Healthcare in Motion: Giving Docs and Nurses Mobility

6 Nov 2014 by Chuck Appleby

A patient sitting in a hospital bed surrounded by her family and hospital staff

When the NFL’s new use of tablet computers on the sideline was featured in a recent Los Angeles Times article, you knew tablets had become, well, de rigueur in America. The article discussed how teams have adopted tablets to study opponents’ moves, review previous possessions and strategize.

Along with the gridiron, intuitive tablets are making an impact in healthcare — an industry with life-and-death factors that are driving effective mobile strategies aimed at physician and consumer engagement. That’s the case with Geisinger Health System, which serves three million people in central and northeastern Pennsylvania.

Untether physicians and nurses from desktop PCs

Geisinger, routinely mentioned with Kaiser, Mayo, Intermountain Healthcare and Partners HealthCare as a model for the integrated health system, has developed Geisinger in Motion — the health system’s large-scale initiative. Dr. Alistair Erskine, chief clinical informatics officer in Geisinger’s Division of Applied Research & Clinical Informatics (DARCI), said it untethers physicians and nurses from desktop PCs as well as bricks and mortar — the stand-alone hospitals and other facilities that can drain resources from patient and consumer engagement. “Our goal is to shift care delivery services closer to the patient, closer to home or even in the home,” he said.

Geisinger in Motion casts a wide net, including the health system directly giving iPhones (and eventually iPads) to physicians and nurses for secure, mobile access to patient records anytime and anywhere. Another initiative provides tablets to patients undergoing elective procedures at the hospital.

The health system partnered with Verizon for mobile services, because it provides the best coverage at its main facility, Geisinger Medical Center, where the pilot was launched. Geisinger negotiated a single plan for all users rather than individual plans; that made it easier to distribute devices and AirWatch mobile-management software.

Doctors can share photos of wounds

Despite the greater burden for ensuring HIPAA privacy and confidentiality protections, Geisinger expanded coverage to allow photos, to accommodate the picture-taking capability of Epic’s mobile app — Haiku — for physicians. Doctors now can share photos of wounds, for example.

Rounding no longer restricted to paper charts

A typical use case for the portable devices is rounding on the hospital ward, where the screen display can remind physicians and residents of questions to ask the patient without having to shuffle through paper charts. Another advantage for clinicians is the ability to use the devices outside the hospital within a micro Virtual Private Network (micro VPN) that can secure a single clinical app without restricting use of consumer apps.

Secure messaging provides communication to entire team

HIPAA-compliant, secure messaging is a critical component of Geisinger in Motion as it allows communicating patient information — whether medical images or a text noting Mrs. Smith is being admitted to the hospital — to the entire care team. Erskine said another significant, but often overlooked, feature of the platform is 24/7 clinician access to a library of previously underutilized resources such as reference tools and calculators. “Now, we have a platform to promulgate them,” he said.

Patients use tablets to stay informed

The same mobile infrastructure supports tablets for patient engagement. For elective procedures such as lumbar spine surgery, Geisinger provides patients with a tablet a couple of weeks prior to surgery and for 90 days following surgery. Patients can view videos of their doctors explaining procedures, watch movies while recovering, check lab results, and receive reminders to take medications and perform other therapy for three months after the procedure.

Preliminary findings are positive

Chanin Wendling, director of eHealth at DARCI, noted that because the program has been in full operation only since May, the organization is still collecting performance data. However, preliminary findings are quite positive. Prior to the iPhone rollout, 75% of anesthesiologists, for example, expressed dissatisfaction with communications. Following the rollout, that figure flip-flopped to 75% expressing satisfaction.

Geisinger has deployed the smartphones to 200 of its physicians in the pilot; it plans to roll out smartphones to all of its nearly 2,200 physicians as well as 3,320 iPod Touches to nurses, pharmacists and other care-team members. The health system also is developing a tablet model for physicians that will allow them to use Canto, the iPad mobile app similar to Haiku, on the iPhone, according to Wendling.

Three key lessons learned

Erskine cited three key lessons learned to date. One: the fear that using smartphones or tablets in the hospital would disrupt the radio frequencies of biomedical devices, did not occur — largely as a result of careful testing and work with the biomedical engineering department.

Second: the concern that because Geisinger was paying for physician smartphones that would be used for personal calls, the organization might thereby violate federal statutes against conflict of interest. Discussions with the Internal Revenue Service have allayed those fears. The IRS has reassured the health system there is no problem as long as the devices are primarily used for patient care.

A third lesson involved infection control. Geisinger was able to resolve that issue by acquiring LifeProof protective cases for its mobile devices. The waterproof and light-weight cases still allow unimpeded screen access.