Mobile Devices: EMR Integration Is Just Beginning

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As the process to convert and integrate EMRs to mobile devices begins, here’s what the mobile-savvy CMIO should expect.

About 72 percent of U.S. physicians are currently using smartphones—up from 2009’s 64 percent—and the percentage should reach 81 percent by 2012, according to Manhattan Research’s 2010 “Taking the Pulse” report. No wonder a no-holds-barred, all-out war among vendors is on in the mobile technology market space. The prize: Clinicians’ workflow—and thus purchasing—loyalty.

In addition to Apple’s iPad, Research in Motion’s Blackberry and Google/Open Alliance’s Android, a stream of competitors is taking aim at healthcare. These include Dell, which in September announced it is integrating its EMR and mobile clinical computing (MCC) products into its 5-inch Android-based Streak tablet for medical applications. Verizon Wireless and Samsung Telecommunications America in November made available the Samsung Galaxy Tablet.

This influx of tablet/smart technology has not gone unnoticed by healthcare professionals. For example, John D. Halamka, MD, MS, health IT guru and CIO of Beth Israel Deaconess Medical Center and CIO at Harvard Medical School in Boston, opined in a blog entry in November that iPhone/Android smartphones, iPod Touch, iPad, Playbook, Galaxy and Streak “will become the platform for healthcare.”

That future may be now. Clinical users have already begun adopting creative solutions/applications of these platforms to suit their facilities’ mobile needs. In the third quarter of 2010, Android—an open-source platform—held almost 44 percent of the market, followed by Apple with 26 percent and RIM with 24 percent, according to technology vendor analysis firm Canalys.


Glen Geiger, medical director of clinical information services at The Ottawa Hospital (TOH), a 1,172-bed teaching hospital serving 1.5 million people in Ottawa and eastern Ontario, Canada, outsourced a developer to integrate TOH’s customized EMR for iPads usage to enhance the organization’s mobile capabilities beyond its computers on wheels (COWs). Out of the 1,183 physicians at TOH, 100 are piloting a native iPad app with plans to deploy 500 iPads to clinicians this month, Geiger says.

“Preliminary feedback is very good,” he adds. “Clinicians are anxious for us to deliver the full linkage to the image viewer but the initial rollout has been a good down payment on future functionality.”

The EMR app took three months to design and build, and contains an ED-patient tracking module as well as the primary clinical viewer that provides access to patients’ clinical data. The mobility of the iPad and its native EMR app will improve patient/physician interactions, Geiger says. Physicians will be able to access up-to-date information such as x-rays or consultation reports at the bedside.

TOH is currently determining the iPad’s optimal place in the workflow within the organization, says Geiger. “We’re trying to figure out basic stuff like if clinicians want lab coats with big pockets to carry them around or not, and how to sterilize the devices.” He expects the iPad technology will be a huge asset for e-prescribing, especially at the bedside.

The iPad’s lack of an internal microphone or camera has garnered some criticism from healthcare professionals that the device is not the best fit for healthcare. Geiger acknowledges that the device is not the end-all, be-all of mobilization/functionality/efficiency.

However, “we’re not done by any means in terms of improving mobility and efficiency,” Geiger says. “We recognize that better technology might come along later and if it does, we’ll consider the options, but for now, we’re hitting the ground running with this initiative.”

“Our strategy is to develop our mobile EMR once instead of moving across multiple platforms,” he says. “For us, this is a better investment than going after every single tablet.”

It’s about the patient …

Without patient engagement, mobile platforms are useless, says Henry J. Feldman, MD, chief information architect, Division of Clinical Informatics at Harvard Medical Faculty Physicians, and a hospitalist with the Division of General Internal Medicine at Beth Israel Deaconess Medical Center (BIDMC) at Harvard Medical School in Boston.

Feldman uses an internally built, web-based EMR platform from his iPad to engage patients at the bedside via devices like electronic anatomy textbooks to show and compare reference