July 16, 2012

Armed for Care
By Selena Chavis
For The Record
Vol. 24 No. 13 P. 18

A California home care group has successfully mobilized its EHR by putting it into the hands of its on-the-move clinicians.

Healthcare is fundamentally a mobile environment. Hospitals and health networks have long recognized the potential of linking mobile devices to patient care to create workflow efficiencies and enhance care quality.

Depending on the care setting, the availability of EHRs on mobile devices can make a dramatic difference in positioning an organization for the future when the expectations for quality and efficiency will be heightened significantly, according to industry professionals.

Sutter Care at Home, the home care affiliate of California-based Sutter Health, is reaping the benefits of a recently deployed EHR that runs on smartphones. The organization also has plans to introduce tablets to all clinicians, according to Phil Chuang, director of information services, who points out that the tablet initiative is an outgrowth of demand.

Physicians may be reluctant to adopt EHRs—statistics reveal an uptake of between 20% and 50%—but when it comes to mobile technology, the numbers tell a different story. A survey conducted earlier this year by Manhattan Research encompassing 3,015 practicing physicians revealed that 62% have adopted media tablets, with one-half saying they are using the technology at the point of care.

“That’s what everyone is striving for,” Chuang says, noting that in the Sutter Care at Home program, 60% to 70% of documentation is done with the patient, a notable contrast to the previous 10% prior to smartphone deployment. “We’ve seen a significant increase in documentation at the point of care.”

Ed Elliott, technical services manager for Sutter Health, notes that the deployment has addressed one of the fundamental workflow issues that has plagued home care for years: timely documentation. “When you have a case like we do with a mobile business, the use of mobile technology adds tremendous value,” he says.

The end-to-end process for claims and billing used to take 35 days, according to Elliott. Now, patient billing is completed within five to eight days, and there is an expectation that documentation will be completed within 24 hours. “It speeds the whole cycle,” Chuang says.

The move toward greater use of mobile devices is a game changer, says Edna Boone, MA, CPHIMS, senior director of the HIMSS Mobile Initiative, and one that took the industry by surprise. “One of the challenges was the unprecedented speed of uptake with these devices,” she explains, “especially by physicians who have historically not been on the forefront of health IT adoption.”

Because of this surge in interest, healthcare organizations are trying to catch up with clinician demand and implement strategies that will help them garner the benefits of a mobile workforce with the technology to support it, Boone notes. Quoting from the first annual HIMSS Mobile Technology survey, she notes that of the 164 healthcare organizations that responded, only 38% had mobile technology policies in place to regulate the use of mobile devices and outline the organization’s mobile strategy.

It’s just one of the fundamental challenges facing the mobile EHR movement, Boone says. “From a technical perspective, many chief information officers are not up to speed with consumer electronics,” she says.

However, successful deployment and adoption of mobile EHRs can be achieved. Sutter Care at Home is one such success story. Chuang offers a look at how the organization achieved its goals through a well-thought-out strategy that helped it clear significant hurdles by harnessing the power of clinician engagement.

Overcoming Initial Challenges
Nearly all the 164 respondents in the HIMSS Mobile survey indicated that clinicians accessed some form of patient information from a mobile device, with the majority using laptop computers and computers/workstations on wheels.

However, for Sutter Care at Home, laptops did not make the cut. According to Chuang, in 2005, the organization tried to deploy a mobile EHR via laptops and air cards. When he came on board in 2008, the system still had not been completely rolled out.

“Clinicians didn’t like it or use it,” Chuang says, pointing out that the combination laptop/air card system, which was not easy to use, put a huge crimp in productivity. The laptop would have to be launched, followed by the air card and then the application. “If that took 20 minutes, it was a really good day,” he says.

Engaging clinicians and back-office personnel, the IT department reassessed the situation and decided to go a different route. “Whether using a mobile device or a laptop, it needs to be easy to use,” Chuang says. “In our situation, the laptop was not easy to use.”

The Manhattan Research survey found that while tablet adoption (mostly iPads) is mainstream for physicians, those with three screens—tablets, smartphones, and laptops—spend more time online on each device and go online more often during the workday than physicians with one or two screens.

Because tablets were relatively unknown in 2008, Chuang says Sutter Care at Home made the decision to deploy smartphones because the devices turn on quickly and are always connected to the Internet. “It gives you faster access and less stuff to carry,” he explains, adding that the last thing clinicians want is another bag.

Since that time, the organization has made the strategic decision to move clinicians to tablets. As tablets became more mainstream, many clinicians preferred the larger screen size and believed it to be more conducive to typing. However, some clinicians still like smartphones better because they fit in their pockets, Chuang notes.

It appears the situation at Sutter Health mirrors the rest of the industry, where reports suggest that tablets and smartphones are the darlings of the mobile deployment scene. The HIMSS Mobile Technology survey revealed that two-thirds of respondents were planning to expand the types of devices they offer to clinicians for daily use. Nearly 71% of those not presently providing tablet computers planned to do so, while approximately 62% not offering smartphones planned to introduce the device in the near future.

Technical Considerations
Elliott points out that when considering a mobile device vendor, healthcare organizations must look for a common platform or a common device management tool set. “The reality of the mobile device world is that there will always be multiple devices and operating systems,” he explains, adding that vendors need to be willing to advance and move with the market. “You need a mobile device management vendor that is committed to supporting multiple operating systems.”

During the decision-making process, Chuang recommends targeting vendors that design applications specifically for mobile devices. Having a clear understanding of the capabilities and limitations of mobile devices, especially when it comes to data entry, is important in a healthcare setting. Boone notes that most successful vendors have been EHR companies that design a modular solution just for mobile EHRs.

“If a lot of data entry is needed, you need to consider how to address that need,” Chuang says, pointing to such additions as keyboards, docking stations, bluetooth keyboards, and styluses. “You need to think about the physical tools that allow users to be more productive.”

Battery life expectations should also be addressed. Chuang notes that a key advantage of mobile devices such as smartphones is that they have a much longer battery life than laptops. To compensate for any battery life shortcomings, in some instances Sutter provides clinicians with car chargers, says Chuang.

Deployment Best Practices
With 18 branch offices, Sutter Care at Home had a decision to make when implementing its mobile EHR: go all in at every location or take a gradual approach. In the end, it decided to go live at one locale. “That gave us the opportunity to learn the hard lessons in a much more controlled environment,” Chuang says.

After the initial challenges were fine-tuned, Elliott recalls that the final rollout “was incredibly rapid,” taking a mere four months to get all branch offices online. Critical to success was clinician feedback and testing. “They are the ones who have to use it,” Chuang says. “We needed early adopter clinicians who were excited about the technology but willing to be tested.”

Referring to early adopters, Chuang notes that identifying a group willing to support the initiative and spread a positive vibe is critical to success. “They are that last step that makes it go well,” he emphasizes, pointing out that feedback from these supporters helped Sutter make the decision to move to tablets.

Following the deployment of smartphones, Elliott notes that the organization realized several immediate improvements, including the fact that the remote management of mobile devices became much easier. Even so, he points out that “smartphones, while an improvement, were not the final destination.”

The fact that the IT department engaged clinicians in the process enabled effective communication about any smartphone limitations that could have resulted in push back. For example, many clinicians found screen size to be less than ideal and data entry to be troublesome.

“There are limitations with any technology, and there were some frustrations,” Chuang acknowledges, adding that the IT department tried to be responsive and address many of the issues by introducing tablets. “We can’t fix everything. ... [Clinicians] just want to know there is a dialogue.”

Going All In
Is it wise for a healthcare organization to go completely mobile with an EHR? Industry experts suggest that many considerations must come into play, including care setting, expectations, and vendor capability. “It’s appropriate to look at the care setting … the home care market is obviously a wise choice because it has a staff that is mobile and lends itself to fully deployed capabilities,” Boone says.

Chuang suggests organizations ask themselves, “Are we expecting a smartphone or a tablet to be our only computer or is it a nice accessory when you are not in the office? Is your expectation that your staff be mobile all the time? In our case, all care is delivered in the field. We have to be mobile.”

After determining the project’s expectations, it’s important for healthcare organizations to consider a vendor’s ability to support an “all-in” move. Most vendors are not ready to support that type of initiative, Chuang says.

With those factors in mind, Chuang says going fully mobile doesn’t make sense in many cases, especially hospital environments. “Our back-office employees use computers. Clinicians use devices,” he says. “Putting the back-office people on tablets would not make them more productive.”

Boone suggests that acute care settings and office environments will often benefit most from a combination of mobile devices and hardwire computer support.

— Selena Chavis is a Florida-based freelance journalist whose writing appears regularly in various trade and consumer publications covering everything from corporate and managerial topics to healthcare and travel.