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Are Health Systems Getting The Most Out of Their mHealth Platforms?

A mobile communications study released in advance of HIMSS18 finds that hospitals and health systems aren't yet adapting their mHealth platforms for care management and coordination.

Source: ThinkStock

By Eric Wicklund

- A new survey finds that healthcare providers are using their smartphones for communication – but not for the growing variety of mHealth capabilities that these devices now feature.

The study, developed by HIMSS Analytics and PatientSafe Solutions and released ahead of this week’s Healthcare Information and Management Systems Society (HIMSS) conference and exposition in Las Vegas, blames the disconnect on a lack of integration. Either the devices themselves can’t mesh with mobile health platforms, or the platforms aren’t fitting into provider workflows.

“(I)t looks like the primary use of mobile clinical communications solutions today is texting and other forms of communications, versus leveraging ‘smart’ capabilities - like easier access to patient data, that are available today,” Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN, Vice President of Informatics for HIMSS North America, said in a press release. “To me, clinicians are still reliant on mobile devices for general communications, as opposed to a detailed clinical care focus, which makes sense given we’re still early in the evolution of smartphone use in healthcare settings.”

According to the survey of some 302 healthcare providers, conducted last November, more than three-quarters said the primary use of their clinical communication platform is for HIPAA-compliant secure messaging. Slightly less than half chose either consolidation of voice and secure messaging services or delivery of critical results and alerts.

Farther down the spectrum, however, were mobile access to patient data, at 30 percent, mobile clinical workflow management and documentation (23 percent), communication with patients and their families (12 percent) and assignment management (7 percent).

READ MORE: CMS Clarifies Texting Rules Amid Rumors of mHealth Message Ban

When asked what was most important in selecting a clinical communications solution, respondents cited improving patient safety (51 percent), faster response time between care team members (46 percent) and faster response time to patients (42 percent).

“Responding to nursing calls and telemetry alarms accounts for a large part of a clinicians’ workday,” Steve Baum, PatientSafe’s Vice President of Products, said in the report. “Alert, nurse call and alarm integration is key. Other information - such as falls risk, sepsis alerts and critical results -  improve efficiency and patient safety. If a nurse knows a patient is at a high risk of falls, when he gets an alert that a patient needs to use the bathroom, he can quickly respond. That reduces that risk significantly.”

The challenge, HIMSS and PatientSafe executives say, lies in moving from first-generation mobile devices to more expansive solutions that offer uses beyond communication. While providers are ready for them, their existing IT infrastructures and workflows aren’t.

“As the survey data shows, if you look at all the different tasks a care team member needs to accomplish, there is considerable workflow fragmentation caused by the sheer number of devices and apps on those devices they still need to use,” Baum said in the report. “This has resulted in clinicians carrying so-called ‘fat tool belts.’ Still all too common are nurses who must carry one device for communications, another for, say, blood administration and a third for specimen collection.”

Indeed, according to the survey, while physicians are the predominant users of smartphones and pagers, nurses are far more likely to be using legacy handsets and badges.

READ MORE: Challenges, Opportunities of Mobile Health Devices in the Hospital

“The bottom line is they shouldn’t have to deal with this,” Sensmeier said of the nurse's role in healthcare. “They are managing the patient situation, maintaining patient safety and keeping people alive. It’s shocking that the people doing this critical work are worrying about not having the right device, or information, when they need it. They should have a seamless workflow.”

To that end, more than half of the survey respondents who now have a secure messaging platform said they want to add new functions. And almost 80 percent said they want their platform to integrate with clinical workflow management and documentation solutions.

But that isn’t easy.

“Even when organizations successfully consolidate clinical tasks onto one device, there still may be multiple applications to open,” the study points out. “A physician may need to open several different applications to access the assigned, on-call care teams and specialists across her health system network, then he/she must go to a different application to contact them via secure messaging and another application to access patient information the team needs to make care decisions.”

To improve that integration going forward, the survey suggests involving clinicians in the decision-making process, and in measuring ROI.

READ MORE: Health System CIOs Are Ready to Take mHealth to the Next Level

“Typically, IT allocates budget to replace aging phones,” Baum said in the study. “However, we see an increasing focus on clinical impact and outcomes for mobile solutions measured and owned by clinical and/or clinical informatics stakeholders.”

In terms of Wi-Fi connectivity, 60 percent to 78 percent of those surveyed rated their Wi-Fi experience neutral to excellent. But as health systems move to replace legacy devices and platforms, they’ll need to take a closer look at how their resources match up to new capabilities. More than half of those surveyed, in fact, have already transitioned to a 5Ghz Wi-Fi platform.

“A lot of legacy phones were simply capable radios, so IT teams felt that since these technologies performed well, their Wi-Fi infrastructure was solid,” Baum said in the study. “However, ask any nurses or clinicians who are still using those technologies, and they’ll know where dead spots are and avoid them when making a call. A similar issue with signal strength throughout a facility exists today with call quality and smartphones.”

“It’s going to be a constant battle,” added Ash Goel, MD, CIO and CMIO of the Bronson Healthcare Group in Kalamazoo, Mich., in the study. “The move to 5Ghz is the right direction to go. Wi-Fi providers now are providing multiband integration so devices auto-connect to the best available strength. But it has its limits.”

The report concludes that health systems are moving toward an mHealth communications platform that focuses on the smartphone, and on deployments that span multiple departments. Single-department implementations tie up IT resources and strain interoperability, it points out, while specialized devices like VoIP phones or badges have limited uses and can be expensive and short-term.

“People see how smartphones have transformed the consumer world and can envision putting those same phones in the hands of their care teams to provide access to secure messaging and voice calls,” Baum concluded. “Then, when you add clinical systems integrations — such as routing alerts through the device — there is an even greater return on their investments. The value increases when smartphone applications integrate with paging systems and care team directories, leverage current investment in telephony and free patient data from the EMR. They can also help nurses decrease documentation time, providing better productivity for the care team.”

When asked what they’d like to see included on those platforms, those responding to the survey targeted three critical uses: communicating various results across care-setting boundaries (80 percent), proper coordination of post-discharge follow-up (73 percent) and anytime anywhere patient data access (74 percent).

“Investing in the future means integrating smartphone technology, clinical communications and workflows,” Baum said. “The study shows that IT, clinical informaticists and clinicians all agree: A unified platform of clinical communications and workflows would yield better clinical, financial and operational outcomes. Strong foundations laid down today will be leveraged in all care coordination efforts moving forward.”

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