Mobile Solutions in Healthcare: Technical and Managerial Issues

1
Mobile Solutions in Healthcare Technical and
Managerial Issues

• Mihail Cocosila
• Ph.D. Candidate
• DeGroote School of Business, McMaster University
• February 14, 2006

2
Agenda

• Introduction
• Why mobile in healthcare?
• Mobile answers
• Technical issues
• Managerial challenges
• Conclusions and future research

3
Introduction

• Essential challenge of healthcare provision
  today

population demands for higher quality healthcare
limited resources of the system to meet the
demands
4
Introduction

• Demands aggravated by
• growing incidence of chronic diseases and
  conditions (54 of the burden of all illnesses
  worldwide in 2001 and over 65 in 2020)
• ageing population (ratio working
  people/non-working pensioners in the developed
  world from 3/1 in 1999 to 1.5/1 in 2030)
• impatient patient (better educated, more
  dynamic, and asking for higher quality
  healthcare).
• Healthcare system strained by
• limitation of resources (shortage of hospital
  beds and healthcare personnel)
• health providers always on the move and short of
  time
• time and efficiency have become critical factors.

5
Introduction

• Possible responses
• increasing focus on prevention besides curing
  diseases and conditions
• treating some diseases in out-of-hospital
  conditions.
• Intended gains
• reducing costs
• easing the work of health providers
• improving patient quality of life and saving
  lives.
• A potentially innovative approach implementing
  mobile and wireless healthcare solutions.

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Why mobile in healthcare?
7
Why mobile in healthcare?...
8
Why mobile in healthcare?...
9
Mobile answers

• Access To Evidence Based Data
• Tough decisions
• opting for or against a certain medical
  intervention
• deciding the most appropriate procedure for the
  patient
• choosing the treatment with the best-expected
  outcome and the highest cost-effectiveness.
• Possible mobile IT answers
• electronic versions of useful medical books
  (e.g., The Handbook of Evidence Based Critical
  Care Medicine)
• specialized software (e.g., InfoRetriever
  containing all InfoPOEMs-The Clinical Awareness
  System-, all Cochrane Systematic Review
  abstracts, 230 decision rules, over 2,500
  predictive calculators, 750 summaries of
  evidence-based practice guidelines).

http//www.infopoems.com
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Mobile answers

• Electronic Medical Records
• Existing approaches
• physicians review hard copy of medical records,
  or
• access patient information from a server through
  desktop PCs.
• Both interfere seriously with physician hospital
  mobility.
• Possible mobile IT answers
• wireless solutions offering physicians, among
  others, data on patient lab test results,
  previous consultations, surgical reports, and
  medical treatment history (e.g., Cedars-Sinai
  Medical Center or MData Enterprise System
  both in the U.S.).

http//www.itechresearch.com http//www.mercur
ymd.com
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Mobile answers

• Drug Reference
• Problems
• physicians choose from lists of thousands of
  drugs the most appropriate to be prescribed to a
  patient in a certain health condition, and
• there is an avalanche of information continuously
  being revised which is impossible to remember or
  maintain in hard copy.
• Possible mobile IT answers
• database with recommended dosages, possible
  interactions and warnings, adverse reaction
  factors, restrictions, test interactions, brand
  names, spelling of various medical terms, drug
  costs (e.g., EPocrates, Skyscape, Handango
  Software Suite).

http//www.sciencedaily.com
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Mobile answers

• Checking and Validation
• Problems
• physicians when writing prescriptions must ensure
  that the drugs do not result in adverse reactions
  or side effects for specific cases
• pharmacists can help to check this, but doctors
  are at the intersection of the two relevant
  branches of information patient and drug.
• Possible mobile IT answers
• early checking and validation for mismatches at
  the point of care (e.g., PocketScript ).

http//www.wirelessnewsfactor.com
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Mobile answers

• Prescription Writing
• Problems
• each year there are a reported 7,000 deaths
  attributed to medication errors, and more than
  150 million calls from pharmacists to physicians
  to discuss prescription problems in the U.S.
  alone.
• Possible mobile IT answers
• sending prescriptions electronically (e.g.,
  OnCallData service which is said to allow
  significant timesaving of up to 10 minutes per
  prescription and a total of 2-6 hours a day for
  an office by sending prescriptions electronically
  or via fax to one of over 72,000 participating
  pharmacies in the U.S.).

http//www.oncalldata.com
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Mobile answers

• Other Professional Needs
• Physicians
• have a very busy agenda
• must consult specialized reference books for
  medical calculations or try to remember formulas
• must communicate with healthcare providers
• should communicate with their patients
• may have other diversified off-duty needs.
• Possible mobile IT answers
• combinations of PDAs (personal digital
  assistants) and cell phones with increased
  capabilities and loaded with appropriate
  applications (e.g., Archimedes medical
  calculator).

http//www.skyscape.com
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Mobile answers

• Issues Specific to Physicians in a Hospital
  Setting
• Physicians should
• have access to patient data in emergency
  response
• be able to communicate, no matter where they are
  in a hospital (because patient situations may
  become acute at any time)
• be able to locate specific patients fast in large
  hospitals
• have access to discharge summaries of patients
  for future reference.
• Possible mobile IT answers
• using of handheld devices for collecting or
  retrieving needed information (e.g., American
  Medical Responses system that captures patient
  information at the site of an emergency response
  or during transport to the hospital).

http//www.pdamd.com
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Mobile answers

• Issues Specific to Physicians Outside a Hospital
  Setting
• Physicians should develop communications with
• hospitalists (about the state of patients who
  were referred to hospital physicians or
  specialists, especially for follow-up
  appointments)
• homecare personnel (for improving the quality of
  home care services).
• Possible mobile IT answers
• using of handheld devices relying on central
  systems (e.g., 300 physicians of IPC-The
  Hospitalist Company of North Hollywood,
  California, empowered with wireless PDAs can
  share information both with a central server and
  with primary care physicians - advantages time
  and cost savings, and early diagnosing of patient
  conditions)

Singer, A.D. (2003) A good connection.
Hospitalists and primary care physicians keep in
touch best via wireless. Healthcare Informatics,
http//www.healthcare-informatics.com
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Mobile answers

• Homecare Nursing
• A significant part of the daily activities
  involves paperwork on
• patient admission/status change/discharge
• supply ordering
• wound care.
• Possible mobile IT answers
• using of handheld devices communicating with a
  central system (e.g., handheld devices equipped
  with Pixalere - a software helping nurses to
  treat patients with minor wounds at the scene
  and, if necessary, get wireless access to a
  healthcare professional at a local hospital - may
  save in some situations the 1,000 cost for the
  health system and the 60 amount from the
  patients own pocket required by a round trip to
  the Emergency Room, or handheld devices provided
  with a supply ordering application under
  development at Simcoe County CCAC).

Zeidenberg, N. (2003) Wireless solution allows
nurses to better serve patients at bedside. CHT,
8 (2), p. 4
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Mobile answers

• Outpatient Self-Management
• Outpatients often have difficulties with
• self-managing chronic diseases while living an
  active life
• adhering to the necessary medical treatment and
  behavioural changes.
• Possible mobile IT answers
• using of handheld devices as virtual healthcare
  providers (e.g., a wireless text messaging system
  reminding about upcoming appointments and
  experimented at Homerton Hospital in London,
  U.K., was considered a success since, at less
  than 10 U.S. cents per message, the savings -
  less missed appointments with 8 - significantly
  offset the costs)

Dyer, O. (2003) Patients will be reminded of
appointments by text messages. BMJ, 326, p.1281
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Technical issues

• Technology selection criteria
• Answering the targeted user needs (e.g.,
  communication and data exchange needs of homecare
  nurses in a mobile context)
• Matching infrastructure requirements (e.g.,
  real-time or by synchronization data access,
  local or wide area networks)
• Ensuring integration with existing systems (e.g.,
  multiple systems and health records maintained by
  hospitals, home care organizations, and private
  physicians)
• Using mobile devices with satisfying capabilities
  (e.g., data input/output features, expandability,
  weight, processing power, memory, battery life)
• Ensuring that benefits substantially outweigh
  costs.

Mobility does not necessarily involve wireless
access
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Technical issues

• Real or virtual reasons of concern
• Security and privacy
• of wireless communications and patient data
  storage and updating involving patient data
  (regulated by HIPAA or PIPEDA and PHIPA).
• Connectivity
• one hundred percent wireless connectivity is not
  an achievable goal
• limited communication bandwidth.
• Interference
• with sensitive electronic equipment in hospitals
  or clinics, or with patient medical devices.
• Reliability and flexibility
• of applications (e.g., always on, fit to users
  needs, device-independent)
• of devices (e.g., robustness, voice and data
  capabilities).
• Ease of use and learning time.

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Managerial challenges

• Management problems generated by the use of the
  latest technology
• uncertainty of investment in an immature
  technology
• difficulty of choice among similar products in an
  incipient stage of the market
• uncertainty about vendor and technical support
  stability in a new market
• concerns about technical and human consequences
  of using the new technology
• necessity of a smooth implementation (both
  technically and human) so as not to disturb
  patient care and healthcare work processes in the
  transition period.

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Managerial challenges

• Implementation of new technology considerations
• system design
• device and vendor choice
• planning of the deployment
• actual installation
• support and training
• prototype and usability testing
• installing of control mechanisms for the
  deployment stage and for the future.
• Essential for success early and continuing
  involvement of all major stakeholders
  (physicians, nurses, homecare workers, hospitals,
  homecare centers, funding institutions, and last,
  but not least, patients) in the development and
  evaluation of new technology.

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Managerial challenges

• Human issues
• User perceptions and apprehensions
• doubts of the mobile solutions usefulness
• difficulties with technology
• interaction with devices
• perceived risks with wireless applications
• user acceptance obstacles.
• Changes of the existing health care providing
  pattern for
• physicians (e.g., handling devices while with
  patients, overwork, liability, and reimbursement
  issues)
• homecare nurses (e.g., less time for nursing
  visits and more time for remote interactions with
  patients)
• patients (e.g., handling and carrying potentially
  invasive devices).

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Managerial challenges

• Healthcare system issues
• Alteration of existing healthcare system
• setting up or improving call centers empowered by
  wireless technology for remote care of
  outpatients
• re-design or reduction in jobs
• creation of other jobs requiring more IT skills
• increasing delegation of health care
  responsibilities to outpatients.
• Important missions of the system
• appropriate training and education for the new
  technology at all levels
• managing possible resistance to change from the
  main stakeholders.

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Managerial challenges

• Recommendation

Implementation of mobile and wireless solutions
in healthcare should be designed with
intermediate targets that are relatively easy to
reach and demonstrate, so as to increase the
confidence of major stakeholders in the following
steps.
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Conclusions future research

• Conclusions
• Mobile and wireless solutions may address some of
  the information and communication needs of
  todays health providers and outpatients
• Mobile IT may contribute to better quality of
  care and improved efficiency of the healthcare
  system
• Real or virtual technical and managerial issues
  moderate the possible use of mobile healthcare.
• Future research should investigate implications
  for accommodating m-healthcare solutions
• changes necessary to the existing medical
  information technology systems
• specific business cases associated with
  implementing the new technology.

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Messages to remember

• Technology, no matter how advanced,

could not and should not replace the
relationships between people in the healthcare
system (especially between patients and their
health providers)
cannot solve by itself existing organizational
and managerial problems in healthcare
organizations
should not be justified by its novelty but by
improvements in the quality and cost
effectiveness of health care processes
Archer, N. (2004). The business case for
employee mobility support. International
Association for Development of the Information
Society (IADIS), Lisbon, Portugal.
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Thank you!

• Contact
• Mihail Cocosila
• Ph.D. Candidate
• DeGroote School of Business,
• McMaster University, Hamilton, Canada
• cocosim_at_mcmaster.ca