Dr. Stephen Beck, CMIO at Catholic Health Partners discusses how his organization is enhancing clinical decisions at the point of care through mobile health to improve the quality and effectiveness of healthcare.
Smartphones, tablets and other mobile devices are becoming ubiquitous in doctors’ offices and hospitals as a means to standardize care protocols, improve the flow of information, and ease the implementation of electronic health records (EHRs).[i] In fact, mobile devices are becoming as essential as the exam table, according to a 2013 survey conducted on behalf of Wolters Kluwer Health by Paris-based market and technology firm Ipsos.[ii] Nearly 80 percent of the 300 practicing primary care, family and internal medicine physicians surveyed said they were using a smartphone in their day-to-day practice. Another 61% were using tablets.
A 2013 infographic on mhealth[iii] compiled by Strategy& (formerly Booz & Company) supports these findings, reporting that 85 percent of doctors use smartphones and medical apps. In addition, 86 percent of all clinicians – doctors, nurses and nurse practitioners – now use smartphones in their practice areas every day, up from 78 percent in 2012.
EHR Management and Clinical Documentation
According to the 2013 Wolters Kluwer Health Physician Study, more than half (55%) of physicians who use mobile devices use both smartphones and tablets in their daily practice. The top use of smartphones is accessing drug information while tablets are used most to access medical research. In addition, mobile apps are being used by 24 percent of physicians, making these the top digital/social media channels used for work purposes. Further, a separate study found that while the majority of charting and EHR interaction is performed via laptop or desktop, nearly half of all clinicians who own a tablet commonly utilize it for EHR management and other clinical documentation.[iv]
At Catholic Health Partners (CHP), one of the largest non-profit health systems in the U.S., we use mobile devices to provide our clinicians with anytime, anywhere access to the clinical answers they need alongside our mobile electronic medical record (EMR) system, during rounds, in the hall between patients or at home catching up on charts. For example, we implemented UpToDate Anywhere to ensure our clinicians have mobile access to our evidence-based clinical decision support resource, UpToDate. Among IT system enhancements, UpToDate Anywhere has been the most positively received upgrade we’ve implemented recently.
Managing Care – and Access
Using a mobile device to search on a medical topic when and where it’s most convenient is key for our clinicians. Just as more patients are using smart devices to manage their care, so too can providers use their smartphones to bridge the gaps when they can’t be near a hard-wired computer, a computer-on-wheels, a workstation or office.
Our experience and actions run parallel to the results of one national survey of primary care and internal medicine physicians who indicated a strong preference for EHR usability on their mobile devices.[v] In fact, of the medical specialties polled by Black Book Rankings in 2013, all hospitalists and the vast majority of primary care physicians (98%) and internal medicine physicians (97%) surveyed reported a strong preference for EHR systems that include mobile apps, as did 92 percent of office-based physicians, 88 percent of rheumatologists, and 87 percent of nephrologists. Most respondents also favored mobile applications that focus on patient data and core parts of medical practice most needed when the physician is away from the office setting.
At CHP, we also are committed to offering mobile EHR viewer access on iPad, iPhone, or Android to any physician provider. This allows access in remote areas where Internet or PC access is not available so providers can view data when off-site and on-call. Our secure patient record viewers store no information on the local device and do not require a unique log in so private information is protected.
Progress Made and a Look Ahead
Many clinicians agree progress is being made in leveraging health IT to ensure patient safety and improve patient care. Fifty-one percent also cite progress in leveraging EMRs to advance evidence-based medicine. However, a majority of physicians believe little to no progress has been made when it comes to ensuring ease of use (56%), improving patient relationships (61%), or increasing efficiency/saving time (66%).[vi]
At CHP, we’re trying to improve those percentages. Our dedication to providing remote access to information for physicians ties in with one of our core values, that of service and a commitment to respond to those in need. Our focus is on the underserved. While a direct correlation is difficult, there does appear to be an opportunity for providers to conduct outreach even when working in remote locations. This is one way to leverage those skills. Mobile searches using UpToDate Anywhere at CHP are approaching 10%, and are expected to continue to grow over time.
We’ve worked to improve the quality and effectiveness of healthcare throughout our organization by enhancing clinical decisions at the point of care. As a result, we’ve also noticed an impact on hospital metrics that improve the efficiency of care. For example, education associated with one electronic advisory resulted in a reduction of 23%, from 58% to 35%, of Metformin administration delay 48 hours following IV Contrast—a current safety standard around renal protection. This reduction occurred rather quickly—over the course of two months. Clinicians, we find, can make the best decision when they have access to a true clinical decision support resource that is always at their disposal.
Remote mobile access to clinical data means clinicians can answer medical questions when and where they arise. Medicine is continuously changing with a continuous torrent of new research making the need for up-to-date clinical information—particularly direct access to changes that affect current practices–so critical for physicians. When a doctor can research a topic and get current, expert insight on diagnosis and treatment, providers and patients alike benefit.
With the Affordable Care Act already in effect and implementation of key provisions impacting clinical workflows scheduled for 2014, mobile devices are poised to play an even more critical role in providing convenient access to information and helping to ease communications among colleagues and healthcare facilities.
Stephen Beck, MD, FACP, FHIMSS, currently serves as Chief Medical Information Officer at Catholic Health Partners (www.health-partners.org). He has more than 15 years of experience in planning, implementation, training and follow-up of EHR installations in civilian and military populations and was one of the first physician users of a fully integrated EHR in Southern Ohio. Dr. Beck was among the first physicians to attain CPHIMS certification, has been a content reviewer for the HIMSS National Conference, and chaired the HIMSS National Professional Practice Task Force. He is a Fellow of both HIMSS and the American College of Physicians and serves on the HIMSS Clinical Decision Support Workgroup.