering/Technical Development /Testing Implementation/Deployment • Define Direction, • Core Architecture • Build the Product • Customize for specific Roadmap, Clinical Use need of a paying • Define Workflows, • Maintain Quality customer • Vision, Strategy Making Features • Ensure acceptance and • Involved in Deployment, • Pricing, Business • Enhance the vision adherence to core vision Implementation Outlook given by Core Team • Technical and quality • Support & Maintenance • Long term goal setting • Technical, Clinical, representation in majority Quality Systems and • Pure Developers and • Representation from all operational • 10-50 members Support staff Org. functional units representation is must • 5-10 members per • 6-10 members • 5-20 members support contract -8-
  • Building the Right Team Team Composition Clinical Staff Technical Staff Regulatory Experts Operations Staff • Providers • Architects, Leads • Healthcare IT • Support (Tier 1-3) Specialists • Nurses • UX Consultants • Administrative • QMS Representatives • Consultants • Platform Engineers • IT and ITES staff • QC Engineers • Project Management -9-
  • Building the Right TeamThe following skill sets are involved: Skill Sets  Management Professionals - Project Managers, Business Analysts, Technical Writers)  Solution Architects - Java, .Net, Database, UX, Mobile Technologies  Mobile Platforms/Device Management - MEAP and/ or MDM Developers  UX Consultants - UX Designers, UX Developers  Senior Mobile Developers - iOS, Android, BB, etc.  Programmers -C++, Java, Dot Net, Objective C, PL/SQL  Quality Control Professionals, Leads and Engineers – Automation, Manual Testing Experts  Build and Configuration Engineers - 10 -
  • Mobile EHR Trends1 Phasing EHR Functionality to Mobile Platforms Formulating a Development Strategy2 Building the Right Team UX Considerations Security Challenges/Best Practices3 Representative Case Studies4 Q&A
  • UX ConsiderationsUnderstand & Analyze Design Stage Usability Test Understand the objective  Physicans/Clinical interviews  Clinical test of visual ergonomics Branding  Live user scenario & records  Easy to find (learnability test) Solution priority/Product Mgt  Movement capture  Record lock & feedback loop Focus group study - 12 -
  • UX Lessons Learned Some lessons learned:  Mobile Context is Key – It is not possible to transfer all EHR functions to mobile platform. Focus on key ‘out of office’ functions that are regularly used by physicians  No Silver Bullet – it Is unlikely that a single device (e.g., iPad) will support all documentation needs. Recognize that smart phones and tablets complement a broader set of “situational tools” – e.g., during rounds tablet may be used; on road a smart phone; in the office a laptop, and so on.  Be Aware of Ergonimic Constraints – ergonomic factors such as the absence of a physical keyboard, the need to carry the device need to be considered during the design process.  Mobilization is not Miniturization – recognize that moving an EMR to a mobile platform is not a “minituratization exercise; a replication of the desktop system for a mobile device. Instead it requires unique design considerations. - 12 -
  • UX OpportunitiesDespite challenges, severalopportunities for innovation exist forMobile EMRs: Speech Recognition and NLP Unified Communicaton Camera/Image Capture Gesture-Based Computing Visual Display Video - 13 -
  • Mobile EHR Trends1 Phasing EHR Functionality to Mobile Platforms Formulating a Development Strategy2 Building the Right Team UX Considerations Security Challenges/Best Practices3 Representative Case Studies4 Q&A
  • Security Challenges/Best Practices  Security means - Maintain privacy, integrity and high availability of the solution, data contained within - Restrict unintended, unauthorized access to any or all parts of the solution by all means  Three Levels of Security - 1) Device 2)Network 3)Application  Enterprise Grade - EHR apps need enterprise grade security - robust enterprise and organizational policies to be implemented. No exceptions allowed!  Demographic Challenges - Local Government Laws for Electronic Data Security - Health Information Exchange between heterogeneous systems. e.g. Labs, Pharmacies, patient facing Applications, Operations and Scheduling, Accounting Systems - 14 -
  • Security Challenges/Best PracticesSecuring and Provisioning Medical Devices • The proliferation of devices on the network presents unique challenges. E.g. BYOD Strategy • Ensure that only known and authorized devices access • Effective Guest Access Management (Visiting providers, clinicians)Secure Access to Patient Information • See exactly what you need to see. Nothing less, nothing more! • Access control list, Exercise Roles and Access rights strictly. • Building Extensive Audit Log and keeping the performance top notchRegulatory Standards Compliance • Follow Government and Industry standards for securing Electronic Information • Health Insurance Portability and Accounting Act (HIPAA), Payment Card Industry data Security Standards (PCI DSS), CITI, CIA, HITECH • Validate the system security architecture from regulatory compliance point of view - 15 -
  • Security Challenges/Best Practices Device Level  Policy Enforcement, Extend the organization IT policies to Mobile devices with little or no waivers!  Use standard MDMs and MEAP Solutions or build custom hooks to manage the devices.  Secure Device Configuration – Authorize, De-Authorize, Wipe, Disable  Device Restrictions – bring all devices under one umbrella. BYOD devices may need some waiver, but they must pay the price by having limited access that accompanies the waiver! Service Level  Health Information Exchange (HIE)  VPN, SSL/ TLS, WPA/ WPAs  Stick to the Industry Standard transmission methodologies such as Local only networks, Private networks. Solution Level  Crypto Architecture (Encrypt/ Decrypt)  Runtime Frameworks, Integrity  De-identify data (Protect Privacy), Enforce that authorized personnel to handle the data must be CITI certified (Or equivalent certifications)  Secure Authentication Framework - 25 - - 16 -
  • Security Challenges/Best Practices Security is everywhere! Stick to Device Capabilities Use Industry standard solutions instead of re- inventing new Educate technical staff to acquire HIPAA, CITI certificates Build robust access and audit mechanism in the solution - 17 -
  • Mobile EHR Trends1 Phasing EHR Functionality to Mobile Platforms Formulating a Development Strategy2 Building the Right Team UX Considerations Security Challenges/Best Practices3 Representative Case Studies4 Q&A
  • Mobilizing Electronic Healthcare RecordsRequirements Solution Access to vital patient  Patient Summary information away from the  Messaging System office  e-Prescribing Communication between  Schedule care teams  Managing Rooms Mobile ePrescribing  Charge Capture Reliable Documentation at point of care/out of office Enable productivity – task lists, lab results Charge Capture -18-
  • Mobile Chronic Disease Management SolutionRequirements Solution• Develop a “patient coach” that WellDoc Diabetes Manager guides patient with care • Patient Coach/Mobile App• Develop unique • Expert System messages/prompts based on • Decision Support health status • Integrated with EMR• Support data entry with educatonal content• Deliver feedback to patient, physician, utilization managers - 19 -
  • Mobile EHR Trends1 Phasing EHR Functionality to Mobile Platforms Formulating a Development Strategy2 Building the Right Team UX Considerations Security Challenges/Best Practices3 Representative Case Studies4 Q&A
  • Questions ? - 20 -
  • Thank you!All ownership of ideas, products and solutions referenced in this presentation belong to the people and +1 917-623-2564companies who have created and have the rights and copyrights to the solutions and ideas. Thissession is educational and the speaker and Endeavour does not own rights to this incredible work being info@techendeavour.comdone across the world. Material has been derived from the internet, articles and journals as well as www.techendeavour.comexperiences of Endeavour in Healthcare