March 16, 2009
The 411 on Cell Phone Applications in Healthcare
By Annie Macios
For The Record
Vol. 21 No. 6 P.14
The buzz on mobile devices is getting louder as the industry continues to search for the most efficient means of exchanging health information.
Walk into any public venue and you’re likely to see someone using his or her cell phone to send a text message. With so many individuals—from the very young to the very old—regularly using cell phones, it seems clear that the time is ripe for cell phone applications to become an integral part of the healthcare landscape. The vision is there and, more importantly, the technology exists to accomplish this goal. How are cell phones currently being used as a healthcare tool, and what lies on the horizon?
C. Peter Waegemann, CEO of the Medical Records Institute and executive director of the newly established not-for-profit mHealth Initiative, says that in the last several years, cell phone use had been forbidden in most hospitals and clinics. Now, however, they are moving toward becoming among the most prized tools to decrease costs, improve care, and provide an optimal way to communicate with patients.
The vision of the mHealth Initiative includes 10 application clusters that will enhance the overall delivery of healthcare through the use of cell phone technology.
A primary goal is to foster better communication between patients and doctors through avenues such as short message services, texting, or even calling rather than scheduling an office visit. For example, the patient can send medical information via a cell phone or an agenda prior to an appointment to make the visit more effective. “There is a major move to having personal medical records available on their cell phones. We expect between 10 [million] to 30 million patients to have this information by the end of 2009,” says Waegemann.
He also mentions the idea of healthcare providers using cell phone technology to access data and information, as well as to document information while with a patient by dictating or using the keyboard to input information into the phone and then synchronizing it with the electronic medical record (EMR). In addition, the mHealth Initiative sees communication between pharmacies and hospitals improving and patients being able to leave the doctor’s office with the ability to receive documentation of their visit at a later point via their cell phones.
Mobile phones are also being used successfully as a teaching mechanism. For example, nurses are informed of proper procedures or, in remote parts of the world where access to specialists is limited, physicians can communicate proper healthcare delivery techniques to colleagues who are in need of direction regarding a case.
Dictation is another important area, and many clinics can capture information directly, helping them to identify a patient’s insurance eligibility and real-time financial information. The technology can also improve reporting.
The initiative also envisions cell phones helping patients to manage chronic diseases such as diabetes, sending medication reminders to smoking cessation participants, and documenting medical situations that can be shared with physicians.
“There are such a wide range of applications where the cell phone can be used, and I believe that patients will become increasingly involved with the consumer applications available to them regarding their healthcare—from managing their blood pressure and diabetes to having their personal medical records available on their cell phones,” says Waegemann.
To get healthcare facilities to adopt this technology, Waegemann believes three things must happen. First, they must familiarize themselves with the potential of mobile health—known in short form as mHealth—and its future impact on physicians, staff, patients, and others. Second, each organization has to work out a strategy that includes examining current Wi-Fi capabilities, existing or future contracts with telecommunication carriers, and user preferences. Third, healthcare organizations must consider how they will integrate such systems. “When there is no EMR, components can be put together that may have the same effect as EMRs but could be much cheaper and even more efficient,” says Waegemann. “Or, more likely, this is the time where one should not wait any longer and buy an EMR system. In any case, management needs to look at the interfaces between mHealth systems and the health information system.”
Why would a facility adopt cell phone technology when there is still some resistance to EMR adoption? “The big difference between EMR systems and mHealth systems is that EMR systems had trouble with return on investment [ROI], whereas mHealth systems are low cost,” says Waegemann. “EMR systems are based on documentation functions that take a little longer than traditional dictating or handwriting. Use of the phone to document, however, is easier even in the exam room or when doing rounds.”
While there has been little progress with EMRs, with less than 20% adoption, he adds, it is expected that mobile phones will have a major impact in the next two years. “In other words, cell phone developments will go much faster than other technologies. Worldwide, cell phone developments and adoptions have outpaced those of computers or other technologies,” says Waegemann.
To gain buy-in for adopting the technology, Waegemann says HIM managers should alert upper management of the need to develop a strategy and start showing physicians, staff, and others that the facility should implement these new technologies to stay competitive. “Not preparing for mHealth can have a very negative effect on physicians, staff, and nurses,” he adds.
R. Craig Lefebvre, PhD, a research professor in the department of prevention and community health at George Washington University in Washington, D.C., says mobile communication in healthcare offers a huge opportunity over the next decade. His work focuses on using the technology to prevent diseases, manage adherence, and change patients’ health behaviors.
“The patients are there, waiting for practitioners to come up with ways to make the delivery of healthcare easier,” he says. “Right now, healthcare professionals think of cell phone use as a way to simply talk. Frankly, they need to take the blinders off and realize that this technology is being used in all populations. They have to ask, ‘How can I get started?’”
Over the last several years, however, Lefebvre has encountered several organizations that use cell phone technology to improve patient care and enhance communication among physicians and patients. He says these types of organizations demonstrate the value of changing the practice and perspective of healthcare providers.
One example is San Francisco-based BeWell Mobile Technology, which provides patient engagement software for the healthcare industry and fosters cell phone technology use to manage chronic diseases and provide patient outreach communication and medical research support.
Employing cell phones, BeWell collects relevant, real-time data from patients, allowing healthcare providers to track the individual patient’s progress and determine whether personal intervention is required. If needed, it sends text messages to chronically ill subscribers, reminding them to follow a prescribed healthcare regimen. Patients also have access to information that keeps them informed about their treatment regimen and goals.
Some believe smartphones trump cell phones when it comes to applying them to healthcare. According to Tom Giannulli, MD, president of Caretools, “The iPhone is probably the best example of technological advancements on the market and opens a whole new library of applications. For use in healthcare, I think the iPhone is currently the best platform because it is where technology is leading, while others are trying to match its capabilities.”
It isn’t beyond the scope of a smartphone to manage patient lists, capture coding, perform e-prescribing, and create notes. And because of its enormous storage capabilities, it’s possible to store 20 to 30 years’ worth of information.
The iPhone is unlike any other device, says Giannulli, because it can work independently within a healthcare setting but also interface with larger servers and perform tasks that streamline workflow. One feature includes being able to interpret voices, stream the voice to the server, and bring it back to a text note in an extremely accurate manner.
The Caretools software offers the ability to construct patient lists, track lab data, store medication lists, use e-prescribing, perform coding at the point of care, and generate notes, all of which can be customized and modified to suit a physician’s practice or specialty. Using Web-based applications, it also enables the user to sync data, including patient information, prescriptions, coding, and notes.
The technology is built on a single database and doesn’t necessarily require a network. It can interface with a 3G or Wi-Fi to synchronize with the data of another healthcare organization.
According to Giannulli, many first-generation point-of-care and handheld devices offered value but often left users saying, “This is useful, but...” With the iPhone, he believes a technology chasm has been crossed, offering accessibility and value with a low entry cost.
For those healthcare organizations that don’t have large investments in other systems, smartphone technology can provide an entry-level solution. If a facility already has a large investment in its technology infrastructure, it’s possible to integrate with existing systems to implement iCharting, which is user definable and customizable for a particular practice’s needs based on specialty.
Giannulli says privacy concerns are not an issue because the software is HIPAA compliant, data exchange is encrypted, and a remote wipe is available if the iPhone is lost or stolen, which enables the owner to log in with a special code to delete all application data.
“Previously, adding point-of-care technology required a significant investment. With iChart, for as little as $400, you can purchase the iPhone and the software, download it, and start using it with no configuration or network issues,” Giannulli says.
Most importantly, Giannulli believes the application’s simplicity can realistically change the face of healthcare information management by offering providers a viable solution that will help them make the transition into the electronic age. “The game is changing, and it’s important to have a product that not only saves you money but time. If a facility is ready to make a commitment, this is the least invasive method to automate the point of care,” he says.
According to Kelley Carr, president of custom solutions for Cellular Specialties, healthcare has always been a strong vertical market for in-building wireless because it is a truly mobile environment. From incoming patients to hospital staff, virtually every person in a hospital setting is on the move.
“The management teams and boards of directors of these facilities understand that wireless coverage is the most critical component to the success of the staff in their day-to-day activities,” Carr says. “The ROI of an in-building system is achievable in a short period of time because of the efficiencies the system brings to the day-to-day responsibilities of each individual, from the maintenance personnel to the doctors and nurses.”
To integrate with a hospital’s current IT system, he says that, in most cases, the existing fiber infrastructure can be used to deploy the distributed antenna system. If there is not any fiber available, the existing cabling backbone can be followed. This would provide staff with access to complete patient records via cell phone, providing up-to-the-minute information. “The ability to provide immediate care to a patient can be a lifesaving occurrence. Not only is the response time important, but the ability to see the information in a text format rather than handwritten can prevent human error, which has been one of the leading causes of death in hospitals,” says Carr.
To deploy this technology, he says the process is simple. First, a site survey is performed to determine the construction and radiofrequency requirements for the distributed antenna system to be deployed. From this, a design is put together and presented to the hospital. Once the design has been approved by all parties, including the wireless service providers, and an order has been submitted, construction starts. “Project management is critical during this phase, and we work very closely with the hospital personnel during this process,” Carr explains.
With electronic documentation at the forefront of the national healthcare discussion and a vast majority of the population using cell phones and smartphones, these devices could offer the low-cost solutions that can decrease costs and improve communication between providers and patients.
“Every few years, the technology cycles, and now we’re at a point where it can impact the way we interact with clinical information from the palm of your hand by using just your finger,” says Giannulli.
— Annie Macios is a freelance writer based in Doylestown, Pa.
Looking to Learn More about Mobile Healthcare?
The mHealth Initiative will hold an mHealth Initiative Spring Seminar & Workshop on March 31 and a two-day conference, Mobilizing Healthcare, December 9 to 10. Both events will be held in Boston. For more information, visit www.mHealthInitiative.org or contact C. Peter Waegemann, CEO of the Medical Records Institute and executive director of the mHealth Initiative, at firstname.lastname@example.org.