mHealth Monthly Mashup: release 5.0 – the challenges and opportunities facing mobile electronic health records
Few areas of mobile health captivate and frustrate like the integration of electronic health records (EHRs). As mHealth rapidly evolves so, too, has EHR, making for a multidimensional moving playing field of competing and often incompatible technologies. Medical computing expert Scot Silverstein of Drexel University has criticized most medical records systems as being overly complicated, difficult to use, and prone to glitches, a perspective substantiated by IT behemoths such as IBM and Microsoft that have discovered highly lucrative revenue streams helping hospitals integrate and extract data from disparate and unwieldy software systems.
But the need for simplification and integration has never been more urgent. Prescription medication errors have resulted from this chaos, while physicians and even patients are increasingly embracing both EHR and mobile: according to the Cybercitizen Health 2011 report from Manhattan Research more than 56 million patients in the US have accessed their medical record through an EHR and an additional 41 million are interested in doing so, while 28% of US adults already use their mobile phones to access health information.
“More than 56 million patients in the US have accessed their medical record through an electronic health record and an additional 41 million are interested in doing so.”
In the midst of all this transformation hundreds of companies have sprung up dedicating millions in venture capital to finding the Holy Grail of mobile EHR – so let’s take a quick look at a few apps and communication services paving the way from several angles for the mobile EHR revolution, and speculate what the future may hold for this exciting technological transformation.
The name “Epocrates” has been synonymous with point of care medical information since the earliest PDAs, so their foray into EHRs is both inevitable and intriguing. Leveraging an already established base of over a million physicians and led by Dr. Tom Giannulli, CEO of Caretools and responsible for the first iPhone-based EHR, the Epocrates venture has both the critical mass and expertise to make a big impression in the crowded, fractured, and still predominantly experimental mobile EHR universe.
Figure 1: Epocrates EHR
A web-based system that runs on most PCs and Macs, the software core hosts numerous features, including encounter notes, patient face sheets, lab orders and viewing, ePrescribing with interaction checking, and integration with the Epocrates suite of products. Significant for our purposes here, however, is the simplified version of the desktop interface in the form of iPhone and iPad apps. Since these mobile apps are organic extensions of the desktop product, integration and connectivity issues often plaguing mobile EHR systems can be mitigated. Only time will tell if Epocrates can stake the claim in EHR, but their opening salvo seems well-orchestrated and built on a scalable foundation.
The need for EHR integration is so important that the US government has incentivized it. Obama’s Health Information Technology for Economic and Clinical Health Act, also known as HITECH, has allocated $19 billion to hospitals and physicians who demonstrate meaningful use of certified electronic medical records (EMRs)– translating to as much as $44,000 per physician as an incentive to integrate. Practice Fusion has capitalized on this opportunity by marrying a sophisticated software interface with contextual advertising to provide an easy to use, quick to learn, free EHR platform for physicians eager to take advantage of the incentive and willing to enter the space.
“The need for electronic health record integration is so important the US government has incentivized it.”
Figure 2: Practice fusion mobile EHR solution for iPad
Understanding that mobile extensibility makes Practice Fusion an even more viable contender, they have already released an iPad version, with charting available on the iPhone and Android devices. As Practice Fusion evolves and expands its user base of over 100,000 users, their mobile apps will become increasingly sophisticated and seamlessly integrated into the platform. And as all these mobile EHR solutions evolve, the boundary between desktop and mobile channels will progressively vanish, putting the full power of EHR directly into the hands of physicians and patients at the point of care.
Peering into the near future, enterprise software titan SAP has recognized the importance and potential of mobile HER and have entered the fray with their vision of providing a completely unified and comprehensive vision of patient data. Still unnamed but accompanied by enticing screenshots, the SAP mobile EHR iPad app strives to provide an intuitive and simple user experience, so important for physicians demanding complex information in manageable, actionable chunks. Through it physicians are provided instantaneous access to patient records, diagnostic images, and real-time vitals.
Figure 3: SAP EcoHub iPad app
Experts at content management and data integration for businesses, SAP hopes to apply that knowledge to mobile EHR with this cloud-based, streaming solution. Interfacing with existing physicians databases in all their variegated forms and integrating data from multiple peripheral sensors will no doubt prove challenging, but the commitment from SAP reveals the importance and potential of this emerging mobile medical channel. Few doubt the urgency and validity of the approach: the only question is when will mobile EHR reach critical mass, and by whom?
Central to the success of EHR integration and connectivity is privacy, a concern addressed across multiple mobile platforms by the recent Verizon UIS upgrade. Designed to enable healthcare professionals to identify their credentials quickly, simply, and at no cost, the system securely automates the transfer of health records from multiple sources to facilitate the access and retrieval of patient data strictly to authorized users, thereby protecting both patients and their physicians.
“…the only question is when will mobile EHR reach critical mass, and by whom?”
Acting as a mobile bridge between users and their respective EHR systems, the Verizon UIS not only coordinates authentication and access to ePrescribing applications via Apple iOS, Android, Blackberry, and even Windows Mobile devices, but includes such features as digital signatures for plans, orders, and lab reports. An ID message center allows practices to sign docs digitally and coordinate which items are pending, accepted, rejected, or expired – optimizing efficiency while protecting patient information.
The future mobile EHR
As EHR turns to mobile, current challenges become imminent opportunities. Data entry has remained a legacy issue facing all EHR, leaving users prone to tedious input fatigue and resulting in avoidable errors. Cutting edge technology including voice recognition, Near Field Communications (ultra short range wi-fi), and advanced sensors will mitigate and eventually eliminate the problem, while gradual unification of today’s fragmented and disparate EHR universe will further encourage mobile adoption and connectivity. As devices continue to shrink, bandwidth and processors increase in breadth and speed, and mobile becomes ubiquitous with computing, the boundary between physicians, patients, and devices will vanish to the point mobile EHR will become as ubiquitous as it now seems inevitable.
Part 6 of this series is here.
About the author:
Michael Spitz is VP of Digital Strategy at Ignite Health, with offices located in New York City, New York, and Irvine, California. Spitz combines his passion for technology with more than 15 years of clinical content expertise to help engineer healthcare communications solutions across numerous treatment areas for many of the pharmaceutical industry’s major companies. Follow @SpitzStrategy on Twitter for his daily – often hourly – updates on all things digital for the ultimate benefit of patients worldwide.
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