Today's cell phones and other mobile devices like the iPod Touch and iPad are increasingly part of today's health landscape. Used by health professionals, patients, educators, students, and researchers alike, mobile devices offer a wealth of powerful tools that can be used in a multitude of ways. In this module, we'll cover some of the long-term and cutting edge trends in how mobile devices are used in hospital and academic settings, as well as discuss some of the concerns with the prevalence of mobile devices.
Topics covered in Module 3:
Clinicians, nurses, and other health care professionals use smartphones and other mobile devices like iPods and tablets for many reasons:
iPads are particularly popular in hospitals and clinics. In fact, many hospitals are buying iPads in bulk for their staff. iPhones, Blackberries, and other smartphones are commonly used by physicians as well.
Though health professionals have long had access to medical tools and references on their mobile devices (Palm Pilots and other PDA’s, for example), only recently has the electronic health record moved to a mobile platform. Many medical institutions now provide access to the medical record via smartphones and tablets. Some major electronic health record providers (Epic, for example) have mobile versions of their EHR system. Others use software like Citrix and VMWare to access the virtualized desktop version of their EHR. Still other institutions have created their own unique EHR apps.
In the future, new EHR systems are likely to be developed with iPads and other mobile devices in mind as the primary access point. Several competitors have already emerged into this space, bringing a cleaner, visually appealing sense of style to the generally clunky and cumbersome EHR space, as well as bringing the mobility on which health care professionals rely. Two great examples are:
iPads are also very popular to take on rounds and for surgery. This video from Japan was the first to show the iPad in action in the OR.
Radiology apps like OsiriX (seen in the video above) are used in conjunction with EHR systems, but many other apps are available for health professionals. Some of the most unique are those that turn phones into medical devices. See the presentation below for some examples of how smartphones are being used by physicians and patients to monitor conditions and transmit patient information to physicians instantaneously.
Note: ivormedical.com - mentioned in the presentation above - was not working as of 3-14-12
Many hospitals and clinics are comfortable using iPads, iPhones, and iPod Touches for clinical information because of built-in security features and the ability to use VPN, plus Citrix and VMWare for virtualization. Though Android, Windows Mobile, and Blackberry phones have many medical applications available, they have not had the uptake amongst hospitals for clinical (not just email) use.
For more resources on clinicians and other health professionals using mobile devices, plus links to information on security and privacy using these devices, see: http://www.delicious.com/tag/getmobilized+topic3clinical
Schools were quick to pick up on mobile trends, both in K-12 education and in higher education. Students are simply used to using their cell phones. Schools use mobile devices in a number of ways, ranging from sending out emergency text messages to the student body in crises to using phones as “clickers” in classrooms. Teachers have also embraced using tools like Twitter to generate classroom discussions. Many universities have created mobile apps to help their students navigate campus, learn about campus history, find fellow students, and much more.
Health professions students are particularly benefited by the mobile revolution, due in large part to the sheer amount of available apps to help students study and learn. Students have access to mobile versions of textbooks, 3-D interactive anatomy atlases, flashcards and question banks, medical calculators, databases, video tutorials, and hundreds of other useful reference materials and tools. Tools like Evernote, Mendeley, and Papers allow researchers and students to create their own personal libraries and to access their journal articles and other documents on the go.
Many medical schools recommend or require mobile devices; some provide their students with mobile devices such as iPads and iPod Touches. Schools that do provide devices may also provide students with helpful clinical apps and other study and course materials and books. Some medical schools even create their own apps for students. Ohio State University was one of the first medical schools to give out mobile devices (iPods) equipped with clinical apps:
Residents are also using iPads on their rounds. Here is an example of an iPad program for University of Chicago Medical Center residents:
To see more examples of how medical schools and other academic areas are using mobile devices, see http://www.delicious.com/tag/getmobilized+topic3education. Particularly recommended are the @Hand conference presentations.
Tools for Patients
In topic 2, you learned about apps, including apps for patients and consumer health. Apps are a great way for everyone to manage their health, but there are lots of other reasons to use mobile devices for patient care. Patients in the hospital, for example, can use mobile devices to keep in touch with their friends and family. Some hospitals already provide Skype-enabled laptops for patients to use; devices like the iPhone 4 and iPad2 have front-facing cameras that can be used the same way. Mobile devices can also be used for patient education, whether to show presentations or videos about an upcoming procedure or to give patients information about their condition.
Some hospitals are already beginning to experiment with location-based apps (like foursquare) and augmented reality. Augmented reality, which places a layer of information over what’s really there, uses a smart phone’s camera, compass, GPS, and other built-in features to display information over the live image of whatever the camera is pointing at. Some potential scenarios include using augmented reality to give patients directions to their appointments, to point out restaurants and restrooms, or to give information about the history of an institution.
In the presentation below, some health and fitness tracking apps are shown, along with a few augmented reality applications. There are also some examples at: http://www.delicious.com/tag/getmobilized+topic3patients
Academic libraries quickly saw the potential for mobile devices in their libraries, and academic medical and hospital libraries are not far behind. A few ways that libraries use and support mobile devices are:
For some examples, see http://www.delicious.com/tag/getmobilized+topic3libraries
Any innovative uses of mobile devices in health care or academic settings are subject to HIPAA and FERPA compliance regulations. HIPAA stands for the Health Insurance Portability and Accountability Act. HIPAA was established in 1996 to protect patient confidentiality. It provides strict regulations that are meant to safeguard patient health information from being lost, stolen, or otherwise mishandled, especially regarding the electronic exchange of health information.
Mobile devices make it possible for health care practitioners to remotely access and share patient health information, whether it takes the form of a home health care nurse entering a patient’s blood pressure date into his health record using an app on her iPad or a physician emailing a patient from her smart phone. Remote access of electronic patient health information requires that an institution insures that certain steps take place to guarantee patient confidentiality is maintained in accordance to HIPAA guidelines.
The Department of Health and Human Services issued a guide (PDF) to maintaining HIPAA compliant portable computing devices which gives several scenarios for conducting a risk assessment.
FERPA stands for the Family Educational Rights and Privacy Act of 1974. FERPA provides students and their parents the right to access the student’s educational and behavioral records, the right to seek amendment or correction to these records, and protections against unauthorized disclosure of the information from these records. Institutions looking to support or implement services utilizing mobile devices that are affected by HIPAA and/or FERPA must include appropriate risk assessment to protect patient and student data to meet federal regulatory rules.
Many institutions, such as Thomas Jefferson University, are educating their staff on FERPA issues and how they can secure their own mobile devices. This presentation (PDF) provides examples of security concerns and specific steps individual can take to secure their own smart phones. Some common areas of risk assessment for both HIPAA and FERPA compliance include:
For more information about HIPAA, FERPA, and steps your institution can take to be in compliance, see the links at http://www.delicious.com/tag/getmobilized+topic3privacy