Mobility in Healthcare: Perfect Storm of Needs and Solutions

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Thought Leadership SERIES | September 2012



Mobility in Healthcare: Perfect Storm of Needs and Solutions The perspectives of both the patient and provider must be considered when talking about successful mobility in healthcare. Ultimately, empowering the enterprise will significantly enhance the provider/patient relationship and improve care.

september 2012

And, in fact, both patients and providers are

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utilizing the same systems to access critical data.

Pressure on Providers

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Risk from Errors

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Tablets Rule

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Mobility Benefits

P4

Bar Codes for Safety

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Going Forward

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By Bill Atkinson

SPONSORED BY

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ME Thought Leadership SeRIES | Mobility in Healthcare: Perfect Storm of Needs and Solutions



Research shows that the majority of healthcare organizations are embracing mobility and have some sort of mobile strategy in place, but for those who don’t, be forewarned, patients are quickly turning to mobile devices and apps to manage their health and access records, and regulations are forcing the need for secure access to this data. Any healthcare mobility gap must be filled. According to the Billian’s HealthData and Porter Research (“Providers’ Perceptions: Mobility in Healthcare”), almost two-thirds (62%) of the organizations surveyed have developed an enterprise mobility strategy, with a quarter of them indicating this strategy has been in place for more than three years. Another quarter of those surveyed plan to develop enterprise strategies in the near future. Nonetheless, there is still some trepidation among providers as to what mobility has to offer. According to the study, “Emerging mHealth: Paths for Growth,” conducted for PwC Global Healthcare by the Economist Intelligence Unit, 64% of physicians and payers said that “mHealth” offers exciting possibilities, but with its relative infancy compared to other industires, they also say there are too few proven business models. Yet, the same study showed that the majority of consumers have adopted or are ready to adopt mobility to manage their health. Both of these perspectives must TA K E AWAY be considered when talking about successful enterprise Both patients and providers are utilizing mobility in healthcare because, ultimately, empowering the same systems to access critical data. the enterprise will significantly enhance the provider/ patient relationship and improve care. And, in fact, both patients and providers are utilizing the same systems to access critical data. Typical mobile devices like smartphones and tablets are driving communication and information sharing, but healthcare mobility involves so much more. Lynne Dunbrack, program director, Connected Health IT Strategies, for IDC Health Insights, and author of “The Second Wave of Clinical Mobility: Strategic Solution Investments for Mobile Point of Care,” indicates that spending on mobile point-of-care solutions in the United States is expected to grow from $2.8 billion in 2010 to $4.4 billion in 2015.

Pressure on Providers

Healthcare providers in the United States continue to face more regulations and relentless pressure to provide higher quality and easily accessible care that also protects patients’ privacy, keeping their information accurate and confidential. Glenn Aspenns, senior media applications analyst, product manager for Intermec says, “In today’s highly-regulated healthcare environment, they are trying to achieve new levels of efficiency and effectiveness while meeting the FDA’s rules on recordkeeping and HIPAA requirements for privacy and protection.” These regulations and pressures have become drivers for implementing a mobile strategy. Billian’s HealthData and Porter Research (“Providers’ Perceptions: Mobility in Healthcare”) reports: • 52% are adopting it due to internal pressures from administration and/or physicians • 38% are responding to demands from the American Recovery and Reinvestment Act (ARRA) and Health Information Technology for Economic and Clinical Health (HITECH), as healthcare reform deadlines have drawn closer and new guidelines have been issued. (HITECH focuses on patient care and safety, and clinical efficacy.)

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ME Thought Leadership SeRIES | Mobility in Healthcare: Perfect Storm of Needs and Solutions

• 28% are responding to organizational changes, including the adoption of new delivery models, such as Accountable Care Organizations (ACOs) and/or Patient-Centered Medical Home (PCMH) programs. Technology is viewed as a way to lessen this pressure and, mobility in particular, is seen as a conduit for shifting some of the burdens of improving care and lowering medical costs to those who are receiving the care according to a report from Galvin Consulting and Technology Coast Consulting, ( “Transforming Healthcare with mHealth Solutions”). Several trends are driving this: Aging populations are experiencing higher levels of chronic disease, leading to increased pressure to utilize mobile technology to reduce costs and improve care. Also a shortage of healthcare workers and burnout among existing workers is expected to worsen with more budget cuts creating the need for greater efficiency. And despite some research to the contrary, this report does indicate that physicians themselves are at the forefront of mobility adoption.

Risk from Errors

Communication is a major challenge for healthcare providers, and resulting errors from miscommunication are a significant cause of avoidable patient harm and pose a risk to the enterprise. In addition to the volume of information and changing nature of it, the fragmented environment of a hospital or other healthcare facility adds to the complexity of the effective communication. Mobile technology can significantly reduce errors and many providers are beginning to implement electronic medical records systems, supporting easy and timely sharing of critical information. These record systems capture large amounts of important patient data and the proper mobile strategy will enable any time anywhere access from smartphones, tablets and other mobile devices across the disjointed organizations that are so spread out and on the go.

M i n i C a s e St u d y Lehigh Valley Health Network (Allentown, PA), began exploring mobility when staff from its ob/gyn department wanted to deploy iPads to the visiting residents as a mobile bookshelf. “Once I began studying the iPad and what it could do, it became readily apparent that we needed a way to secure them, especially if we were going to put a network-capable device on a network where users could have access to protected health information,” says Jim Shellhamer, technical systems analyst and mobile device administrator. This led him to mobile device management (MDM) system research and selection of AirWatch. Shellhamer says, “Once people found out about the pilot, everyone wanted a device, and they came up with more and more ideas on how to use them. We have been scrambling to keep up with demand, because everyone wants one.” The

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original pilot was in December 2011 for 50 devices and within a month, they rolled out 200 more; 250 more in February 2012, and 1000 more in June. Individual departments are responsible for purchasing the devices. Shellhamer’s department enrolls them and manages them. “We are currently enrolling 20 and 60 iPads a week,” he says. Once demand slows down, the department will start looking at more ways to integrate it into direct patient care. Shellhamer notes, “Currently, we enroll users in AirWatch with corporateissued devices,” he states. “Right now, we don’t allow personal devices on the network. Down the road, I can potentially see it coming.”

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“Physicians and nurses are not stationary,” notes John Papandrea, senior vice president, Healthcare and Collaborative E-Care Management for SAP. “They move from building to building, station to station and room to room. Quite often, they have different transactional systems on the back end. So it is often difficult for them to visualize the information across the spectrum of areas they cover.” Dunbrack agrees that physicians are particularly interested in mobile technology, because it helps them to streamline information workflow and provides easy access to health information, such as lab results, at the point of decision-making. “It allows them to move from room to room with all of the information they need,” she says.

Tablets Rule

Kevin Kiley, director of enterprise sales for AirWatch, attributes the growth of mobile technology in healthcare to the confluence of a number of factors. With the increased adoption of electronic health records in the last few years, especially as a result of legislation there is a “perfect storm” of needs and solutions. The “solution” to which he refers is, in fact, not a solution, but a device. He explains, “For one, this is a technology TA K E AWAY that is ‘ready for prime time. Over the last decade, there “With the increased adoption of electronic has been a long list of failed technologies, including a health records in the last few years, especially as tablet, that were meant to empower care providers but were too heavy, had short battery life and were just not a result of legislation there is a ‘perfect storm’ effective. Even today, there are still hospitals trying to use of needs and solutions. ” computers on wheels (COWs) hooked up to a couple of car batteries.” Enter the iPad, and just as it had changed most enterprises, its influence in healthcare is apparent. “The dramatic change was the iPad introduced by Apple, which deserves a lot of credit. It is something physicians can carry and is powerful enough to run all of the applications,” says Kiley. Gavin Consulting data also reveals that doctors have a particular affinity for tablets for their larger screen size that allows viewing and sharing of imaging test results. Another study, “Taking the Pulse U.S. 2012” by Manhattan Research, shows that physician adoption of tablets for professional purposes almost doubled since 2011, reaching 62% in the survey and that half of tablet-owning physicians have used their devices at point of care. The Billian’s report noted that the top four mobile devices already in place at respondent healthcare facilities include: Computers on wheels (COWs), handheld barcoding devices, portable medical monitoring equipment and mobile laptops, and that smartphones were being used by 67%. However, COWs will be replaced with tablets in the coming years.

Mobility Benefits

Since the benefits from mobility in healthcare cross from provider to patient, and unlike mobility models in other industries, enterprise and end user needs are often the same, improvements to productivity and collaboration in the enterprise tend to result in improved safety and services for the patient. The U.S. Department of Health and Human Services believes the number and severity of patient safety incidents can be significantly reduced with the use of automated detection and computerized records. Aspenns says, “Patient safety concerns span all areas of healthcare

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operations as the potential for human error is still there, albeit less so than in the past. With healthcare providers challenged in providing the right amount of staffing resources equipped with the right technology to manage the patient care situation at hand, the patient safety problem can quickly become acute.”

Bar Codes for Safety

In just one example, Aspenns cites a USFDA report (“Bar Code Label Requirements for Human Drug Products and Biological Products: Final Rule”), which claimed that hospitals could eliminate 50% of their medication administration errors by scanning bar codes at the point of care to positively identify patients, the medication they are about to receive, and match the information to a physician order. The potential for mistakes in a hospital is constant, but higher at certain times. “During shift changes, the issue of stressed staffing levels comes to light with the potential TA K E AWAY degradation or even loss of vital patient communications Positive patient ID is so obviously the basis and information necessary for proper and safe shift for effective healthcare, it should go without turnovers,” notes Aspenns. “It is therefore imperative that healthcare automation in the form of mobile apps saying, but in a chaotic hospital setting mix enable caregivers to successfully adhere to what’s known ups occur. as ‘Five Rights of Patient Safety’ — the right patient, the right drug, the right dose, at the right time, with the right method of administration.” Positive patient ID is so obviously the basis for effective healthcare, it should go without saying, but in a chaotic hospital setting mix ups occur. From admission, to diagnosis, to treatment, to discharge and post-treatment check-up, there are a lot of steps and a lot of people involved. Barcode medicine administration (BCMA), delivers accountability and the ability to validate the five rights. Handhelds are used to scan caregiver ID, unit-dose containers and the patient wristband to eliminate error. Further integration with the pharmacy and the HIT system can drive scan-enabled smart infusion pump flow rate calibration. Captured data flows directly to EHR and billing. Mobility can enable and touches virtually every department and function in the healthcare chain. Here are just a few more examples.

Snapshot of europe Spending on mobile point-of-care solutions in North America and Western Europe is expected to grow from $4.4 billion in 2010 to $7.2 billion in 2015. Outside of North America, Claudius Metze, senior solution architect, ISM Healthcare Provider, for SAP says, “In Europe, there is a general demand for mobility in healthcare. Clinical users, particularly physicians, often complain about the usability of the systems. They are often very cumbersome and complex clinician systems.” Hence, Metze notes, physicians

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want the same usability and ease of use that they have in their private lives. For example, they expect from the clinical vendor that their system follow the same patterns as their iPhone apps. Cost is one of the biggest obstacles in Europe, according to Metze. “In Europe, one concern is total cost of ownership. Some countries have public healthcare systems, and some have financial turmoil. As a result, investment in a system is difficult,” he says.

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Mobile Phlebotomy Mobile technology also improves patient safety when it comes to specimen labeling. There can be inherent risks when nurses or phlebotomists print labels ahead of time for multiple draws before proceeding to make their patient rounds. Along with an associated risk of mix up, this process is very inefficient. When the draw is ordered on a handheld mobile computer, the patient is verified through wristband scanning, which sends the print command directly to a mobile printer at the point-of-care. “In short, mobile phlebotomy eliminates opportunity for misidentification of specimens inherent with batch printing,” suggests Aspenns. “Draw orders pushed to the handheld also really help maximize efficiency.”

User Productivity Healthcare mobility technology provides easy, quick and accurate access to: nurses notes, therapy and medication scheduling, patient medical histories and Computerized Physician Order Entries (CPOE). CPOE is a process of electronic entry of medical practitioner instructions for the treatment of patients, primarily hospital patients. The physician communicates his or her orders over a computer network to the medical staff and/or the departments that are responsible for fulfilling the orders (e.g. pharmacy, radiology, and/or laboratory). The collection and transmission of patient data at the point of care is enabled by mobile technology and also allows report monitoring and consultations. Images can be transmitted from the scene to others for instant response, or to be saved for later analysis.

Finding the Equipment

TA K E AWAY

So even though all the research data says that mobility in healthcare is already here, the usual suspects are obstacles in adoption — cost and IT resources/bandwidth and existing infrastructure.

A Real Time Location System (RTLS) enables healthcare facilities to manage and locate all of their assets. RTLS is a system that allows a user to track and identify the location of objects in real time, such as hospital equipment, within the facility. Wireless RTLS tags are attached to the equipment, and the system can thus receive wireless signals from the equipment to determine the location.

Connectivity Inside In addition, most of today’s technologies are able to provide free-roaming voice coverage throughout the whole facility, that penetrates garages, covered walkways, elevators, from building to building and even on roofs. In addition, clear RF transmissions don’t interfere with medical equipment.

The Usual Suspects So even though all the research data says that mobility in healthcare is already here, the usual suspects are obstacles in adoption — cost and IT resources/bandwidth and existing infrastructure. But in the case of healthcare, security is the top concern. Generally speaking, the Billian’s HealthData and Porter Research report predicts that over the next five years, mobile phones, portable medical devices, laptops, sensor technology and associated applications will play a key role in connecting not only healthcare providers across care settings, but also patients with their providers. Healthcare organizations will need to develop or enhance their existing wireless strategies that support clinical and workflow processes.

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The report also noted that providers’ top concerns related to implementing mobile solutions are security (60%), funding (56%), connectivity/bandwidth (54%), interoperability and integration with existing infrastructure (52%), and interoperability and integration among mobile solutions (48%).

Security Clearly mobile devices will create new security challenges for healthcare facilities IT professionals. With HIPAA policies in place and countless other regulations, security must literally be guaranteed. Companies who suffer data breaches risk huge fines. Kiley says, “In healthcare, there are special regulations that govern how data has to be protected. On the one hand, hospitals want to make the information available and accessible to empower providers, but on the other hand, they need to know that they can protect it - to make sure that only the right users are getting the right information.” He notes a number of strategies to ensure security: • Content management: A central data repository from where data gets pushed to mobile devices in a way that keeps the data protected, secure and encrypted at all times. • Shared devices: Hospitals don’t want to buy an iPad for every user there is. They are not tied to individuals, but are rotated through the care staff. The right technology can enable a user to register to a specific device so all of the information they need (e-mails, apps, contacts, schedule) is synced to the device Then, at the end of the day, they push a few buttons to wipe all of their information from the device. • Secure Web Access: With increased interest in ACO, hospitals need to collect survey information from patients and they may be asked to fill out the survey using an iPad. Secure web access is a must.

Going Forward

In the past, a lot of healthcare facilities focused on introducing various apps, but often, people didn’t bother to use them. For those who did, few of the apps were connected, which basically cancelled out the objective of mobility in the first place — to communicate with each other quickly, seamlessly and accurately. The optimal mobile strategy is one that ties the various technologies together within a single platform, rather than a collection of random and disconnected “apps.” This is the trend today, where all of the devices and apps are integrated with decision support tools and electronic medical records. Like with any other implementation, mobility requires a roadmap and requirements determination. To begin working on this strategy, healthcare organization should first focus on hiring and training efforts in the area of wireless and mobility. Start with bandwidth management and wireless security. Standardize mobile and handheld devices to make support easier, but be prepared for the introduction of user-owned devices. Consolidate the various enterprise medical device private networks whenever possible for increased interoperability and visibility. Develop strategies for clinical and business workflows and constituents that can most benefit from mobility enhancements. But to successfully gain user adoption, identify the workflows already in place, and then integrate the new systems and technologies into the existing workflows. Align the wireless and mobility strategy with clinical and patient portal strategies, since they have much in common. Plan for new security, integration and compliance issues associated with the introduction of mobility-generated healthcare information. Dunbrack says, “IT professionals need to spend a fair amount of time determining the problem they want to solve before embarking on it. In addition, education and training are important, especially emphasizing the importance of security.” l

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SAP offers healthcare providers with instant access to patient clinical data, including images, on their mobile devices with the SAP EMR Unwired mobile app. This enables better decision-making and collaboration to improve clinical outcomes – all while ensuring the privacy and security of patient data. Learn more about SAP healthcare mobile solutions: www.sap.com/mobile/emr.

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