Use of mobile device in health care setting
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Mobile devices are enforcing its use in all aspects of life, health care is one major area where mobile device could enhance operations, or improve quality and efficincy. Here is a presentation I gave at HIMSS which may be useful to you if you are considering using mobile device in your health care discpline.
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Use of mobile device in health care setting
- 1. Use of Mobile Device in Health Care Setting Samir Sawli, PhD Jaime Bland, MSN, RN, PMP, CPHIMS Sidra Medical and Research Centre Doha Qatar
- 2. Do you want to go Mobile? • Do you want to extend the boundaries and efficiency of care at your organization? • Do you want to make health information accessible to your staff and consumers • Then we share the same objective
- 3. SIDRA Medical and Research Centre Sidra Medical and Research Center (Sidra) in Doha, Qatar, will be a state-of-the-art, all-digital, academic medical center. Sidra will encompass three essential missions: • World class patient care • Medical education • Biomedical research We did market search and best practice research and ended up with a discussion paper which will be published after HIMSS 2010
- 4. Objectives • Describe, at high level, elements of planning a mobile health strategy.
- 5. Corner Stones for Mobile Health Strategy • Organization Goals Objectives and Strategy • Enterprise Architecture • Gather Business requirements taking into consideration: People (Patients, Physicians, Nurses, Allied Health professionals, Support staff) Process workflow benefits Technology Hardware options Applications ,what and where to use a mobile device Benefits of using mobile technology User adoption • Risks Privacy and Security Incident management Infection Control • Cost and Return on Investment (ROI) • Integration • Policies and Procedures • Testing • Training • Go live plan • Wish list of providers
- 6. Strategic Information Systems Plan Strategic Information Systems Plan Defines • Mission • Goals • Objectives • Technology needs • Infrastructure • Priorities Mobile health strategy should be aligned with Organization's IT strategy
- 7. Enterprise Architecture • Enterprise architecture is the organizing logic for business processes and IT infrastructure reflecting the integration and standardization requirements of the firm’s operating model
- 8. Enterprise Architecture Framework Data, Function, Network, People, Time, Motivation
- 9. Applications
- 10. Gathering Requirements Take Into Consideration • Process • People • Technology
- 11. Process: Benefits of Using Mobile Technology • Increase efficiency by making information readily available to health care providers at their finger tips • Accessibility to Electronic medical record and ability to place urgent orders • Enhance communication through messaging and audio/video communications in regards to patient’s condition • Provides audit trail, meeting JCIA requirements
- 12. People What the Patient may use it for • Scott Eising from Mayo clinic said: “in our research into mobile health consumer, we found that people are looking for action oriented information” .Consumer will not use mobile device for in depth research using PDA. • To access their PHR/EHR to view or update their health information • To control a chronic disease like diabetes or ulcerative colitis • For Medication adherence and compliance. Help patient log and time his medications. Some applications can send reminders to patient to adhere to the prescribed dosages, times and rotation sites in case of injection. • Smart phones coupled with sensors are used to Monitoring of vital signs like temperature, heart rate, blood sugar and activity. Results are transmitted to monitoring authority who may call the patient or initiate an intervention, or trend the results over time.
- 13. People What Physicians may use Mobile device for • Most often physician will use mobile device for Drug Clinical reference alerts and awareness from FDA , CDC, example FDA Recalls • Drug Dose calculators and interactions • Medical Reference (help avoid drug errors by 3 errors /month, and save around 20 minutes per day according to a study by Brigham and Women's hospital) • Receive Blood test result with alerts to abnormal results • To track and monitor patients (receive Fetal heart rate monitoring , ECG wave, Hemodynamic values, Mobile PACS) • To earn CME’s and listen to lectures and Webcast
- 14. People Nurses Use Mobile Device for • Nurses are using mobile computing device in the rounds, for communication and for drug administration • Drug Dose calculators and interactions • Receive Blood test result with alerts to abnormal results • To track and monitor patients
- 15. People What support staff may use Mobile device for • Laboratory and radiology technicians are gradually replacing pagers with handheld devices to receive requests and chart completion • Support staff are using handheld devices for warehouse inventory, delivery of supplies, and mounting up medication dispensing machines • Throughout the healthcare facility handheld devices are enhancing efficiency through event messaging example, communication with housekeeping, case managers, blood bank, discharge planners and code team
- 16. Technology Software Market Screening • By Feb 2010 5805 health and fitness applications were available in the APP store • 73% of APPS were developed for end-user or patient while 27% were developed for health care providers • While APP store is leading the market of Health related applications developers are making applications for other operating systems
- 17. Technology Adoption • According to MANHATTAN RESEARCH the number of Physicians who own SMART phones will increase from 64% to 81 % by 2012 • Universities are encouraging use of handheld device through giving medical students handheld device during their medical study (Columbia University Medical School)
- 18. Hardware options • Lets define 1. Cell phone- Provides Voice communication and SMS over 3G wireless network 2. Feature Phone: have in addition to voice communication and sms, some media tools like camera, games, and MP3/MP 4 players 3. Personal Digital Assistant or PDA combines featured phone functions with web browsing and organizer and email. 4. Smart Phone: Run on specific operating system like windows mobile, Iphone operating system, Blackberry operating system, symbian and Linux. The operating system allows installation of downloadable applications 5. Tablet PC is a complete computer contained entirely in a flat touch screen that uses a stylus, digital pen, or fingertip as the primary input device instead of a keyboard or mouse example C5 , and H1
- 19. Health Care IT Architecture
- 20. Technical considerations Signal Interference • In England, then NHS (National Health Service) issued report DB9702, Electromagnetic Compatibility of Medical Devices with Mobile Communications. In that 1997 report, • only 4% of handheld transmitters (all types) cause any interference at a distance of one meter (3 feet) due to inadequate shielding • The risk of interference from a cell phone device is no greater than other handheld communication devices, in fact there is less interference than portable radios. • Further tests and trials are needed to recommend the right device for the right health care setting
- 21. Technical considerations • Fall and break of the handheld device require fully rugged devices and or case to prevent break • Durability of the battery and suitable recharging options is another concern to address by technical staff
- 22. Gathering Requirements Category Subcategory Requirement Patient Disease control Ability to track Blood Sugar level Physician Medication Prescription Ability to look up drug interaction Nurses Medication Ability to look up drug administration information Technical Integration Ability to integrate with the organization portal
- 23. Risks • Misinterpretation of data ,images and waveforms due to clarity of display • Communication failure due to connectivity • Device failure due to battery depletion and fall breakdown of the device • Device loss or theft which constitute security breech concern • Privacy and security breech of information • Nosocomial infection to patient and staff
- 24. Security Considerations • Privacy invasion through wireless transmission of patient care data • Device theft and loss of patient and corporate sensitive information
- 25. Privacy and Security Standards • International Organization for standardization (ISO) • Federal Information Security Management Act (FISMA) • Health Insurance Portability and Accountability Act (HIPAA) • German Leach-Bliley Act of 19999 • PCI Processing Rules • UK Data Protection act of 1998 • European Union Data Protection Directives
- 26. Threats and Vulnerability • Identify threats • Identify vulnerabilities • NIST ICAT vulnerability database – http://nvd.nist.gov/ – Likelihood determination • Impact analysis
- 27. Risk Management • Risk Assessment • Risk Mitigation Train all stake holders on process of reporting incidents • Evaluation and Monitoring
- 28. Infection control • Hand held device constitute a major concern from spreading infection to patients and staff in the absence of strict infection control policies, decontamination measures and practices • A multi-disciplinary team of experts at Johns Hopkins University School of Medicine has created a seven-foot-tall, shower cubicle device that can automatically sanitize hard-to-clean equipment such as computer keyboards and cell phones in just 20 minutes • The SUDS (self-cleaning unit for the decontamination of small instruments) invention disinfects noncritical equipment better than manual cleaning • Another strategy to contain the risks of infection is the implementation of a RTLS (Real Time Locating System) tag to track and record trails movements of devices and patients wirelessly.
- 29. Cost and Return on Investment • Mobile devices and infrastructure is relatively costly • Project 5 years return on investment • Emphasize problems and their cost in the absence of the mobile technology • Project maintenance and upgrades of mobile technology (Batteries, replacement of device) • Present plan to executives seeking approval and budget
- 30. Policies and Procedures • Gather a team from stakeholders • Gather existing policies and procedures • Involve users and first line supervisors • Consider privacy and security standards • Place policy development on Project plan • Define technical access controls • Define data access controls for access and authentication • Once Policy is final, teach it to users at all levels
- 31. Integration • Electronic Health Record, CIS • Enterprise Resource Planning ERP • Web Portal • Messaging tools and software • Communication Software • Business Intelligence
- 32. Testing Mobile Technology • Gather testing team • Unit testing • System testing • Load or volume testing of concurrent users • Integration testing • Log errors • Report errors and deficiencies • Track resolution of errors • Map results to contractual requirements
- 33. Training Plan • Super user (Nurses, Physicians, allied health) • Patient • On going training plan • On line training material • Attractive content using multimedia • Training environment
- 34. Go live plan • Preparation of infrastructure • Interfaces • Training • Support at the point of care and not only behind command center desks • Helpdesk • Pilot Mobile technology solution
- 35. Mobile Device, Wish list of providers • Function as communication device, between the health care provider and the patient, and between the health providers themselves • Function as source of information for drug dosages, compatibility and formulas • Reader for RFID, BARCODE and finger print especially upon delivery of care • Basic charting tool, compared to desktop advance charting tool • Well connected to health information system, health care portal and community • Be light weight easy to carry in the scrub pocket or hospital gown • Durable if fell down on any surface solid or liquid • Long battery life, does not need frequent charging • Reasonable cost in case we lost it • Easy to use • Elegant looking • Small size • Infection resistant, does not spread organisms around • Safe to use in any environment especially intensive care areas and operating rooms
- 36. References • • Rothschild, J.M., Fang, E. Liu, V., Litvak, I., Yoon, C., Bates, D.W. (2006) Use and Perceived Benefits of Handheld Computer-based Clinical References, JAMIA 2006;13:619-626 • Wireless Devices and Electromagnetic Interference in Hospitals, Urban Myth? Retrieved 22 January, 2010 from http://www.pdamd.com/features/interference.xml • Gilfor,J.M. (2001) Report on Electromagnetic Interference in Hospitals, Retrieved from http://www.pdacortex.com/EMI.html • McCormack, J. (2009) Healthcare Goes Mobile: Mobile Devices and Infection Control: Do You Have Game? Retrieved 22 January 2009 from http://www.healthcaregoesmobile.com/content/mobile-devices-and-infection- control-do-you-have-game • CPHIMSS study guide • http://dictionary.sensagent.com/enterprise+architecture/en-en/
Editor's Notes
- Accessibility to the information we need, when we need, is vital to the smooth and efficient running of any healthcare organisation – the challenge…. Replacing a proven, reliable but costly solution with new technologies and electronic ‘process’.