How Healthcare’s Embrace of Mobility has Turned Dangerous

No industry has adopted mobility faster than healthcare.

Doctors love their devices. 81% of physicians have smartphones. They also love their apps. 38% of them use medical apps daily. One-third use smartphones or tablets to access electronic medical records today, with another 20% expecting to start using them this year.

For instance, 200 doctors and nurses at Charite Berlin, one of Europe’s largest hospitals, are piloting SAP’s new Electronic Medical Record app on iPad.

The app allows medical providers to trade their clipboards for (electronic) tablets, which present them a clean dashboard that lets them drill down into data such as medical history, medications (and allergies), X-rays and vital signs. It pulls that data down from a speedy SAP Hana in-memory database.

“The future of healthcare IT is mobile. It must be able to handle very big data, must be secure, and, of course, in real time,” said Martin Peuker, CIO at Charite.

(You can watch more of Peuker’s comments from a panel at SAP TechEd Europe in November, or see a 3-minute video here.)

Or take Ottawa Hospital in Ontario, Canada. It has deployed 3,000 iPads to doctors, interns and pharmacists. One custom-built app gives providers a dashboard showing patients’ health records; another lets doctors to order lab tests, medical images or medication, according to Network World.

Here’s a nice overview of worthy mobile healthcare apps from Tab Times. Or check out publications such as iMedicalApps.com, which is written and edited by medical professionals, and MobiHealthNews, which predicts there will be 13,000 health apps aimed at consumers by this summer.

The half-empty view of the glass

At the same time, no industry appears to be deploying mobility in a more risky fashion than healthcare. Because this potentially involves your doctor, your nurse, your surgeon, your health, that’s scary.

First, many healthcare organizations appear to be careless about your data as a patient. According to a report last month from the Ponemon Institute, half of the 72 organizations surveyed don’t do anything to protect mobile devices. Only 21% lock devices down with a password, only 23% use encryption to protect data, and only 46% have any policies governing proper use of mobile devices.

That’s ironic, because I was always under the impression that healthcare organizations were very conscientious about data security due to regulations such as HIPAA.

The scarier risk is related not to your data, but to your life. “Distracted doctoring” is what the New York Times is calling the phenomenon of medical professionals using tablets or smartphones during the middle of surgery and other procedures. No, they aren’t always checking patient records or vital signs, as some/many are doing things like texting, checking airfares or stock prices.

Here’s the Times:

“You walk around the hospital, and what you see is not funny,” said Dr. Peter J. Papadakos, an anesthesiologist and director of critical care at the University of Rochester Medical Center in upstate New York, who added that he had seen nurses, doctors and other staff members glued to their phones, computers and iPads.

“You justify carrying devices around the hospital to do medical records,” he said. “But you can surf the Internet or do Facebook, and sometimes, for whatever reason, Facebook is more tempting.”

“My gut feeling is lives are in danger,” said Dr. Papadakos, who recently published an article on “electronic distraction” in Anesthesiology News, a journal. “We’re not educating people about the problem, and it’s getting worse.”

One study found that 55% of technicians who monitor heart bypass machines during surgery had talked on their cellphones during the surgery. A similar percentage of technicians admitted to texting during surgery.

Here’s a frightening anecdote:

Scott J. Eldredge, a medical malpractice lawyer in Denver, recently represented a patient who was left partly paralyzed after surgery. The neurosurgeon was distracted during the operation, using a wireless headset to talk on his cellphone, Mr. Eldredge said.

“He was making personal calls,” Mr. Eldredge said, at least 10 of them to family and business associates, according to phone records. His client’s case was settled before a lawsuit was filed so there are no court records, like the name of the patient, doctor or hospital involved. Mr. Eldredge, citing the agreement, declined to provide further details.

And here’s still-another anecdote reported by the Times earlier this week that quotes a federal report written by the CIO at Harvard Medical School, John Halamka, about medical multi-tasking that went wrong for a 56-year-old man with dementia who needed the feeding tube into his stomach removed:

Before the feeding-tube procedure, the doctors increased the patient’s dose of anticoagulation medicine to reduce his risk of stroke. After the procedure, the doctors held a meeting about the case. They decided the patient needed an echocardiogram, a heart image, to determine whether to continue the blood-thinning medication.

During the meeting, the attending doctor instructed the medical resident (a junior doctor) to order the anticoagulation treatment temporarily stopped. The resident began to enter that order into her phone using a computerized doctor order entry system. These are increasingly common systems that can be used on phones or tablets.

Before the resident could finish the order, her phone beeped with an incoming text. It was from a friend. She got lost in the text and failed to finish the order. The patient continued to get the blood thinner at the elevated dose he was getting before the feeding-tube procedure.

On the patient’s fourth day in the hospital, his heart raced and he was gulping for air. He was rushed into emergency open-heart surgery. Blood had filled the sack around the heart. He’d received too much blood thinner, but he survived.

Obviously, I’m all for medical institutions deploying mobile devices. They have huge potential in helping medical providers diagnose patients more quickly and accurately, improving the patient-provider relationship, and reducing extra paperwork – and the medical errors that are sometimes caused by them.

But I wonder if hospitals need to draft up an industry-wide set of best practices governing the use of mobile devices in hospital settings (lest the federal government steps in, and nobody wants that). So no personal apps or incoming phones and texts inside certain locations of a hospital, or during shift hours. Or even the outright blacklisting of non-work web sites, apps and data from these devices.

Bring Your Own Device (BYOD) might seem to be a non-starter in the healthcare industry, but I don’t think that’s necessarily true. All of the above policies can be enforced using Mobile Device Management (MDM) software. Just make sure to choose an MDM software that offers very fine-tuned and granular control over your devices, says Tom Maxwell, COO of Homecare Homebase LLC, a Dallas, Texas provider of software for the home health industry.

Homecare’s self-named app runs on Android tablets such as the Samsung Galaxy Tab. It is used by nurses that go and make house call visits to check on elderly or otherwise immobile patients.

Rather than relying on Android to secure its patient data, Homecare built its app to have its own password, its own authentication scheme for users trying to download data from the server, and its own 1024-bit encryption for data that is stored on the tablet, said Maxwell.

The Homecare app also synchronizes wirelessly with the server throughout the day so that all patient data downloaded from the server along with the data typed in by the nurse during a visit is sent back to the server or simply deleted from the tablet after the visit is done. Such policies can be enforced by MDM software, true. But it would be great if other healthcare app vendors emulate Homecare and make such security and compliance features standard.

Eric Lai reports on and analyzes how organizations are adopting mobile devices and apps. This piece is reposted from his UberMobile blog at ZDNet. He is interested in writing more about the intersection of healthcare and mobile technology. Please contact him at ericyolai@gmail.com or via Twitter @ericylai.

9 replies »

  1. I agree with Samuel, that the place for care is in the hospital, not at the poker table using chips and smart phones! Using mobile devices can be both time consuming and expeditious. It really depends on the the person who is inputting the data. Off of the topic a little, the healthcare industry is becoming more and more high tech when its comes to technology and I personally think that is not a good thing. I mean whatever happen to the one on one patient /physician care? Now physicians are spending more time on their mobile datas inputting data then they are spending with the patient! To me, this is not patient quality care! To think waiting rooms in offices will soon be handing out mobile devices to patients so they can check themselves in and put their own information in, in order to save the nurses, medical staff, and front desk time is beyond ridiculous! Yea okay, how is that going to happen when some patients aren’t even incompetent to do this? Due to some patients health statuses and internet experiences, I’m sorry but i don’t see how this would ever be efficient in saving time. Some patients have bad vision and aren’t even internet savvy, let alone mobile device savvy! I think technology is getting a little out of control in the medical field. Other fields I say “bring it on” but when you are dealing with a human being and their health for God’s sake put the tablet down and put your focus on them!

  2. I’m not sure that it is part of the same trend, John, that sounds more like centralised information than healthcare at a distance. I can’t see a direct relationship myself.

  3. As a researcher involved in the field of health care innovation, I found the comments regarding the improved basis of care on a face to face insightful since it seems as though industry is on the progression toward care practiced at a distance with the introduction of EMR and other digital innovations. According to recent news, West Viriginia adopted an electronic registry to provide doctors, providers and patients access to advance directives. This includes, “Do Not Resuscitate” orders, living wills, medical powers of attorney, and physician orders for scope of treatment. Is this not a part of the trend everyone is talking about here?

  4. Yup, blame the user. Cognitive distraction and disruption is widespread from multitasking and the brain is chronically adversely affected by it, neurophysiologists have noted.

    The place for care is in the hospital, not at the poker table using chips and smart phone.

    That is not to say that the current hospital environment with nurses focused on the newest iatrogenic disease, CPOEitis, is safe; but it sure beat the crap care being practiced at a distance.

  5. Many states are banning texting while driving. Will we one day need similar injunctions against texting while ordering, chatting while operating,and friending while monitoring anesthesia? Or will the malpractice attorneys be the ones to provide the “check and balance?”

  6. Horrifying but predictable. Somewhere, someone will always push the limits of any system. Before the explosion of smartphones and the networks needed to feed them, plans for providing similar facilities to medical personnel were based on the concept of a private network with its own terminals – portable or semi-portable.

    It’s far cheaper in hardware terms to build a system using components whose price reflects their enormous market, but the system designers should not forget that, in their work environment, the terminals have a dedicated function.

    Before smartphones became part of the practitioner support network, were staff allowed to make unrelated calls while performing critical tasks like surgery or running an intensive care unit? If so, management must carry a lot of the blame for failing to understand the impact of mobile telephones. If not, then part of the specification for the smartphone-based system should have include a firewall to prevent access to or from the outside world while practitioners were on duty.

  7. Yeah , that was pretty much my reaction. A toast to these forward thinking docs embracing truly disruptive innovation.

  8. Those darn docs – embracing technology like there’s no tomorrow. We have to act now to curtail this trend.
    In other news, Doctors continue to show their fear of new technology as they drag their feet on implementation of EHRs…..