As the smartphone overtakes the PDA, questions arise as to whether they are simply just cool new alternatives or whether they are clinical tools, critical to healthcare practitioners’ workflow. Are some smartphones “smarter” than others?
With the introduction of the smartphone, the cumbersome technology belt—upon which the PDA, pager and cell phone have been clipped for years—has gotten a lot lighter. With one clip or a slip into the pocket, a physician has a single communication tool at his or her fingertips that could help close the crucial, internal communications loop across the healthcare enterprise, and ultimately, improve patient care and safety.
With poor communication fragmented across all levels of the healthcare enterprise, it is no surprise that it was the most frequent root cause of medical errors accounting for more than 60 percent of events between 2006 and 2008, according to a 2008 report from the Joint Commission on Accreditation of Healthcare Organizations.
Communicating in the field
Utilization within healthcare is on the rise, just look around the hospital or likely into your own pocket. In 2008, more than half of U.S. physicians reported owning a PDA or smartphone, and that number is expected to increase, as consumer use escalates and as more medical schools require such devices in the classroom, according to the research firm Manhattan Research.
The University of Virginia Health System in Charlottesville can attest to that claim, approximately 520 medical students use handhelds; about 80 percent have chosen the Palm Treo 700p smartphone.
Students are required to have some sort of PDA or smartphone, as well as residents in graduate education, says Scott Strayer, MD, associate professor, department of family medicine. Why? Using the device, they can check drug doses and interactions on application like Epocrates, which is compatible across Palm, BlackBerry and iPhone devices. Strayer says they also use the Treo to track patient encounters and procedures that residents and student perform for credit.
“It reduces the device clutter,” according to Strayer, who can download medical and billing applications to track his procedures, without going to IT.
Physician satisfaction is a top priority, too, for Ray Duncan, MD, CTO at Cedars-Sinai Health System in Los Angeles. Until last August, the enterprise was using primarily BlackBerrys and Palm Treos for mobile access to email, and a homegrown web portal for patient test results, reports and images. Then they added support for Apple’s iPhone 3G, due in part to the device’s growing popularity as well as its capability to serve as a medical assistant. “In the past, we had to subsidize PDAs and coax people to use them for clinical data, and the BlackBerrys were inadequate for the delivery of such data due to problems with the web browser,” Duncan says. “With the iPhone, users want it and love to use it.”
And that capability as medical assistant could be expanding. Apple recently announced a new version of the iPhone OS, with functions like cut and paste, global search and voice navigation. Two new applications are also in the works: one app would transform the iPhone into blood pressure monitoring device, while the other would sync it to a blood glucose testing device. Since an iPhone is always connected thanks to its 3G modem, these new apps could give real-time information to adjust pharmaceuticals or treatment. Dedicated nursing applications also were introduced recently.
In addition to being portable reference tools, smartphones hold promise to allow remote diagnosis of patients, access to electronic medical records (EMRs) and even diagnostic images. Of course, security and patient privacy concerns have arisen over the potential for wireless transmission of sensitive medical information.
Interpretation on these issues varies. It is up to the healthcare organization to determine the level of HIPAA compliancy. From password protecting the devices to SSL encryption, users like Strayer say they are inherently more secure from day one. But, as an added means of protection in an event of loss or theft, IT departments are able to wipe an individual device clean remotely via a third-party application or service contract with the manufacturer. At Cedars-Sinai, Duncan says they not only use password protection and SSL-encryption, but incorporate additional security measures and perform targeted surveillance of remote access to the web portal.
Mobilized for clinical impact
As one of the first sites to go live with the BlackBerry Enterprise platform from Research in Motion, the University of Pittsburgh Medical Center in Pennsylvania is poised to leverage the current capabilities of its BlackBerry smartphone and Enterprise server platform to improve physician and clinician workflow, says F. Matthew Campbell, a director of the UPMC Center for TeleHealth.
Currently, approximately 2,000 BlackBerrys—the only approved smartphone at UPMC—are used by administrators, executives and physicians for enhanced communication, such as email functionality, calendar, contacts. Campbell says they are starting to explore its use as an extension for software applications such as EMRs, hospital information systems or image and information management systems in use across various departments in the medical center.
“There is a shift to use smarpthones to make people more accessible and improve patient care by giving physicians access to the information they need, when they need it,” Campbell says. “Central administration is the key to manage the devices effectively and maintain HIPAA compliancy. I think the challenge is going to be for healthcare systems to decide on a device they prefer.”
Beyond being “cool,” smartphones such as the Apple iPhone and other handheld devices are putting new applications at the fingertips of physicians, such as OsiriX, the by-product of a desktop open-source interactive image navigation and visualization software designed to display and analyze large sets of 3D medical images. The smartphone version can download images via WiFi with a simple drag-and-drop option on the desktop software.
Osman Ratib, MD, PhD, professor and chair of radiology, department of medical imaging and information sciences, at the University Hospital of Geneva in Switzerland, says OsiriX can query images from any DICOM-compatible PACS or workstation using standard DICOM query-retrieve protocol. Alternatively, the desktop version has a web portal which iPhone users can query images.
The potential of the OsiriX app is “clearly in notifying referring physicians and surgeons or other care providers that might be on call of a given result that may be relevant for decision-making or patient management such as a surgical decision,” Ratib adds.
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