The rapid transition to EHR and the integration of information technology in the delivery of patient care has had a transformational impact on medical offices and hospitals. There are many positive effects of the technology, including rapid access to laboratory information, diagnostic reports, and medication histories. However, there is also a potential dark side to the technology. Earlier policies dictated that in order to use a device on a hospital or health system network, it had to be “approved” by that institution. Enterprise-wide implementations meant that both administrators and clinicians had little choice over the mobile devices that they used. This was in large part the formula behind the success of the RIM Blackberry. Devices were secure, they could be managed through the organizational network, and could be controlled in terms of both the messages they were able to transmit and receive as well as the content.
The success of iPhones and Android mobile phones began to crack open the RIM business model in the last few years, primarily driven by Apple products. Executives as well as clinicians began demanding that they be allowed to bring their own mobile devices into the hospital or large clinic and connect them to the network. While this created some security challenges, it also solved a financial problem for large IT departments. Rather than purchase hundreds or even thousands of hyper-secure devices that had to be managed by the organization, clinicians and staff started being encouraged to bring their own phones (and tablets) to work. Using secure protocols as well as apps that allowed them to view and interact with hospital or other clinical data, this has become the standard business model. Maintenance costs are lower for IT departments, as they no longer have the responsibility of owning the devices. In addition, the flexibility offered by mobile apps provides increasingly more sophisticated ways to access clinical information. What hurt BlackBerry (in addition to poor performance in the last five quarters) was the shortage of available clinical and non-clinical apps to meet the needs of users.
However, with mobile devices functioning as both work and social tools, it has become increasingly more difficult to separate the two functions. What happens when a personal text message arrives while doing rounds or entering orders into a patient chart? It is very tempting to respond to these types of messages as they pop up in front of one’s current application and to launch a response simply involves clicking on a button or link. It takes a great deal of personal discipline to separate these two roles, especially as the content is delivered through the same device... continuously.
An article on this topic in Kaiser Health News recounts the experiences of Dr. Feldman at Beth Israel Deaconess Medical Center and Dr. John Halamka, the hospital’s chief information officer. Dr. Halamka has written a case study for the Agency for Healthcare Research and Quality (AHRQ), which describes an incident in which a patient who was on anti-coagulant therapy was to have his Coumadin discontinued prior to surgery. However, a resident forgot to stop the medication due to distraction from an incoming personal text message.
The case study and article are well worth reading — in particular as a warning of the potential risks when mixing business and pleasure through one’s connected personal mobile devices.
What are your thoughts? Should mobile devices be strictly controlled when used in clinical settings in terms of messaging and available applications? Is this even possible in 2012, and should strict policy rather be used to manage these types of risks? Add your comments below.