Perhaps the best-known hospital CIO in the country loves the potential of mobile devices to improve care, but he cautions that healthcare organizations had better understand and act to mitigate the risks mobility can introduce.
Writing on the Agency for Healthcare Research & Quality's Web M&M online journal, Dr. John Halamka, CIO of CareGroup Healthcare System in Boston, discusses his experience with mobile devices at Beth Israel Deaconess Medical Center. Halamka suggests hospitals need to develop best practices for employing mobile devices in clinical settings.
"At present, our mobile device policies [at BIDMC] include requirements to encrypt all data, to comply with specific password complexity settings and to follow infection control best practices," the CIO writes. "We are investigating technologies to segregate personal and patient functions in a given device. We are also investigating the possibility of providing mobile devices to healthcare workers that can be checked out for a shift. To try to reduce security and distraction risks, we will pilot test several new policies such as restricting access to personal e-mail and social networking sites."
According to Halamka, physicians and nurses at the hospital together have purchased more than 1,000 iPads and 1,600 iPhones with their own money—and that doesn't even include other brands of smartphones clinicians might have. "Nearly 100 percent of our hospitalists and most of our emergency physicians use iPads for entering orders into the system, viewing test results and documenting in the medical record," he writes.
He says that the multiple capabilities of smartphones—voice, text, video chat, photo sharing—make the devices powerful tools for coordinating care. But there are drawbacks, too. "Some studies conclude that such communication improves the quality of the work environment, patient safety, and care without increasing bedside interruptions. Others, however, note a significant increase in interruptions and disruption of workflow because of the lowered barrier to instant communication," Halamka notes.
He cites a study at the hospital, published in the journal Academic Emergency Medicine earlier this year, showing that physicians using iPads in the emergency department spent 39 fewer minutes at computer workstations per 8-hour shift than those who did not carry wireless tablets. "Presumably this time was spent performing their information-related tasks (order entry, results viewing and clinical documentation) at the bedside," Halamka says.
Mobile devices, of course, also permit quick access to patient data and clinical decision support tools, no matter where the doctor or nurse might be.
However, clinicians have to be vigilant about disinfecting their smartphones and tablets between patient encounters, lest they spread bacteria and other infections. "In the BIDMC emergency department, caregivers are taught to wipe their mobile devices with alcohol at the same time they wash their hands," Halamka says.
The biomedical engineering department needs to understand that even though the risk of electromagnetic radiation interfering with telemetry monitors and embedded medical devices such as pacemakers is minimal, it is still a concern. Halamka suggests that the risk could increase as mobile technology advances and proliferates.
Then there is the issue of device security. "The same portability that makes mobile devices so useful also makes them easier to lose, posing significant risk if protected health information (PHI) is stored on the device. Since many mobile devices are purchased by clinicians themselves and not provided by IT departments, they may lack the high-level enterprise-wide security controls used by most hospitals," Halamka says.
Massachusetts law requires encryption on any computer that stores PHI, but not every state has a similar standard. Consumer-grade devices that clinicians buy on their own may be difficult to encrypt, according to Halamka.
Additionally, users often mix their personal and professional lives on mobile devices. Halamka cited a case where a clinician got interrupted by a personal text message while trying to enter an order on a smartphone. He also mentioned a study of medical residents that counted 4.6 interruptions per hour, including phone calls, e-mails and in-person communications. "Such interruptions are a significant potential danger," he says.