Mobile Technology in the Doctor's Office

"Let's pull up your chart," mumbles a physician, visibly weary from a long day of health histories, patient consultations and diagnoses. He thumbs through a worn manila folder, past forms, charts, X-rays and sticky notes. "And what medications are you currently taking?" he asks, adjusting his glasses to his own harried scrawl. The patient answers dully, while the physician places the folder atop another stack of equally indistinguishable manila folders on a cluttered desk. He pulls a worn book off the shelf, squints through the infinitesimal lists of drug interactions, places a finger on a chart, silently re-reading the information before pulling out an anatomy diagram and clearing his throat for a long discussion. "Ok, let's talk about your insurance options..." Though a dated (and slightly exaggerated) analogy, these types of physician-patient office interactions are becoming less and less commonplace as physicians embrace mobile technology, smartphones and tablets, to assist them in their duties.


Mobile technology's presence in the medical sector isn't anything radical at this point, in fact, it's practically becoming the mainstream. Healthcare Informatics magazine describes the development as "explosive," while Manhattan Research reports 80% of practicing physicians owning smartphones, 90% of which use them for professional purposes. Additionally, hospitals and large practices across the country are proactively ushering the smartphone boom directly into their facilities. Both Stanford and Georgetown Universities have begun issuing iPads to medical students, a measure geared towards assisting in bedside training, Beth Israel Hospital, an instructional campus near Harvard, houses some 1,000 iPads and 1,600 iPhones sanctioned for physicians on the hospital floor, Bruce Haviland and Bill Feca have developed and issued fully secured Blackberry Curves for nurses and physicians on the floor of UPMC Mercy in Pittsburgh and a Sarasota Hospital reports that 100 of their provided phones are producing up to 15,000 inter-office work-related text messages a week (and the average nurse age is 46-47, how's that middle-aged/technology stereotypes?).

Mobile Technology Benefits
Dr. Henry Feldman (affectionately nicknamed "the iDoctor") maintain an outspoken stance on the advantages of mobile technology where he works at Beth Israel. "Mobile technology has made me a better, faster physician," he says. "It lets me do anything I could do at my desktop while at a patient's bedside, and some that I couldn't do." Many physicians agree, as mobile technology allows physicians to securely access patient charts from anywhere, to find drug information and interactions instantly, and to use animated diagrams, illustrations and even photos from a patient's own surgery in helping patients better understand a medical condition.

As more and more physicians implement Electronic Health Records in their work (Lauren Neergard's Washington Post article indicates a 100% increase in EHR usage since 2008, and predicts further increases by 2015), secure applications that allow physicians to channel these records directly onto a handheld device become increasingly valuable and time effective. Flagship mobile device apps like Voalte One (an encrypted messaging service which allows physicians and nurses to message each other within a practice, quickly and efficiently) and Epocrates (a secured database of drug information, interactions and insurance options) bring the technological benefits of a standard physician office desk into their pocket, lending them supreme capabilities, even on the move. Furthermore, mobile technologies hold tremendous economic benefits for hospitals and large health care practices, as a large percentage of these devices are purchased and owned personally by physicians and staff members.

Mobile Technology Challenges
However, the mobile technology trend isn't universally recognized as a beneficial one. An Eweek article highlights cell phone disadvantages, like poor cellular reception in big hospitals, citing the tried and true method of paging as the most efficient method for messaging in hospitals.

Also, the "bring your own device" phenomenon ushers certain security risks into play. The looming problem for many Hospital IT technicians is that the mobile technology physicians are bringing in often outpaces the security regulations put around it. While the preceding Eweek article profiles a 44% physician preference for the iPhone and 25% for the Blackberry, IT technicians can't put all their stock into one model infrastructure as fringe devices appear. Even more concerning is that the while the iPhone is the preferred smart phone for physicians (largely based on its identity as a status symbol), many IT technicians believe it to be the most technologically unsecured. Mark Hagland's Handheld Juggernaut calls on a survey of Health Care IT professionals when he proclaims that health care information is perceived as less secure than it was twelve months ago. 

Still, Mac McMillan, CEO of Austin TX based Cynergis Tek, remains optimistic and encourages Health Care IT professionals to focus on the information, rather than the devices that house them. "If you try to rely on controlling every device that comes in, you'll never stop chasing that rabbit," he says. Instead, he suggests that technicians control where the information lives, where it can move and to disallow patients from moving data from too many designated areas. Taking the principle further, CIO Michael Restuccia and associate CIO/chief technology officer Bryan Wells allow clinicians to bring their own Blackberries and iPhones to work, but require that hospital internet security departments configure them to remotely shut down if lost of stolen. Additionally securing measures include disallowing any hospital data to be saved on the device itself, to ensure that they're self locking and even that they wipe themselves clean if a user fails to input a correct pin entry multiple times.

Not Just for Big Practices
However, the mobile technology trend isn't just a problem isolated to big practices and hospitals, as small and medium level physicians face challenges as well. Many physicians feel comfortable multi-tasking, something the "smart" nature of phones and tablets freely encourages, and while computers in the office aren't new to the medical landscape, rampant smart phone use is steadily blurring the line between personal and professional obligations, and physicians might not be keeping the two worlds as segregated as they think. During the work day, they're hit with flurries of notifications, texts, emails and images on their smartphones and tablets, and according to John Halamaka, a physician's biggest work day detriment is non-medical things being viewed on mobile devices. A recent NPR story records an extreme case in which a man was admitted to a hospital to be taken off a blood thinner that was dangerously affecting his heart. As he was about to be taken off, a nurse received a notification for a party and while RSVP'ing temporarily forgetting the patient, who almost died. Per Kaiser/NPR respondent Jenny Gold, an absent minded mis-step at the grocery store is an inconvenience, but a botched step at the hospital can be a literal life and death situation. 

Doctors at small and medium level practices can implement a few steps to prevent smart phones and other mobile technologies from mounting a substantial distraction. Active efforts to only field personal calls and texts in designated areas or designated times can render a profound difference in how they go about their work. They can also avoid spending patient visits staring at their device screen. When physicians seem distracted and disinterested, patients are less willing to talk candidly and physicians might miss out on important symptoms or piece of information in a health history. When absolutely unavoidable, physicians can position their phone or tablet screen so that patients can see what they're using it for, and they won't suspect their trusted medical confidant of playing solitaire or checking NCAA scores. Also, physicians can fully involve the patient in the process by explaining what they're doing with a device rather than simply ducking out to twiddle on it. "I'm pulling up your chart here," or "here, let's see what your insurance will cover" eliminates potential barriers between patients and physicians, and keeps them fully involved in the medical process.

Where Henry "iDoctor" Feldman insists that phones can "always be turned off", and Jonathan Mack, director of clinical research and development at West Wireless Health Institute says distraction from mobile technology is "case by case, but not a huge problem overall," mobile device etiquette will go a long way to fostering patient loyalty and satisfaction for physicians operating a small and mid-level practice.

As the mobile trend displays robust staying power and shows no signs of slowing down, effective physicians that use technology to add more efficiency to their practice, and will cut down on the things that take away from it, will find increased success and customer loyalty as the landscape continues to reform and we march deeper and deeper into the future of healthcare.

References:

Dark Daily. "Tech Savvy Doctors Are Putting Smartphones and IPads to Work in 
     Their Medical Practice." Darkdaily.com. Dark Daily, 1 Nov. 2010. Web. 12 Apr. 2012. 
      <http://www.darkdaily.com/tech-savvy-doctors-are-putting-smartphones-and-ipads-to-work-in-their-medical-practice-1101#axzz1rqskt5b0>.

Epocrates Media Resources. "Smartphones and Mobile Health Apps Regarded as Essential to Medical Practice." 
     Epocrates.com. Epocrates. Web. 12 Apr. 2012. 
     <http://www.epocrates.com/who/media/mediaresources/story-angles>.

Gold, Jenny. "KHN: Kaiser Health News." Doctors' Smartphones And IPads May Be Distracting. Web. 12 Apr. 2012. 
     < http://www.kaiserhealthnews.org/stories/2012/march/26/doctors-smart-phones-ipads-distracting.aspx>.

Gold, Jenny. "Hospitals Warn Smartphones Could Distract Doctors." NPR. NPR, 26 Mar. 2012.Web. 12 Apr. 2012.

< http://www.npr.org/2012/03/26/149376254/hospitals-guard-against-smartphones-distracting-doctors>.

Hagland, Mark. "Handheld Juggernaut." Healthcare Informatics Magazine. Healthcare Informatics, 20 July 2010. Web. 12 Apr. 2012. 
     < http://www.healthcare-informatics.com/article/handheld-juggernaut>.

Horowitz, Brian T. "Doctors Embrace Smartphones, but Struggle to Connect with Colleagues, Study Says."
     EWeek.com. EWeek, 28 July 2010. Web. 12 Apr. 2012.
     <http://www.eweek.com/c/a/Health-Care-IT/Doctors-Embrace-Smartphones-But-Struggle-to-Connect-with-Colleagues-Study-Says-168240>.

Payne JR, Perry W. "Are Smartphones Distracting Doctors?" IMedicalApps.
     IMedical Apps, 4 Apr. 2012. Web. 12 Apr. 2012.
     < http://www.imedicalapps.com/2012/04/smartphones-distracting-doctors/>.

Neergard, Laruen. "Healthbeat: Helping Doctors Keep Human Touch Amid Distraction." Washingtonpost.com. Washington Post, 29 Mar. 2012. Web. 12 Apr. 2012.
     <http://www.washingtonpost.com/national/health-science/healthbeat-helping-doctors-keep-human-touch-amid-distraction-of-laptops-smartphones-in-exams/2012/03/29/gIQAhcG2hS_story.html>.