Physicians are all about smartphones, embracing them en masse. Adoption rates hover anywhere from 72 percent (Manhattan Research, Taking the Pulse, May 2010) to 94 percent (Spyglass Consulting Group, Point of Care Communications for Physicians, July 2010). The numbers, however, don't tell the full story, because adoption does not necessarily equate to robust clinical use. At this stage, there are a few killer apps, but true integration into the clinical practice of medicine and the meat of clinical workflow, a.k.a. the EHR, remains a work in progress.
One of the key differences between smartphones and other clinical IT systems is the bottom-up nature of dissemination. With EMRs, the C-suite and health information management administrators pushed technology onto clinicians, but not always with great cooperation, observes Claudia Tessier, CEO of mHealth Initiative in Boston.
"The utilization of smartphones and related apps is reversed. It's spontaneous among clinicians," says Tessier.
"Physicians are becoming accustomed to gaining access to various apps and services via the smartphone," adds Steve Flammini, CTO of Partners HealthCare in Boston. "My sense is that physicians view the smartphone as a computer, which gives rise to the expectation that they would be able to connect to clinical systems on it."
Smartphone technology is just about primed to meet that expectation. Battery life, display quality and size, operating system power and the maturity of wireless technology have progressed to the point where the systems may be capable of meeting physicians' expectations.
Flammini and his team were charged with testing the hypothesis late in 2009, when health system leadership challenged them to develop version 1 of a mobile EHR viewer.
One of the primary early flaws in EMR development, says Tessier, was focusing onmaking paper records electronic instead of thinking about what technology could do to improve documentation and care. Flammini et al apparently learned the lesson.
"We did not create any new infrastructure for the project. We optimized presentation for mobile devices, which represents a 90 percent re-leveraging of existing assets and 10 percent net new development," says Flammini. The end result is an effective, intuitive application without a lot of bells and whistles.
Physicians use the mobile EHR to inform clinical decision-making without interrupting rounds, update patient charts without leaving their rooms and check results, notes and clinic schedules from home. "It's a useful adjunct to the systems they currently use. They aren't ready to abandon conventional apps in favor of it, but they see its value when they are on the go," continues Flammini.
A large part of the success of the project is due to its simplicity. Flammini and his development team gathered input from a group of physicians and other stakeholders before devising an architectural approach that recognizes the potential and the limits of mobile technology. For example, physicians aren't likely to write a progress note on an iPhone, but template-driven documentation is feasible, and will be developed with ease of use top of mind.
Although version 1 is a home run with many users, the project was not without opportunities for learning. Partners' mobile EHR viewer initially supported iPhone, iPad and Blackberry devices. However, Flammini found that demand was much higher for Apple devices and that the volume of demand didn't justify development costs for the Blackberry.
The technology team will continue to evaluate emerging platforms, such as the Android-based devices—with a caveat. "Security is not perfect on any of these devices, but it is adequate on the iPad and iPhone 3GS and above, with enterprise-strength Android-based devices on the horizon," says Flammini.
The Partners HealthCare mobile project worked around key players—EMR vendors. But that model may not suffice in most organizations.
However, Tessier is cautiously optimistic about EMR vendors' growing acceptance of mobile technology. "The EMR community is taking notice of mobile technology and making moves toward integrating mobile device data into EMR systems so that data can be accessed, used and even created and generated through a mobile app."
Beyond the EHR
Indeed, the message about clinical utility of smartphones is a bit mixed. Bleeding-edge adopters may be stretching toward EHR integration. However, the bulk of U.S. physicians may be content with other