Mobility Supports EHR, but Barriers Remain

In its broadest terms, mobility has been a part of healthcare for decades. Think of computers on wheeled platforms, beepers, personal digital assistants (PDAs) and various other devices. The new era of powerful mobile systems, however, takes the idea of clinical mobility to another level.

The Healthcare Information and Management Systems Society (HIMSS) noted several years ago in its Clinical Mobility Report the newer generation of mobile devices had begun to change patient care delivery. In early-stage tele-monitoring, for example, alerts regarding patients' vital signs once triggered immediate home visits by care nurses. Now nurses first respond by calling the patient.

To determine how health consumers used mobile devices, the Pew Research Center found in a survey some 70 percent of U.S. adults regularly tracked at least one health indicator—such as symptoms, weight and diet—and more than 20 percent used technology to do that.

The numbers keep coming. In its 2015 Mobile Technology Study, HIMSS found slightly less than 40 percent of the healthcare organizations it surveyed said implementing mobile services for healthcare data access was a high priority. However, only 18 percent indicated their mobile environment was "highly mature."

There have been some notable successes. New York Presbyterian Hospital is one of the largest health systems in the country. It started developing a clinical mobility platform in 2012. This was intended as a "five-year journey to iterate on the right form factor, right integration, right infrastructure setting, and right use cases," says Rosemary Ventura, director of nursing informatics, in a recent blog post.

It now has nearly 2,000 Apple iOS devices deployed, and all hospital clinicians use the system. It supports continuous improvement in eliminating harm, reducing waste and improving productivity, says Ventura, as well as providing real-time messaging and cooperation between clinicians. The whole thing resulted from extensive collaboration between Presbyterian stakeholders and industry partners, she says. This was a "truly interdisciplinary" group of technical, infrastructure, informatics and clinical experts.

Clinical mobility is also driving virtual clinics or virtual care teams. These bring the patient together with clinicians in a virtual setting that doesn't require a physical meeting. It also promotes a seamless handoff from the hospital to a patient's post-acute care team, reducing the potential for readmissions, which are penalized under the Affordable Care Act if they are deemed excessive.

That's especially useful in smaller and more rural clinics, where the clinics' resources are limited and it's hard for patients to travel regularly to meet their doctors. It's also useful for enhancing the patient experience and patient compliance with their treatment plan. Studies have shown patients are more likely to stick with a treatment regimen if they have more personal face time with doctors and clinicians. Mobile systems now allow for that without having patients go back to the hospital, or nurses visiting them at home.

Barriers to implementing clinical mobility solutions range from the usual suspects like security, authentication, device management, network capacity and so on; to those specific to healthcare organizations. User interfaces, for example, must minimize the possibility of data input errors, which can be far more serious in a healthcare setting. Clinical environments are often more constrained and chaotic than other workplaces, which puts restrictions on the size and portability of the devices that can be used.

One primary problem that's unlikely to go away anytime soon is how to pay for all of this. In its 2015 survey, HIMSS found lack of funding is still cited as the biggest barrier to clinical mobile deployment.