The introduction of iPhones and iPads revolutionized the way people communicate and made transmitting large amounts of information more convenient and instantaneous. With the expansion into different types of smartphones and tablets — Android- and Windows-based — society has grown increasingly dependent on these devices to transmit and receive information, and this dependence has greatly impacted healthcare. Morris Panner, CEO of DICOM Grid, said that, “For the new generation of physicians, using mobile technology is as common for many of them as a stethoscope. They walk into medical school with one of these devices and expect to receive information on it.”
As physicians continue to find ways to utilize the convenience and speed of mobile technologies to enhance patient care, hospitals, healthcare organizations and mobile technology developers are working to ensure that patient information remains protected.
Mobile Apps In and Out of the Clinic
Today, healthcare organizations are introducing mobile applications that make the trip to the doctor’s office more convenient. Andrew Underhill, senior solutions engineer at Systems Made Simple, has seen this in his work with the U.S. Department of Veterans Affairs (VA) on its patient engagement initiative.
“The veteran population is very dispersed around the whole country, and the VA has a lot of communication problems between its patient population and the medical centers,” Underhill said. In its patient initiative, the VA is pushing out different mobile applications (apps) that allow patients to schedule appointments, look up results and find the location of the nearest medical facility. Underhill expects these mobile apps will offer convenience and help cut down on travel costs. Illinois-based Northwest Community Healthcare’s (NHC) MyNHC app for iPhone and Android offers similar services, allowing patients to view their lab and imaging results, and identify the NHC facility nearest to their location and the services provided. The app reviews the level of care provided at each location and gives driving directions and estimated wait times.
Physicians are also using mobile devices in the clinic to help deliver healthcare information. Panner said that mobile-enabled medical software has allowed physicians to bring a lot more medical information to patients’ bedsides or into an office in a way that maintains a personal touch and comfort — especially in imaging. “We were working with a leading pediatric specialist for pediatric oncology. He looked at the form function of the mobile product, and his response was, ‘My kids are going to love this,’ ” Panner said. Showing patients what is going on utilizing a device that many of them are already familiar with makes the problem more tangible.
“Rather than an amorphous, scary thing, patients can see there’s the problem, and to fix it we are going to try to make that smaller or try to kill that,” Panner explained. He also noted that these tools enable children and parents to have a greater deal of interaction with information. “You can pinch, squeeze and do all the kinds of things that you see kids do with iPads. It makes a world of difference,” he said.
Mobile Image Viewers in the Marketplace
Viewing medical images on mobile devices is becoming more and more commonplace, and vendors are staying ahead of the trend. Early last year, DICOM Grid launched its next-generation clinical viewer, which enables the easy access and viewing of complex medical imaging data and associated reporting from any browser-based device or iPad. At the 2013 Radiological Society of North America (RSNA) annual meeting, aycan featured its U.S. Food and Drug Administration (FDA)-cleared aycan mobile iPad app for teleradiology, which is designed for easy, fast and secure viewing and transfer of DICOM images with an iPad. Claron Technology debuted its BlackBerry 10 app for its Nil family of medical imaging viewers at the 2013 HIMSS conference. The Nil app supports anytime, anywhere, Web-based review of a full range of medical imaging modalities and reports, and capitalizes on the enhanced multimedia and multi-touch functionality of the BlackBerry 10 platform. Mach 7 Technologies, MIM Software Inc., GE Healthcare, Carestream and Fuji Medical Systems also offer mobile image viewing technologies.
Responding to Challenges
The rapid and organic growth of mobile technology use in healthcare has posed some unique challenges. One challenge is the lack of guidance on how the technologies should be used. “There is a lack of healthcare-specific standards in the mobile healthcare community,” said Underhill. “Mobile devices grew up organically without standard organizations dictating the way things should be done, but as those devices are maturing we have to get them to adhere to a new set of standards, or existing healthcare standards will be adapted to include mobile devices,” he said.
The FDA is tackling this problem with its final guidance document for developers of mobile medical apps. The FDA said that it would assess mobile medical apps using the same regulatory standards and risk-based approach it applies to other medical devices. The agency also said that it plans to focus its regulatory oversight on mobile medical apps that present a greater risk to patients if they do not work as intended. This would include apps that allow physicians to access picture archiving and communication systems (PACS), or those that convert the mobile device into a patient diagnostic device, such as a patient monitor.1
Another big challenge resulting from the healthcare industry’s use of mobile devices is security. Panner said that rapid adoption has allowed students and younger practitioners to bring these devices into hospitals and different organizations, and this has caused homegrown approaches to mobile application use. These approaches are problematic because of HIPAA and other privacy laws. Developers and organizations are now faced with the task of maintaining the security of confidential patient records and information. But according to Panner, developers are already addressing this challenge. “For developers like us, one of the first things we spend our time thinking about is safety and security. The security audit piece is a significant part of the deployment,” he said.
Organizations are also doing their part to ensure that patient information remains protected. For Marjorie Calvetti, director of medical imaging at Memorial Medical Center in Springfield, Ill., this includes making sure that physicians’ mobile devices are protected at all times. “We have a pretty strong corporate policy on privacy. All of the mobile devices have password protection on them,” she explained. “If they are lost, we have the ability to wipe all the patient information off of the system, and physicians have to log into the app so we can track who is in the system and who is accessing patient information.” The center also has a full-time security officer who works to protect patient security and how patient information is moved throughout the organization from an information systems perspective.
While some organizations such as Memorial Medical Center allow physicians to use their own devices, others supply physicians with them for added assurance and protection. “Some people will say we only want you using devices that we control,” Panner said. “I think it is an emerging trend of how people balance controlling devices versus finding ways to let people bring the device but manage the software platform.”
Creating an Environment for Mobile Technology
For those organizations that are apprehensive to implement a mobile technology program, Calvetti said it could be done rather easily. “It’s not a complicated learning process. You don’t have to have a tutorial to be able to utilize it, and that’s why we are seeing it adopted so rapidly,” she said. Memorial Medical Center upgraded its Carestream PACS last December, and this upgrade allowed physicians to access images and reports on mobile devices. While Calvetti imagined this would be a big ordeal, she said it was actually a non-event. Because many physicians were already familiar with and using mobile devices, the transition to the new PACS was so smooth that even Calvetti could not believe it. “It was the smoothest transition and upgrade that we have experienced to date,” she said. “It was profound. I’m still in shock.”
The administration at Memorial Medical Center communicated to physicians what was included in the upgrade and when it was going to come. There were also demonstrations of the system before it went live, and administration ran the new system and the old system in tandem for a couple of weeks. Her advice to organizations looking to implement a similar program is to have key physicians trial the system so they can give feedback and provide support. She said being able to provide insight about tricks and tips, and having individuals test it to make sure there are no limitations and that the organization is going to want to keep it, is extremely beneficial.
Future of Mobile Technologies
With the simplicity of deployment, as well as the speed at which physicians and patients are able to transmit and receive information, mobile technology will continue to push the limits of healthcare. It has already proven to be invaluable in certain subsets. “There’s real quantitative evidence of how important this is,” Panner said. “Early studies have shown objective ability to improve delivery of care in the stroke context and in trauma care.”
And although Memorial Medical Center allows physicians to bring their own devices, there is one exception. “Right now the organization does not provide mobile devices to any of our referring physicians, except for our stroke team, because the time, treatment and diagnosis is so essential for our patients,” Calvetti said.
Mobile technology has already greatly influenced the quality of patient care and that is projected to continue. “I think it’s going to be very pivotal for patient care. It’s going to expedite the care that a patient gets because you can access images and communicate care plans anywhere,” Calvetti said.
Panner agreed that the future of mobile technology is bright. “As healthcare becomes more virtual and more accessible, and we’re forced to innovate around new models of care, mobile technology is going to be front and center to that,” he concluded.
1. Fornell D, “FDA Offers Guidance on Explosion of Mobile Medical Apps,” Imaging Technology News. 2013: 11:48-50.