Everyone in healthcare uses smartphones nowadays, but no one's quite sure what to do about them.
That's one of the big takeaways from the inaugural HIMSS Mobile Technology Survey, published this past December, which polled policymakers at healthcare provider organizations nationwide to gauge their take on usage and regulation of mobile devices.

The results show that hospitals are still finding their way when it comes to mobile technology, with respondents rating their facilities' "maturity" an average score of 3.88, on a scale of one to seven, with seven representing a high level of maturity.

That number may seem low, for a technology that's become ubiquitous. But with policies needing to address everything from which brands of devices are allowed, how they're used, who uses them and how they're kept secure, there's no shortage of complicating factors for rule-makers to consider.

"I think it's really, truly something people are grappling with," says Jennifer Horowitz, senior director of research at HIMSS Analytics.

"Grappling is the right word," says John Hoyt, executive vice president at HIMSS. "CIOs are somewhat bombarded. Society comes out with these new tools. Physicians walk up to the CIO and say, 'I want to use this.' The CIO is unprepared."

Use of personal devices is especially problematic. "The physicians are walking into the environment, saying, 'I already bought this for my personal use. I want to use this," says Horowitz.

Saying "N-O" (as was one CIO's spell-out answer, Hoyt said) can lead to employee dissatisfaction.
But the alternative is a potentially disastrous security issue. Indeed, privacy and security was the most frequently cited concern for survey respondents, and was said to be barrier to more widespread mobile technology at their organization.

"Something's got to give," says Hoyt. "Either the physicians give or the CIOs give, or society comes up with better technology security tools for these devices that physicians buy in Verizon and walk in, saying, 'I want this.'

That's why things are so tricky. The lack of clarity is not because of ignorance, or because the issue has been pushed to the back burner. It's that CIOs just don't genuinely know what to do.

"They're still surveying and coming up with the plan," says Hoyt.

For the time being, most doctors are using their smartphones to look up clinical guidelines or to view patient information; far fewer are using the devices to enter clinical data. That stands to change soon, however, as mobile EHRs become more widespread, more robust and more secure.

Just viewing patient data is relatively secure. But "if you start entering data, then you get into potentially storing it on the end device," says Hoyt. "That's what scares the daylights out of CIOs."

Ultimately, the security issue is solvable. The likely scenario, says Hoyt, is "VPNs, and the phones do not store anything locally. It's a viewing tool. You can order. That's fine. But you do not store anything locally. If I were a CIO today, that's the rule.

"Can it be done? Absolutely it can be done," he says. "Physicians do it in their homes, with their own personal PCs. They sign on to the hospital's VPN and the go into their records and see anything.

Radiologists have been doing it for years. Can you do it on mobile devices? Absolutely. As long as you do it on a VPN and do not store anything locally. And if you want to use a three-inch screen to diagnose, go ahead."

In the mean time, CIOs keep trying to find a way forward that satisfies the competing interests at stake. "It's that classic double-edged sword," says Horowitz. You have this great opportunity to be able to get this information into people's hands and get potentially more immediate responses. But how do you control it?"

Upward mobility

Asked for a mobile technology trend to keep an eye on in the near future, John Hoyt doesn't miss a beat. "Patient engagement," he says. "Absolutely, I think it's patient engagement. The federal government has goals around patient engagement in meaningful use: What can we do to get people more personally involved?"

"These devices, with the younger generation, have potential," Hoyt adds. "There are some interesting pilot studies. One vendor who's giving away pedometer chips. And the kids sign in at night and put in their numbers. The system comes back and gives you lollipops and hearts and stuff if you've done a lot of steps today. They compete with their friends, and it becomes a social thing. To get kids a) to walk more, b) to be somewhat competitive about it with their other friends, and c) frankly, yes, to use their software and get its name in front of them. Its not that these kids are all going to grow up to be CIOs, but...hey, it's a smart idea.

In a blog post on the mHIMSS.org website, Andrew Watson, MD, medical director at the Center for Connected Medicine in Pittsburgh, explained how telehealth technology – greatly enabled by mobile devices – reduces the burden for patients by expanding access.

"In my current telehealth practice, I consult with both pre- and post-operative patients, while simultaneously collaborating in real-time with the rural clinicians who are onsite with the patients. Laboratory testing, as well as procedures and diagnostic studies, are performed at the rural hospital, and results are sent to me digitally via the telehealth network.

"Increasing patient access to quality medical services is a primary focus of today’s healthcare industry, and telehealth is a valuable tool to help accomplish this mission. Ultimately, we can remove the added travel burden on rural patients, while increasing the quality of care they receive. Most importantly, we are keeping the care in their community where it belongs."