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The wireless revolution

Expanding mobile technology raises news issues for facilities, clinicians

Monday April 7, 2014
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At Children’s Medical Center in Dallas, bedside nurses may carry as many as five mobile devices: a company-issued phone, a pager, a barcode scanner, a specimen labeler and their own smartphone, which they can use to access the hospital’s intranet system but not to call or text anything related to patient care.

“One of the goals of the clinical staff is to have only one device that does everything,” said Debbie Schumann, RN-BC, MBA, chief nursing informatics officer at Children’s Dallas.

The technology for such a device already exists, Schumann said, and the hospital is probably a year or two away from granting the staff its wish. But like many other facilities, the hospital finds itself caught up in a race to provide clinicians with the best, fastest and most convenient mobile technology without compromising patient privacy or spending huge amounts of money on devices or systems that may become obsolete within a few years.

For some healthcare centers, this may mean allowing at least some employees to use their own mobile devices for work. According to a 2012 survey by networking vendor Aruba Networks, about 85% of hospitals allowed employees to bring and use their own mobile devices, including cellphones, smartphones, laptop computers and tablets. Of those, more than 50 percent allowed employees to access the hospital Internet, about a quarter allowed them some access to hospital applications and 8% allowed full access to the hospital network.

Another survey by Spyglass Consulting Group, published in March, showed that about 70% of responding hospitals reported their staff nurses use personal smartphones for work-related tasks, and that about half the respondents said they were planning to buy or evaluate smartphone technology for their clinicians within the next 18 months.

The annual HIMSS Analytics Mobile Technology Survey, published in February, reported about a third of 170 survey respondents — a mixture of health-related organizations, including hospitals, insurance companies, medical offices, nursing homes, government healthcare providers and pharmacies — said they supported only mobile devices provided by their organization, while 21% supported only personal devices used for work purposes. Nearly a quarter supported both types of devices, down from 2012, when nearly half said they supported both devices.

Surveys on use of mobile technology in healthcare settings

Aruba Networks survey: 85% of hospitals embracing BYOD.

Spyglass survey: Hospital IT investments in nursing smartphone solutions
poised for explosive growth.

Third annual HIMSS mobile analytics survey.

2013 HIMSS annual security survey results.

Debbie Schumann, RN
A matter of efficiency

IT nurses and directors say nurse practitioners, clinical nurse specialists, nurse managers, physicians’ assistants and physicians are pushing to use their personal devices to access records, communicate with patients and communicate with other clinicians on secure sites. Bedside nurses want a quick and secure way to communicate with other clinicians, both in and outside the hospital, and to access reference materials, lab reports and records.

“Bring-your-own-device is very much consumer-driven,” said Patricia Wise, RN, MS, MA, FHIMSS, COL (USA ret’d), vice president for healthcare information systems at HIMSS, an international nonprofit organization working for better health through information technology. “Clinicians don’t want to be carrying multiple devices. They want to use one device and they want to use a device they’ve chosen.”

Current methods of communication within healthcare facilities such as pagers, calling on intra-hospital phones or dialing outside lines at the nurses’ station can seem outdated and clunky, especially to a generation of clinicians who have adapted quickly to mobile technology, said Matthew Tibbs, RN, BSN, senior informatics analyst for Inova Health System in Virginia. Some also see it as a barrier to patient care.

“They like the ability to instantly notify somebody,” Schumann said. For instance, at Children’s Dallas, when the lab notifies an RN about critical lab values, someone calls, is put on hold and waits while the nurse is tracked down. With secured texting, lab workers would have a traceable call, showing they alerted the nurse or physician as required, she said. “It would be more efficient for both the lab and the nurse, and the patient information would be transferred securely.”

Patricia Wise, RN
Policies may vary

Although many facilities have policies discouraging bedside nurses from using personal devices while on a shift and where patients and families can see them, most allow their staff to carry their own phones or tablets and understand they probably will use them for activities such as checking calendars, looking up general information on a condition or getting meeting reminders, Wise said.

Some hospitals allow clinicians who use personal devices to access hospital and patient records through secure intranet- or cloud-based sites, with strict policies prohibiting downloading or storing information. Some require employees who use their own devices to register them with company databases, allowing the devices to be scrubbed if they are lost or stolen.

“Usually where they draw the line is at [transmitting] patient-identifiable information,” Wise said. But technology to send encrypted texts, photos and attachments is available, allowing nurses to go to a secure site to send a message that is encrypted and delivered to a server in an unintelligible format that prevents interception. Only the intended recipient, also on the secure site, can pick up the decoded message.

“We’re looking into ways of sending protected information from phones,” said Patricia J. Mook RN, MSN, NEA-BC, chief nursing informatics officer at Inova. “We’re living in a world where people want answers as quickly as possible.”

Stephanie Poe, RN
A major expense

Many hospitals also are weighing whether to purchase newer mobile devices such as smartphones and tablets, which can be more easily standardized, updated and controlled, but are considerably more expensive than letting staff use their own. If clinicians want to use their own devices and the devices can be properly secured, it makes economic sense to let them do so, said Wes Wright, senior vice president and chief information officer at Seattle Children’s Hospital. “Everyone is used to their own phones and they are used to their own devices,” he said. “Why add an expense when it’s not necessary?”

But Stephanie Poe, RN, DNP, director of nursing, clinical quality and chief nursing informatics officer at the Johns Hopkins Hospital in Baltimore, said the benefits and safeguards of using employer-issued devices are worth any added expense in purchasing them. “We do not sanction use of BYOD in patient care,” she wrote in an email. “We believe employer-issued devices are preferable to BYOD. The hospital adheres to national clinical wireless standards and it is more efficient to ensure compliance with hospital-issued devices.”

Dörte Thorndike, RN, CSN, nurse manager of the Bloomberg 9 South Infant and Toddler Inpatient Unit at Johns Hopkins, said nurses on her staff would be thrilled to replace their outdated employer-issued cellphones and awkward one-way texting system with smartphones and a secure two-way communication system, and that the hospital is looking at ways to do this. But she believes letting nurses use their own phones at the bedside might cause misunderstandings with patients.

“The nurses would need to do a lot of explaining to the families about why they are using a personal device,” she said. Even with company-issued devices, nurses probably would have to assure families they were working, not sending personal messages or checking Facebook. Thorndike said it’s something the hospital would have to explore carefully, possibly looking at color-coding hospital-issued phones so patients do not get upset.

At Children’s Dallas, some clinicians use their own devices which they must register with the IT department if they want to access the hospital’s database. Others prefer devices purchased by the hospital for both work and personal use. Few have chosen to register their own phones for access to the company database, Schumann said, and have expressed little interest in turning their phones into work tools. They would prefer a company-owned smart mobile device, passed from shift to shift, that could be used for texting, talking, scanning and researching reference materials, she said.

Regardless of whether employees use their own devices, those provided by the organization or both, mobile technology will become increasingly integrated into healthcare, Wise said, and hospitals need to think about what policies they need to create or adopt to ensure patient privacy and protection.

“The times are changing,” Mook said, and so are the technology needs of clinicians who want to provide the best patient care they can. She said facilities “need to make decisions about what they are willing to provide for employees to make things happen and what they are not.”

Cathryn Domrose is a staff writer. Send comments to editor@nurse.com or post comments below.
Key considerations

Whether employees use their own devices is only one concern for healthcare IT departments in deciding on mobile technology policies. Among the others:

• Expense. According to the annual HIMSS Analytics Mobile Technology Survey, published in February, the greatest barrier to adapting mobile technology is cost, a sentiment echoed by IT directors and nurse informaticists interviewed for this article.

Some facilities may not be wired enough to support an increasing number of mobile devices. New encrypted systems, secure websites or cloud storage, remote wiping systems and secure texting systems and apps all must be purchased through vendors (although surveys say more facilities are creating their own apps). Electronic health records may have to be modified to better fit a format for smartphones and tablets. “Technology is developing so quickly, it’s hard for organizations to stay up to date because of the cost of keeping up,” said Debbie Schumann, RN-BC, MBA, chief nursing informatics officer at Children’s Medical Center in Dallas.

• Security. Almost all of those who responded to the HIMSS technology survey said they used a security mechanism to protect privacy and data on mobile devices used to access clinical information, and 78% said they used more than one method to do so (although this was down from about 90% who reported using multiple security measures in 2012). Password protection was the most frequently used security approach, followed by encryption measures and remote wipe capability.

According to a second HIMSS report, which surveyed nearly 300 IT and security professionals at U.S. hospitals and medical practices, nearly a fifth of respondents reported a security breach, and 12% said their organization had at least one known case of medical identity theft within the past year.

The respondents’ greatest perceived threat was from healthcare workers who might snoop into the electronic health information of friends, neighbors, spouses or co-workers. Other reports have suggested healthcare networked devices and software particularly are vulnerable to hackers. But the studies also suggest many breaches can be avoided by measures such as stronger password protocols and multiple means of controlling employee access to patient information.

“Most of the breaches right now are not coming from mobile devices; they come from computers which are hacked into or stolen, and they are not encrypted,“ said retired U.S. Army Col. Patricia Wise, RN, MS, MA, FHIMSS, vice president for healthcare information systems at HIMSS.

Potential privacy invasions — conversations about patients in elevators, paper files stolen from unlocked drawers, unauthorized staff sneaking a peak at a patient’s folder — existed long before mobile technology. Preventing such breaches may depend more on staff awareness of and adherence to privacy protocols rather than additional electronic security measures, IT directors said.

“I have to trust that like someone with a physical medical record, professionals will protect patient privacy” with mobile devices, said Wes Wright, senior vice president and chief information officer at Seattle Children’s Hospital. “You have to trust folks to behave reasonably.”

In some ways technology can help protect privacy in ways that paper documents could not, Schumann said. Paper files are more vulnerable to theft or snoopers than an electronic device that automatically locks or can be remotely wiped if it is stolen.

• Proper documentation. If clinicians are communicating patient information on mobile devices, they need a way to include this information in the patient’s medical record, Wise said. “Your device is not a substitute for the patient record.” As with privacy and standards of care, she said, nurses need to apply basic documentation standards to mobile devices.

Some facilities have devices that automatically transmit certain information to an electronic record. At Children’s Dallas, nurses can take a photo of a patient’s wound using a phone app on a company-provided mobile device. The photo is automatically delivered to the patient’s medical record, where other clinicians can view it, Schumann said.

About 25% of respondents to the HIMSS survey said about three-quarters of data from mobile devices was integrated into their organizations’ electronic medical records. About another quarter said none of the information was integrated.