Smartphones and tablets and other mobile computing information technologies (IT) have “the potential” to enhance medication care in hospitals, according to San Diego-based health care technology consultant Mike Wisz, MBA.
In a July webinar sponsored by the unSUMMIT, an organization that creates educational events focused on barcode point-of-care (BPOC) technology, Mr. Wisz offered guidance for hospitals going through “the decision process of figuring out which mobile computer options to deploy for acute care in their unique settings and how to build a team to make that happen.”
“Mobile devices, whether smartphones or tablets,” he said, “are increasingly the prism through which patients, families and clinicians view and manage aspects of their health. That trend is going to accelerate, and it will affect the IT world within hospitals.”
Through a convergence of technologies, such as those that enable remote patient monitoring, telehealth, online medical collaborations, cloud computing and coordinated patient care, the worldwide mobile health market is projected to grow to $23 billion by 2017, he said, citing statistics from PricewaterhouseCoopers (Table 1). “At that point,” he said, “$23 billion will be a pretty healthy fraction of the overall health IT (HIT) market.” As early as 2013, according to estimates by Pricewaterhouse, the mobile HIT market will generate worldwide sales of $4.5 billion.
Already there is a great deal of “very good health and medical care software—some 13,000 apps—on the market for iOS and Android mobile devices,” according to Mr. Wisz. Noting that these apps “are more user-friendly than HIT/electronic health record apps,” he said that sets up a need for pharmacists and nurses to bring their own state-of-the-art mobile devices with clinical applications to their hospitals (Table 2). He noted that some pharmacists are starting to do this, “taking their personal iPads to work, using them to look up drug information, such as calculators, to look at images of pills and sometimes to deal with pharmacy shortages.”
A Convergence Of Devices Urged
Hospital pharmacists use mobile devices in other clinical situations, such as when they are “in the pharmacy to perform medication check-ins to facilitate BPOC and for medication repackaging routines,” said webinar moderator Charles J. Still, MBA. He stressed, however, that the pharmacists “should use the same types of devices that nurses use on the floor to avoid scenarios where a bar code reads OK in the pharmacy but is unreadable by a nurse at the bedside using a less capable scanner.”
Mr. Wisz predicted that there would be opportunities “for pharmacy to do more work with mobile devices in the future, particularly for decentralized pharmacists throughout the hospital because the convenience of mobile would seem to be a natural fit for tasks oriented around reading but not order review,” or inputting data. The scanning of medications as they are dispensed—an additional bar-coding safety check—“also could be done on mobile devices like iPad and Android tablets,” he said. Pharmacy specialists can use tablets to help document that an intervention helped to improve health and the value that a pharmacist contributes to enhanced health care. “I haven’t talked to a lot of folks who are actually doing that,” Mr. Wisz told Pharmacy Practice News. “But I think we will see more of that over the next few years.”
Reviewing the results of the Aruba Networks, Inc., 2012 Healthcare Mobility Trends Survey during the webinar, Mr. Wisz noted that half of all hospitals are planning to expand or refresh their Wi-Fi networks this year; 66% are supporting electronic medical record applications on mobile devices and 58% are using desktop virtualization solutions, such as those from Citrix (a Santa Clara, Calif.-based provider of cloud, networking and virtualization technologies).
In a related evolution, he said, smartphones are evolving into medical device platforms, “as an increasingly wide array of accessories can be added to the phone, taking advantage of capabilities such as the camera, which can be adapted to perform eye exams, for example.” A variety of sensor technologies are being developed around these platforms, for use both by health care professionals as well as consumers, Mr. Wisz noted. “Smartphones also are being used,” he said, “to view a wide variety of images, including image types used within radiology, pathology and cardiology.”
In hospitals, he added, smartphones also are being adopted to transmit voice alarms and text messages, “using consumer-grade usability to improve communications, coordination and care.”
In evaluating tablets like the iPad, Mr. Wisz focused on their “promise,” which he said, “will increasingly affect medical computing over the next few years. However, they are not ready for prime time in the acute care environment. Perhaps the most significant drawback of iPads for BPOC,” he noted, “is that the applications have not been redesigned from the ground up to work effectively” with these tablets. “Tablets are also limited with respect to data entry; they are difficult to disinfect; they are fragile and have a short battery life (10 hours); they can’t multitask and they have no bar-code reader.”
He added, however, “that we are seeing a lot of enthusiasm in health care for tablets, and physicians—especially affiliated physicians—are driving IT departments to be able to support tablets. And I think you are going to see iPad and Android tablets more widely used in the future.”
In his unSUMMIT webinar on trends for integrating mobile computing devices with health care apps to Barcode Point of Care (BPOC) systems, Mike Wisz, MBA, offered guidance on how best to evaluate and deploy the various mobile options now on the market.
The choices he discussed included Workstations On Wheels (WOWs), in-room solutions (such as arm mounts and wall cabinets) and mobile computing devices including smartphones and tablets. (See related story, this page.)
Based on his observations as a mobile health technology and medication management consultant with 20 years experience with a variety of hospitals and health systems, Mr. Wisz considers understanding workflow to be the first step in making decisions about which of these options are the best choice for a particular need. “Process and workflow are important, especially with bar coding. There are a lot of things going on, including how the process impacts nurses’ productivity.”
WOWs are “the most popular option right now,” he noted, but “in-room options are getting better and they are becoming more popular, so there is a trend to using more in-room options, driven by new construction that often includes a computer in every room or even by every bed. Some leading vendors are recommending larger screen requirements, as large as 22 inches, to look at all the detailed information that is available through the software applications.
Mobile deployments including smartphones and tablets as well as handheld computers, he said, “have always been dependent on the software that a hospital is using for its BPOC application. Most vendors support both handheld and mobile applications, as well as full screens. But, generally, BPOC applications from most vendors work best on a full screen.”
But the medication distribution process, he said, also can determine the choice of which type of system to deploy. “If a hospital is going to store and manage medications near the bedside, that sets up a nice opportunity to use WOWs as your computer device. It cuts down the hunting-and-gathering time because the medication is right there in the cart.”
The choice between in-room and mobile WOWs and handheld devices, he said, has always been “a trade-off over the years,” between such things as screen size versus portability and considerations like battery life and size. The industry has been looking to tablets as a compromise solution because they are portable and they have larger screens than handhelds and smartphones. Tablets offer significant promise, but they haven’t yet worked as well as their promise would lead you to think.”
Considerations in deploying WOWs, he said, include the availability and depth of wireless coverage, shorter battery life, space consideration because they tend to “get in the way” and their weight and mobility. However, he noted that WOWs are “increasingly getting better, lighter and easier to wheel. And a lot of hospitals are changing their medication distribution model, by storing medications closer to patients’ rooms allowing nurses to spend more time at the bedside.”
To make the most informed choices, said Mr. Wisz, hospitals “will need to draw together an interdisciplinary team to focus on such details as where the medications are being prepped as well as stored, etc.”