Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
Mobile technology, and specifically the mobile phone, has become the new global platform of computing. This is creating significant sociological changes that will greatly impact the practice of healthcare. The unprecedented computing power available to billions in their coat pockets can be leveraged to improve medical practice and consumer health. However, the explosive growth of this modality also creates the potential for growing pains.
Because healthcare providers have a disproportionately higher rate of smartphone ownership, these devices are now increasingly finding their way into the highly regulated environment of hospitals and clinics. This has the potential to threaten patient privacy and the security of information, which are governed by Federal laws such as HIPAA – and violations already have made headlines with multimillion dollar fines. Despite this risk, the majority of hospital Information Technology departments don’t even have robust mobile device use policies.
The issue is complicated by the fact that there are several mobile phone operating systems, although the dominant two, Apple’s iOS and Google’s Android, command a majority of the market share at this time. While Apple’s tight control of iOS has allowed it to make more inroads into the competitive market, Android, because of its more open nature, has spawned numerous permutations which make security for this operating system a challenge. Mobile Device Management (MDM) software is available to deal with this heterogeneous landscape, but at a nontrivial cost. This cost is worth the expense, however, as any device can safely reside on a healthcare network through one of several methodologies and features such as remote removal of sensitive data. Providers need to advocate for policies that support “Bring Your Own Device” BYOD and MDM software that doesn’t disrupt normal workflow.
Although tablets (such as the iPad) are being outsold by PCs by at least a 3:1 ratio, this mobile modality is only now beginning to be used more frequently in clinical environments, especially with the indoctrination of first year medical students with the gift of an iPad. However, this gift can come with problems. It is difficult to clean the device to avoid disease transmission. Different hardware products host different applications due to the high cost of developing apps for multiple operating systems. Construction of mobile devices can be less than industrial strength. And there are relatively few clinical applications that take advantage of tablet interaction techniques (touchscreen, swipe, pinch and zoom). But we can anticipate that innovations such as HTML5 will remedy most of these issues. HTML5 is the new emerging standard for websites, which will include hooks for features unique to tablets (touchscreen, camera, accelerometer, etc.).
Finally, mobile technology is revolutionizing both patient care and data collection. It provides the ideal platform for tight feedback loops to help enable behavior modification and to provide encouragement to consumers struggling with chronic health conditions or maintaining their health. It soon will be commonplace to monitor sleep patterns, moods, activity levels, and activity, in addition to the traditional metrics of blood pressure, blood sugar and weight. This will result in a tsunami of data which can augment, but at times confound, the practitioner. Regardless of the state of readiness of the healthcare industry, this data will be coming fast and furious from your local patient. Strategies to establish data provenance (source of data), data validation and data interpretation will need to be created so that this data can be converted to actionable intelligence. Workflow adjustments and analytics will play a key role in making this possible.
Trackback from Perspectives on the Acute Care ContinuumBy Jeff Bass, MD
Health care spending now represents greater than 16% of our Gross Domestic Product, up from 13% in 2000. It is continuing to grow, some say at the rate of 1.5 times GDP. As we approach the 20% benchmark, we need to... ...
Thanks for your comments Katherine. As sensor technology advances, they become more sophisticated and cheaper. We'll have previously unseen capabilities for self-monitoring and eventually self-diagnosing. Data generated from these sensors can fundamentally change our paradigm of episodic care to continuous care, which should theoretically improve the baseline health of a community. But because consumer devices are not always built to the most rigid specifications of precision and accuracy, we'll have to deal with data that is not as "pure" as the clinical environment. We may also discover occult disease revealed by the higher resolution of such data collection. Challenges and opportunities abound!
Dr. Aratow is making the same argument my colleagues and I made in our graduate final project at U.C. Berkeley - the workflow associated with data collection for the hospitals we observed was unworkable, and doctors and patients were suffering from poor information management (at one public hospital we studied, doctors estimated they had access to patient charts for approximately 50% of patient visits, and doing conscientious documentation required walking to telephones where they recorded dictation that was then manually entered into paper records). I was aware of Dr. Aratow's work in this area, and I am glad he's publishing his findings, because there are a lot more opportunities for clinicians now than in 2008. And as a data analyst I'm very interested in the "tsunami of data" popular adoption of mobile platforms could provide!
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