Personal Tech-Wielding Docs Challenge IT Leaders

This article appears in the June 2012 issue of HealthLeaders magazine.

Healthcare leaders are facing the challenge—and opportunity—presented by physicians and clinicians bringing ever more of their own technology with them to work.

Two years after the iPad's debut, the devices are making inroads in all aspects of society, and healthcare is no exception.

Those who are benefiting now had a virtual desktop strategy already in place. Tablets and other larger-screen devices are often able to fit into the IT picture with relatively little work.

It will take longer for vendors and healthcare IT leaders to truly leverage the native power and ease of use of these devices, and for now there may be a bit of cat-and-mouse game. Rogue innovator-clinicians are being tempted by an ever-increasing number of cloud and device apps available over the Web outside traditional IT approval, while network managers rely on increasingly clever network application monitoring tools to identify protected health information being inappropriately captured, analyzed, and transmitted by these new apps.

As the desktop morphs into a touch-powered platform, vendors are working to bring tablet implementations of their existing desktop apps to market fast enough to avoid being disrupted by newer apps built from the ground up for a touch-based experience.

But even among tech-savvy healthcare leaders, there are differences on the approach organizations should take regarding the "bring your own device," or BYOD, trend.

In the heart of Silicon Valley, leaders at Mountain View, Calif.–based El Camino Hospital—which has a second campus in Los Gatos and is known for HIT innovations—believe now is not the time to embrace this trend. "We are not engaging in BYOD, as I am convinced it is too early for this organization," says Greg Walton, chief information officer of the 542-licensed-bed hospital.

Where BYOD is happening, two things are in place: virtualized desktops and a guest wireless data network for users, rather than the main hospital data network.

One such robust guest network at the 711-bed Maimonides Medical Center in Brooklyn, N.Y., has seen a recent surge of use, with more than 275 logged-in users on the guest network during a recent late afternoon. "We believe a substantial fraction of those are employees," says Steven Davidson, MD, senior vice president and chief medical informatics officer at Maimonides.

"Anyone coming into the institution, with a simple verification process, can log into the guest network," Davidson says. "If you're not known to the institution but have a cell phone, you can usually get a 24-hour password and authentication. If you are known to the institution and have a network login, you can be diverted to an employee portal, which is still a log-on through the guest network and all of its security, but allows a 30-day expiration on your password."

The guest network allows Maimonides physicians to log in to the physician portal, and all users are able to access the public Internet.

A dedicated, high-resolution PACS workstation offers no compromises when viewing images, but a mobile device has its limitations. Performance is only one of them. The virtual desktop software that presents desktop data on portable devices such as iPads carries its own set of tradeoffs.

"The Citrix [virtual desktop] on the iPad is not the world's most friendly user experience," says Davidson. "Because the iPad is a touch-driven tool, you're constantly toggling back and forth between driving the window—the Citrix client—and driving the application inside the window. Sometime in recent months, Citrix has made toggling back and forth easier."

Maimonidies' inpatient EMR, Sunrise Clinical Manager from Allscripts, when delivered on a 1024-by-768 resolution screen such as the iPad 2—or even the new iPad with its Retina display (2048-by-1536)—still is not intended for touchscreen use, Davidson says.

"If you're doing it as I do sometimes from my MacBook Air, it's fine, because I've got my touchpad or mouse," Davidson says. "It's a lot easier to point with that on a screen that was designed for mouse-type pointing and clicking."

At the recent HIMSS conference, Allscripts released an improved client for the iPad, and Davidson says it "seems like it would be worth evaluating and getting some feedback from clinicians as to what they think might be its value."

With a mix of employed and nonemployed physicians, it's possible that Maimonidies might be able to reduce its burden to purchase, implement, and maintain client devices, Davidson says. A study dating back to the 2006 HIMSS conference found that hospitals need one device per active person using devices. But referring to the Allscripts client he saw, Davidson notes that it only solves the tablet problem for one application. "It doesn't solve access to all the other applications in the hospital that people have to use."

At Vanderbilt University Medical Center, a 916-licensed-bed facility in Nashville, BYOD is "a journey," says William W. Stead, MD, associate vice chancellor for health affairs and chief strategy and information officer.

"Our bias is that we have to incorporate whatever consumer technologies people have, rather than trying to stop that," Stead says. The medical center's increasingly virtualized clinical desktop is the enabler, he adds.

Another advantage of BYOD is it lets clinicians move all their personal messaging off the Vanderbilt email system and into a more appropriate system such as Gmail, Stead says. "I can still see messages as they come into both [mailboxes], interleaved as they arrive.

"Prior to that, either everybody put everything into Vanderbilt [messaging] whether it needs to be there or not, or they forward everything Vanderbilt out, so nothing's secure. So once you begin to use some side by side and use the technology to knit them together so they look like one to the user, you create a win for the user, and you actually increase your ability to secure the part that needs to be maintained securely."

Stead knows that physicians can be tempted to use the inherent photo-taking and messaging capabilities of their devices to easily ask for a specialist's opinion directly through texting or photo multimedia messaging services.

"We do have policies that basically say you're not supposed to move protected health information or research health information outside of our secure messaging environment," Stead says. That environment "provides easy tools to communicate both within the Vanderbilt team and to push stuff to the referring providers."

Failing that, Stead's IT infrastructure monitors "for things that appear to have PHI leaving the network, and we spot-audit those, and we use those to identify all sorts of problems," he says. Still, "there are pieces of it we can identify and pieces of it we can't." An example of the latter: communications going from one Verizon network device to another, which never touch the Vanderbilt network.

As for whether BYOD will lower Vanderbilt's capital IT equipment costs, "I think we're going to move to some sort of a communication allowance that will allow people to have whatever they want to have and have us pay some reasonable amount," Stead says. "That's not yet in place. Of the many things we talk about, that seems to be the most likely."

BYOD users also appreciate being able to choose their own tech support provider, says Mark Farrow, vice president and chief information officer at Hamilton Health Sciences, a six-hospital organization based  in Hamilton, Ontario. "They're happier to work with those people than they were to necessarily have us messing with their devices," Farrow says.

Outside the hospital walls, physicians' devices, with data protected by virtualization technology, can boost happiness in other ways. Farrow recalls when a physician had just stopped on his way home to pick up a hot meal for his family. "His phone rings, and it was a nursing station calling him saying there was an issue with one of his patients, and they needed to know what to do," he says.

The physician was able to pull up the patient's EMR on his iPad, then call back the nursing unit and give them the instructions they needed.

"A few years back, it would have meant a trip back to the hospital, going through the charts, making the change, and then going home," Farrow says. "It could have cost him an hour or so and a cold dinner."

Even El Camino's Walton sees the writing on the wall. "I agree BYOD is inevitable, but this will be a space where, again, healthcare will lag," he says. "Just because we lag, doesn't mean we don't understand why other sectors are rushing toward it. For healthcare, the lag might come in some cases from unions. In others it will be fear of the employer peeking at private data. In other cases it will be that many more IT priorities are higher. In some it will be hard to find the ROI."

Walton says El Camino Hospital "is ready now from a technology standpoint but … given some of the reasons I just cited we won't be setting any speed records going on that journey."

This article appears in the June 2012 issue of HealthLeaders magazine.

Reprint HLR0612-7