Mobile EHRs are bringing patient information into the cloud. Experts explain what today’s mobile EHRs can and can’t do.
This information is part of a Medical Economics exclusive ranking of the top 100 EHR companies. (medicaleconomics.com/top-100-EHRs)
In less than a decade, the medical record has evolved dramatically, changing in physical space from occupying walls of shelving, to server rooms, to the cloud-and now even to your pocket. Although many doctors may have been hesitant to switch from paper to electronic health records (EHRs) in the first place, the appeal of accessing these records via their gadgets is nearly irresistible.
providers want mobile
In fact, according to recent research from technology research firm Black Book Rankings, many physicians are now at the point of wanting to replace their current EHRs with products that perform better or are more suited to their needs. While going through the trouble of switching, physicians are demanding the systems they adopt have mobile capabilities.
“A mandate has been issued and progressive vendors are reacting,” Doug Brown, managing partner of Black Book Research, commented in a news release. “A full 100% of practices participating in the follow-up poll [to the previous EHR-switch study] expect EHR systems that allow access to patient data wherever physicians are providing or reviewing care.”
Further, the researchers found that while just 8% of office-based physicians currently use either a mobile device for electronic prescribing, accessing records, ordering tests or viewing results, 83% indicated they would adopt mobile EHR functionalities to update patient charts, check labs and order medications immediately if available to them via their current EHR.
But how close are these dreams to becoming a reality? Experts who spoke with Medical Economics explained what today’s mobile EHRs can and can’t do.
The foremost benefit to providers in having mobile EHR access is simply to be able to make better medical decisions when away from the office, says Joseph Kvedar, MD, founder and director of the Center for Connected Health, a division of Partners HealthCare in Massachusetts.
“So wherever that may be, one has a fiduciary to one’s patients 24 hours a day, and things come up,” says Kvedar, who is also a practicing dermatologist in Boston.
He recounts an example of talking to a nurse from his car about a patient who needed a medication change. Because the nurse had access to the medical record at the facility, she could relay that the patient was in kidney failure and shouldn’t take the medication Kvedar originally suggested over the phone.
“If I were elsewhere [besides the car] and had all that information on my tablet, it would make me a better clinician,” he says. “So having features that go into helping you make better decisions about a patient available in a mobile format is really powerful because it’s going to improve quality and lower the error rate.”
The lifestyle factor is powerful as well. Physicians are already early adopters of smartphones and tablets for personal use, and the ability to use them to handle everyday work occurrences is attractive, notes Derek Kosiorek, CPEHR, CPHIT, a principal with the Medical Group Management Association’s Health Care Consulting Group.
“So a lot of them already have them [devices], but it’s a matter of getting them interfacing with the EHRs to access them anytime they need the info,” he says. “So if they get paged or called, then they would be able to pull up relevant on the mobile device quickly wherever they are.”
Another advantage of having an EHR in a handheld format is the ability to show patients images such as scans, educational diagrams or charts trending certain health metrics such as their blood pressure or weight over time. The same show and tell functionality is also possible with a laptop or desktop computer, but can happen more smoothly with a mobile device, Kvedar notes. While it may not be the primary benefit of using a mobile EHR, doctors and vendors certainly see the potential to leverage it as a tool to improve patient education and shared decisionmaking, he says.
Physicians surveyed by KLAS Enterprises about mobile health applications agreed, according to Erik Westerlind, KLAS’ senior director of financial and services research. According to the company’s 2012 survey of hospital chief information officers, “one of the greatest things doctors appreciated was that they could actually go sit next to the patient and show them the image on that device so the patient would understand.” Westerlind adds, “It was a way for them to connect more personally with the patient.”
It’s important to keep in mind that, as of now, most mobile EHRs work best as a tool to consume information rather than to create it. While Westerlind reports that vendors are working on adding note-taking features to mobile EHRs, Kvedar says that most of the EHRs he works with are still presented in a read-only format.
“I can look at lab data, X-ray data and so forth,” Kvedar says. “When we get to the point I can use it as both a data input device and a retrieval device, I think that will really improve workflow and change the footprint of the exam room.”
Another potential problem to be aware of, according to Westerlind, is the possibility of some record data not being visible (or being hidden) on devices with small screens. “The biggest complaint we got [in our survey] had to do with applications not being optimized for a particular form factor,” he says.
Because of the patient safety risk associated with important data being invisible to clinicians, vendors have put a lot of work into correcting the problem, he adds, though it’s still a glitch to look out for.
Also keep in mind that in applications that do allow input of data, the keyboard when visible can obscure most of the screen, making devices less convenient than they may seem for this purpose.
No matter what kind of mobile tools you adopt, the most important key to reaping their benefits is in training, says Kosiorek.
The biggest mistake practices make in implementing any kind of technology, he says, is to skimp on training, both financially and in terms of time. “If you’re not learning how to use the tool, then you’re kind of winging it and you’re going to be missing the things that you could be doing,” he says.
Moreover, if you’ve only recently adopted an EHR in your practice, get very comfortable with the basics of using it on your laptop or desktop computer before worrying about mobility, Kvedar says. “Understand that it’s a second-order goal. I wouldn’t base my whole strategy around it.”