The Mystery of the Unwed Couple

July 16, 2014
Right now, the interest in mobile health (mHealth) applications is at an all time high, as is adoption of EHR systems. So why can’t these two concepts join together in holy matrimony?

Right now, the interest in mobile health (mHealth) applications is at an all-time high. Walk into the Verizon store and you’ll see the proof. Hell, even your technophobic father is tracking his steps. Adoption of EHR systems is similarly in never-been-before place. Every healthcare provider seems to affirm that reality, whether they like it or not.

So why haven’t the two married yet? Why haven’t they gotten hitched, gone on their honeymoon, moved into a nice three bedroom place in the ‘burbs, popped out a few kids, bought a sedan AND an SUV, and lived happily ever after?

Why is the idea of an effective mobile EHR application still something that is painted in hope rather than reality? Those two concepts should be one, shouldn’t they? I can just picture some old aunt looking at mobile health and EHRs and thinking, “They’re just perfect for each other!”

(Side note: I was married recently, so you’ll have to forgive me if it’s a little bit on the mind)

This was the theme of a feature I wrote in the latest issue of Healthcare Informatics. Like with all great mysterious whys, there is no clear cut answer.

A recent report from athenahealth, a Watertown, Mass.-based provider of a cloud-based EHR system, and Epocrates, an athenahealth service, points the finger directly at meaningful use. In the study, athenahealth found there was a decrease in the number of clinicians using tablets, smartphones, and desktop computers in their workflow because of the push to meet meaningful use standards.

As KLAS’ Colin Buckley told me in the article, first CIOs want to install EHRs on desktops to meet meaningful use and then they’ll focus on mobile apps.

But don’t most EHR vendors offer ready-made mobile apps of their products? Indeed, most of them do. They would be crazy if they didn’t considering how many physicians love to use iPads.

That in itself is another possible reason for the lack of mobile EHR maturity. The apps themselves are an immature. Specifically, an usable form factor, say observers like Buckley. I’ll let Stephen Beck, M.D., CMIO of Catholic Health Partners, a large health system with 23 acute-care facilities and 1,500 ambulatory providers in Ohio and Kentucky, explain:

“I’ve worked with several EHRs in the past, and the challenge around EHRs is that there is so much information to compile and to organize, it’s difficult to get all that information onto a small work space. If you look at a chart on a smartphone or a tablet, there is limited real estate to show the pertinent information on a single screen.”

You have to have an app that truly plays to the strength of the form factor. Nothing is worse than a mobile app that thinks it’s a desktop app. Unlike a desktop app, you can’t cram everything in there. It wouldn’t make sense and will just disturb the flow of the provider. Mobile apps have to scope out trends and showcase vital information, Dr. Beck told me. Buckley of KLAS concurred saying providers would value an innovative way for mobile EHR apps to collect information.

I like what the University of Pittsburgh Medical Center (UPMC) is doing around mobile. I think it plays into what Beck is saying. UPMC has teamed up with the GE Healthcare/Microsoft creation, Caradigm, a Bellevue, Wash.-based healthcare analytics and population health vendor, and developed Convergence, a Windows 8.1 tablet-based platform.

The platform gives providers a longitudinal patient record of vital information from multiple systems that can be used in multiple settings. They’ve made it so the platform is integrated into the provider’s workflow.

UPMC’s commitment (financial and otherwise) shows the underlying truth of this divided couple: Using a mobile EHR cannot be done haphazardly.  It has to be done to the fullest extent of a provider’s capability. Just look at Lee Peter Bee, D.O., an internal medicine doctor in Sesser, Ill., who I interviewed for the piece and extensively uses mobile clinical apps. Dr. Bee told me that his mobile EHR strategy is as followed: “If you don’t do it well, it’s very dangerous.”

There it is. Like any other marriage, it takes commitment, maturity, and patience. Right now, mobile and EHRs aren’t there yet. The good news is everyone I interviewed sees wedding bells in the near future. In 2-3 years I think mobile EHR apps will be all the rage.

Get your rice ready!

Please feel free to respond in the comment section below or on Twitter by following me at @GabrielSPerna

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