WHITE PAPERTen Predictions for 2012 on Smartphones in Hospitals
Introduction2012 will be a transformational year for smartphones in healthcare. 2009-2011 focused on smartphone adoptioneverywhere—from teenagers to senior citizens. Of course millions of healthcare professionals now carry smartphonesas well. 2012 will be very different. It will mark the beginning of an era in which hospitals really figure out how to takethese devices beyond their use as individual reference tools and turn them into technology that is truly interconnectedthroughout the enterprise.By now we know that smartphones are here to stay. Manhattan Research has noted that 81 percent of physicians areusing smartphones 1. Eric Topol, Vice Chairman of the West Wireless Health Institute, told the audience at theWashington mHealth Summit in Dec 2011 that the smartphone had replaced the stethoscope as the “icon ofmedicine.” 2 The exciting news is that people are becoming very clever with how to use them in new ways to makemeaningful improvements in healthcare. With emerging capabilities far beyond phone calls, email, and even access tomedical apps, smartphones have kicked off not only a communications revolution, but a productivity one as well.Given this changing environment and the new possibilities of smartphones, we assembled a roundtable of industry andtechnology experts to compile this list of what 2012 will mean for smartphone use in hospitals. Twelve months fromnow, we’ll know how we fared!10 Predictions for 2012 on Smartphones in Hospitals1. Hospitals will start doing even smarter things with smartphones to make them an essential part of everyday healthcare communications. When smartphones began making inroads into healthcare, the industry was abuzz with the idea that they would soon elbow out pagers altogether as a means of relaying critical communications. But smartphones are an entirely different type of technology, offering far more than pagers. Smartphones have evolved into a core element of a hospital’s communications network. Doctors already use them in meaningful ways, such as to access EMR systems and a host of amazing medical apps. The early cries of ‘pager replacement’ have been replaced with the realization that a smartphone is so much more. Medical staff want a highly useful, portable tool that redefines how they work and access information. Receiving time-sensitive messages is only a small part of this. These devices are capable of actually improving workflow—the way people go about doing their daily tasks. We can throw out all the standard business terms here like streamlining, gaining efficiencies, synergies, etc., but the plain truth is people can just do things better and faster with smartphones.1 Dolan, Pamela Lewis, May 23, 2011. “Doctors driving IT development with their mobile technology choices.” American Medical News website. http://www.ama-assn.org/amednews/2011/05/23/bisb0523.htm.2 Wicklund, Eric. Dec. 6, 2011. “Sebelius lauds smartphones at mHealth Summit.” Healthcare IT News,http://www.healthcareitnews.com/news/sebelius-lauds-smartphones-mhealth-summit
A few examples of how a smartphone can be integrated with the right applications to provide a bounty of new capabilities: • Encrypted critical messaging: A smartphone can provide secure, traceable messaging with an application designed to relay time-critical messages such as consult requests, code calls, and lab results. Delivery confirmations, a full audit trail, and a separate inbox to keep messages away from other text and non-work communications sweeten the deal. • Directory lookup and messaging: Integrating a smartphone to a hospital’s directory gives staff the ability to communicate with anyone in the network, regardless of the recipient’s mobile device type. • On-call scheduling and messaging: Linking to the Web-based on-call schedules of caregivers means always finding the right person or role (e.g., the on-call cardiologist), even at 3 a.m. • Preferences and routing: Tying into systems that let physicians determine how they should be contacted based on the time of day means people actually get a hold of one another on their smartphones more often, speeding care. • Clinical systems: Integration with monitoring systems like nurse call, patient monitoring, and more means that when the machine audibly goes beep, the right person gets a smartphone message of the change in status at the same time.2. An incident involving compromised protected health information (PHI) on a smartphone will cause headlines and fines In December 2011, the Ponemon Institute study found a shocking 32 percent increase in the frequency of data breaches in hospitals surveyed, with an average of four breaches. Surprisingly, only half of those surveyed took measures to secure the protected health information found on mobile devices, which are in use at 81 percent of organizations. The study reports that these organizations estimate an average cost of $2.2 million per data breach related to this negligence. 3 Additionally, RedSpin’s 2011 research on breaches of sensitive information notes that 385 breaches have occurred since the 2009 breach notification regulation was included as part of the HITECH Act. More than 19 million patient records have been affected, and 39% of the incidents involved a portable device. 4 Access to protected health information is an important topic when it comes to using smartphones in healthcare. There is really a two-fold problem when it comes to sensitive information and mobile devices. The transmission of messages must be done securely via encryption, and the information contained in the messages must remain safe once on the smartphone in case the device itself is lost or stolen. Features like encrypted messaging, password- protected inboxes, and IT’s ability to remotely wipe a device remotely of sensitive data are key. Texting is another area that’s getting a lot of attention when it comes to security. A lot of physicians rely on text (SMS) messages for communicating sensitive information such as a patient’s test results or doctor’s orders to mobile devices. Texting is rife with problems. There’s no message audit trail or encryption, and these messages get mixed up with notes from family and friends in the recipient’s inbox. Texting apps also cannot integrate with a hospital’s directory for access to updated contact information.3 Ponemon Institute Research Report, sponsored by ID Experts. Dec 2011. Second Annual Benchmark Study on Patient Privacy & DataSecurity.4 RedSpin, 2011. “Breach Report 2011 / Protected Health Information.”
In November 2011, the Joint Commission posted its position on this in a Standards FAQ. From the Joint Commission’s Web site (Nov. 10, 2011): 5 Is it acceptable for physicians and licensed independent practitioners (and other practitioners allowed to write orders) to text orders for patients to the hospital or other healthcare setting? No it is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting. This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record. The Joint Commission also issues quarterly information showing the ongoing link between poor communications and sentinel events (death or serious injury). Although the Joint Commission stresses that the numbers they deliver represent voluntarily supplied information across a small number of events, it nonetheless provides interesting data points. They show communication problems are consistently the third most common root cause of sentinel events. In addition, when looking at delays in treatment that caused a sentinel event, communication was the number one cause. 6 With texting, poorly secured information, and the potential for lost devices, there are a lot of worrisome activities happening right now. We predict that some healthcare organization will have a highly visible breach of sensitive information in 2012 to highlight this problem for all. The Joint Commission could issue additional standards or requirements in this area as a result.3. The proliferation of different mobile communication devices gets worse Some hospitals have tried to support a narrow set of smartphones. Unfortunately, IT teams are at the whims of doctor preferences, and the latest new smartphone will always need to be incorporated. Additionally, independent physicians with practicing rights at the hospital have to be considered. Smartphones aside, there are many other types of devices in hospitals today, and they all need to get the right messages. Tablets, in-building Wi-Fi phones, voice badges, pagers, desk phones, and more –every role seems to have a different type of device for receiving messages. The fact is having many different types of devices is common in healthcare, and it’s only going to get worse. It is the responsibility of hospital communication/IT departments to manage the diversity of devices. They need a single system that deploys a message to the right individual or group on their preferred devices—no matter what those devices happen to be. A physician gets a consult request on her iPhone. A nurse sees a message about a patient experiencing pain on a Cisco or SpectraLink Wi-Fi phone. Housekeeping is alerted on pagers that there are rooms that need refreshing. The list goes on.5 Nov. 10, 2011. “Standards FAQ Detail - Texting Orders.” Joint Commission web site:6 The Joint Commission. Q3 2011. “Sentinel Event Data: Root Causes by Event Type – 2004-Third Quarter 2011” Joint Commission web site.http://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFaqId=401&ProgramId=1http://www.jointcommission.org/assets/1/18/Root_Causes_Event_Type_2004-3Q2011.pdf
4. Traceability becomes a requirement, not a luxury Even when pagers were the de facto standard in mobile communications, there was always a problem with message traceability and knowing if and when an important notification was received. But everyone knew and accepted that this was the case, because there wasn’t a good solution. The accusations of ‘he said, she said’ ran rampant when, for example, someone in the operator group launched a Code Blue and Dr. X said he didn’t receive it or he was not on call that evening. There have been lawsuits on this very topic because lives have been lost. A 2010 study determined that $91 million in malpractice awards were due to communications errors in three areas: failure of physicians and patients to receive results, delays in report findings, and lengthy turnaround time. 7 Now the game has changed, and messaging traceability is possible whether an electronic communication goes to a smartphone, pager, Wi-Fi phone or something else. Delivery notices have made their appearance. In 2012 we predict the difference between a hospital using the latest technology to do things the right way and one doing it the wrong way will pour light onto the problem. Legal cases or the Joint Commission may establish that a standard of care is traceable communications. Put simply, if better solutions are out there, is a hospital negligent if it doesn’t use an application with traceability built in? Having an audit trail gives a hospital the ability to report on all aspects of messages—this includes showing date and time stamps for all messages, including when they are delivered, who received them and on what device, and how the person responded. This is powerful protection against litigation and malpractice.5. Pagers RIP? Nope. The prediction of the death of pagers will be proved wrong Everyone keeps predicting the death of pagers and paging, but they are still around. There are many communication devices in use today for everyday information sharing. But when it comes to disasters, cellular and even Wi-Fi networks can become clogged with traffic and shut down. In these times, wide-area paging has proven itself over and over in terms of keeping communications flowing. This was the case during 9/11, Hurricane Katrina, and the Minnesota bridge collapse. We predict 2012 will be the year hospitals realize there’s still a need for this trusty pal in unexpected disaster situations. Pagers are like an insurance policy, and a pretty inexpensive one to boot. They may be the right device for a portion of a hospital’s staff for many years to come. But those physicians who have moved from pagers to smartphones probably won’t be going back.6. Specialized communication hardware devices will fail to gain traction Across the gamut of available communication devices, we start with pagers, which are cheap, reliable, and durable. Much of the market will stay with them. Others will move to the other part of the spectrum for smartphones and tablets. In the middle there will be very little room for specialized devices beyond the long- trusted staples like Wi-Fi phones.7 Nov. 3, 2011. “Diagnosticians run higher malpractice risk” UPI.com web site.http://www.upi.com/Health_News/2011/11/03/Diagnosticians-run-higher-malpractice-risk/UPI-45721320377091/
The recent emergence of specialized hardware solutions that attempt to offer, say, 110 percent of what a pager offers will ultimately prove to be a flash in the pan. While intriguing, our research indicates hospitals will scrap this idea and continue to gravitate toward messaging to smartphones which let them do 220 percent (or more!) of what a pager can do. And guess what? They already have the smartphone. Who wants to buy yet another specialized device just to message? Staff are certainly not going to want to add this to their list of things to carry around when the smartphone is already their go-to device. This is no different than having a pager, and there are ongoing repair costs to consider. We predict hospitals will ignore or scrap these trinkets and opt for proven smartphone platform technologies that can integrate with their centralized contact directories and a host of other applications. Those initiating messages in a hospital will support this because they are tired of opening up one system to send messages to staff using the specialized device and another to send a message to someone on a smartphone or Wi-Fi phone. They’ll say one system will do nicely, thank you very much.7. Web out, apps in The first generation of smartphone users saw a barrage of “solutions” on their phones and tablets that just needed a browser to run. This was easy to deploy, but users are sick of it and adoption lagged. Clinical users know a good app when they use it. Good apps make communication and data entry easier, not just mobile. This speaks to having the right form factor and touch screen capability. Savvy 2012 users will demand that mobile healthcare solutions are truly mobile apps—not just browser-based varieties not optimized for these smartphones and tablets.8. Hospitals raise the “Now What?” question with tablets It’s no secret that tablets are amazing and have been purchased by many a physician. Hospitals are working on integrating them into their communications and work processes, with varying results. In 2012, we predict more tablets will be sold than used effectively for communications in healthcare. Mobile healthcare initiatives will continue to struggle with best practices on using tablets for critical communications in particular. People will still be wowed, but the highly compelling use cases might be a ways out. This could be the period of turmoil before tablets find their mojo and regain mindshare. Of note is BizTechReports’ 2011 iPad® tablet research involving 100 healthcare executives and senior IT professionals. The researchers say that many of these IT executives believe pressure from end users regarding support for popular consumer devices such as tablets is trumping important considerations such as security and risk management. The study says that those surveyed mentioned that among other problems, tablets lack the security and durability needed in healthcare. CIOs in particular encouraged healthcare workers to consider alternative options. 88 BizTechReports sponsored by Panasonic Solutions Company, 2011, “Diagnosis Danger: Governance & Security Issues CauseIT Concerns About iPad in Healthcare Setting.”
9. Hospitals will deliver comprehensive mobile strategies The concept of creating a documented mobile strategy has been on the rainy day list for hospitals for far too long. Some of the problems associated with not having this strategy mapped out have been covered in this paper, such as a lack of security and message traceability, especially if texting is common. 2012 will be the year the CIO, CMIO, and others have to outline a strategy on mobile devices and enforce it. This strategy will need to include plans for supporting and messaging to the many different devices in use as mentioned previously. Other areas determined will be whether devices are to run mostly on Wi-Fi or cellular networks—or a combination of the two. Furthermore, these teams will decide which types of devices are needed for which functions/jobs. These considerations should tie to how a clear mobile strategy can improve staff workflow for the good of everyone’s productivity and patient safety.10. IT and BioMed will join forces in the name of improved workflows There are a lot of clinical solutions in hospitals that run well and serve a valuable purpose, but that don’t have a lot of IT involvement for any number of reasons. Examples may include the use of patient monitoring, pulse oximeters, ventilators, infusion pumps, and many more. These systems are essential for patient care, but they typically are handled by the BioMed team versus the IT team. We predict that 2012 will be a pivotal one for IT and BioMed groups as they sit down and develop an enterprise- wide communications platform that links clinical system data with people who can use it to the advantage of the patient in a speedy manner. So all those systems that go beep will be sending actionable data to smartphones and other mobile devices. Conclusion While the Mayan calendar predicts an apocalypse for 2012, our discussion panel thinks the only catastrophe in the smartphone arena to be the collapse of one or more of the start-up, niche smartphone application messaging providers out there. While intriguing, many of these have only a small piece of the solution puzzle. Hospitals simply cannot risk their communications on a start-up and will decide they don’t need another communications island. They need further integrated pieces of a connected enterprise. Overall, the panel believes 2012 will be an exciting year as hospitals start using smartphones and their amazing capabilities to their full potential. Smartphones are wonderful on their own. But when well integrated into a hospital’s broader communications infrastructure—spanning clinical systems, critical messaging, centralized directories and schedules, lab results, and more—they’re akin to having a magic wand when it comes to providing better, more informed patient care. When it comes to healthcare, we would probably all agree that a little magic could go a long way.