A California hospital uses dedicated iPhones to let nurses receive voice messages, text messages and alarms, and they no longer have to cram their pockets with multiple pagers.
A Texas health system gives Blackberries to its transport staff to improve their ability to get radiology equipment where it needs to be. They save hours of time daily, and wear and tear on both equipment and employees.
A New York City hospital has all its administrators bring iPads to leadership meetings and doesn’t allow paper.
The HITECH Act of 2009, in addition to establishing Medicare and Medicaid incentive payments for the meaningful use of electronic health records, also appropriated $2 billion in discretionary spending to the HHS Office of the National Coordinator for Health Information Technology for additional initiatives to aid providers in achieving that goal.
The largest initiative, which snagged $677 million of those funds, is the Health Information Technology Regional Extension Centers program.
Under the program, a nationwide network of 62 RECs has been created to provide heavily subsidized help for at least 100,000 small and safety-net primary care providers, as well as critical access and small rural hospitals, to adopt and achieve meaningful use of EHRs.
The REC services, delivered hands-on and through the Web, include workflow and practice pattern assessments, guidance and technical assistance to aid with implementation, training and use of best practices, and help after go-live to become meaningful users.
The idea of having federally-supported, specialized centers to help an industry accelerate adoption of technology is not a new concept-it happened a century ago with agricultural extension centers, notes Paul Wilder, director of health I.T. adoption at the New York e-Health Regional Collaborative (NYeC), a public-private partnership operating one of two RECs in New York State. Then, as with now in the health care field, the programs were launched in response to a technology disconnect within an industry, he explains.
The health I.T. extension centers are not-for profit organizations that will provide technical and process-change services themselves, contract the services out to other not-for-profit entities, or a combination of both. The RECs are required to provide a core set of services but there will be differences in the depth of services and how they are delivered. Many of the RECs in the fall of 2010 were gearing up to offer the services. All RECs should be fully operational by the start of 2011, says Charlie Jarvis, vice president at EHR vendor NextGen Healthcare Information Systems, Horsham, Pa., which like many vendors is working with multiple RECs across the nation.
As they roll out services, centers also must start developing business plans to become self-sustaining by mid-2012 when the federal grant funds that currently subsidize services run out. Federal funds could be available for "minimal" support for two
Experts have been predicting for a couple of decades that mobile devices will someday transform health care, and the day has come. More than 70 percent of physicians have a smartphone in their pocket, according to Manhattan Research. Epocrates, the maker of a popular drug database that was among the first to be converted to mobile phone use, surveyed doctors last year before Apple's iPad was released, and found that 9 percent were ready to buy the minute the device was available, with another 13 percent planning a purchase within the year. Another 38 percent were thinking about it and needed more information. And all this before anybody had seen one up close.
New mobile devices seem to be announced monthly. New applications abound: many EHR vendors including Allscripts, Siemens and Epic, offer iPhone apps for physicians to access their systems, and other apps are available for an array of medical uses. AT&T recently announced it will offer data center and hosting technology for health information exchanges, including support for preventive and disease management applications on smartphones.
"One of the most potent concepts in technology is the idea of a computer on your person that's always networked," says John Glaser, CEO at Siemens Healthcare. "We're seeing phenomenal innovation in devices and what people can do with them," equaled only by the phenomenal security challenges of managing devices that may be accessing sensitive medical data from anywhere, he adds. Siemens is developing a consulting service for its clients aimed specifically at helping them navigate the issues raised by mobile devices.
They raise lots of issues: For example, making sure the wireless network is up to snuff, complying with HIPAA requirements for information security and privacy, and picking a technology to standardize on internally while being prepared for whatever fancy gadget a physician may bring in.
To choose or not to choose
CIOs are divided about whether to limit the types of mobile devices they allow. David Muntz, CIO of Baylor Health Care System, Dallas, says the Blackberry is his device of choice, because it has tested security features and he can control its use via policies set in the Blackberry Enterprise Server. Users need a password with a prescribed number of characters, and they only get five chances to enter it correctly before the server cuts them off and scrubs sensitive data from their devices. All information on the device is encrypted. "We don't have those abilities with the Apple-based products," Muntz says. "We can tell people we want them to encrypt, but we have to count on them to do it, and we can't wipe their device remotely. If they have a device that's encrypted, we can put it on the network, but we don't know if they're going to do virus checking."
Paul Conocenti, CIO of NYU Langone Medical Center, which runs paperless leadership meetings, has standardized on Blackberries and iPhones, but will support other devices as long as they comply with the hospital's security requirements. "We have a screening process in place," he says. "The user needs to agree to our policies and load our standard management software so that we can manage the access."
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