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Smartphone Apps Liberating Clinicians, Improving Quality

Carrie Vaughan, for HealthLeaders Magazine, February 4, 2010
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Smartphone applications are liberating clinicians and administrators and improving quality all at the same time.

Hampton Richards, MD, no longer has to run down a few flights of stairs from his office a couple of times each hour to check on his patients on the labor and delivery floor, thanks to an application on his iPhone called AirStrip OB. The application from San Antonio, TX-based AirStrip Technologies gives him real-time, remote access to fetal heart-rate tracings, vital signs, and the latest nursing notes.

Mobile applications like AirStrip are liberating physicians by providing them access to information whenever and wherever they are. "It allows me to see the tracings to reassure myself about fetal status more frequently and directly," says Richards, who is an OB/GYN physician on the medical staff at Texas Health Presbyterian Hospital Dallas.

And for those people who are concerned that providing physicians this type of mobility to monitor patients off-site will take them away from direct patient care at the bedside, Richards dismisses that notion. "It doesn't mean that I'm not going to walk down to labor and delivery and talk with my patient and look at the strip myself, but it allows me to monitor the strip more closely and engage in times when I wouldn't be able to otherwise," he says.

It can also free up the nurse from having to make a judgment call that he or she is not comfortable making. Fetal heart-rate tracings are highly subjective and have a huge false-positive ratio, says Richards, explaining that the number of times someone thinks something looks wrong on the strip correlates poorly with when something is really wrong. "Having the primary physician be the one to read and interpret that tracing has a lot more value," he says. "Not that the nurses aren't qualified to read the strip, but 10 different people will interpret it 10 different ways, and you want the person who is making the final call to have the most direct access to that."

Airstrip OB is just one of the mobile applications that Texas Health Resources is rolling out as part of its mobile health, or mHealth, strategy, says Chief Information Officer Ed Marx. "Everything is going mobile in this world, and healthcare IT typically lags. But this is one area where Texas Health and healthcare in general don't need to lag. We can jump right into the fray."

Texas Health's mobile strategy is has three components: connected physicians and clinicians, connected patients, and connected hospital leaders. Within each of those are three or four areas of focus based on customer interaction and where the market is today.

Texas Health, a 14-hospital system based in Arlington, has been using an Internet-based physician portal called CareGate to enable physicians to access all of its clinical systems on the hospital's network, such as the EHR and PACS. Physicians can access these systems via a secure Internet connection from their home or office or while on vacation. "Now that smartphones have a pretty decent Web browser, physicians can log on to CareGate for many functions, even on a smartphone," says Ferdinand T. Velasco, MD, Texas Health's chief medical information officer. "But there are limitations to running clinical applications on a phone, so we are increasingly looking at apps that are specialized for that type of device or platform."

A mistake that many people make is trying to size an application down from a 20-inch screen to 2-inch screen, says Marx. "We are not talking about using the same application but on a miniature screen. We are talking about a whole new mobile application that might have similar functionality but it is not the same application per se."

Aside from AirStrip OB, for example, the health system is beta testing an EHR application for smartphones called Haiku from Verona, WI-based Epic Systems Corp. For hospital leaders, Texas Health is simply trying to ensure that they can approve purchase requisitions and access secure dashboards for monitoring financial and clinical performance. "It is nothing earth shattering. It is what has been done outside of healthcare for the past decade," says Velasco. The health system is also promoting a virtual office. For example, Velasco doesn't have an office in Arlington where Texas Health is headquartered. "My office is wherever I am," he says. "I need technology to support that, so that means having on my laptop Web conferencing technology, instant messaging, and that sort of capability."

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