At Childrens 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 hospitals 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 Childrens 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.
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 retd), vice president for healthcare information systems at HIMSS, an international nonprofit organization working for better health through information technology. Clinicians dont want to be carrying multiple devices. They want to use one device and they want to use a device theyve 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 Childrens 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.
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.
Were looking into ways of sending protected information from phones, said Patricia J. Mook RN, MSN, NEA-BC, chief nursing informatics officer at Inova. Were living in a world where people want answers as quickly as possible.
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 Childrens Hospital. Everyone is used to their own phones and they are used to their own devices, he said. Why add an expense when its 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 its something the hospital would have to explore carefully, possibly looking at color-coding hospital-issued phones so patients do not get upset.
At Childrens Dallas, some clinicians use their own devices which they must register with the IT department if they want to access the hospitals 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.