EMR Benefits: mHealth

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Mobile EMRs

The present day physician is always busy and on the go between hospitals.clinics and own practice.[1] There will be better workflow, improved communications, cost containment, and most importantly enhanced patient care.[1] Ease of access to EMRs using mobile technologies such as iPad and smartphones has decreased resistance to EMR use and implementation in busy settings such as Emergency Departments (EDs). A recent study has shown that use of iPads in EDs presents the following advantages in addition to those observed for EMRs in general (29).

  1. Enhanced patient education and satisfaction
  2. Increased mobility of the device provides a better fit of technology to the application setting
  3. The iPad touch screen enables easy use even without excessive knowledge of computers
  4. Mobile devices was similar to paper charts in that they are extremely portable allowing physicians to carry it around in EDs easily
  5. Remote patient monitoring and diagnosis
  6. Remote ordering capability for physicians [78]
  7. Ability to cross-reference medical terminology and provide multi-language support.
  8. Supports globalization of medical care.
  9. Ability to send health data directly from wearable devices to medical records [1]
  10. Link daily activities of living (e.g. fitness, nutrition data) to health data [1]
  11. Dictate on the iOS device, e-Prescribe, and perform real-time eligibility checks [74].

In addition to voice and text, new mobile device models offer more advanced features, such as web searching, global positioning systems (GPS), high-quality cameras, and sound recorders.[2] The June 2012 Manhattan Research/Physician Channel Adoption Study found that doctors’ ownership and use of mobile devices is pervasive, with 87% using a smartphone or tablet device in their workplace, compared to 99% who use a computer.[3] 13 Surveys have shown that around 80% of physicians use an iPhone, while most of the remainder opt for Android smartphones. [4] [5]

The March 16, 2012, Letter to Us at Kaiser Permanente reported that Kaiser Permanente members can use mobile smartphones (Android, iPhones, or Blackberrys) to access their medical records, lab results, and all other aspects of kp.org. Kaiser Permanente members accessed the smartphone application over 1,000,000 times during the first month of use. In 2011, KP patients participated in more than 12,000,000 e-visits with their health care providers.

Another form of mobile technology that can ease access to EMRs are wearables such as Google Glass, Moto 360, and the Apple Watch [6]. [7]There also other wearables on the market such as BodyMedia Fit system that is FDA approved. These products can collect basic biometrics such as number of steps taken, hours slept, calories burned, etc., and when synced to a smartphone or computer, track your progress over time [8]. Patients with chronic illnesses can wear these devices that can collect continuous data that can be automatically be updated to an EMR. This will allow clinicians to see more accurate trends of a patient's vitals that could not be achieved with regular appointment visits[6].

Architecture of Mobile EMRs

Severence Hospital started developing mobile EMR applications in 2005. In 2010, a mobile solutions for healthcare professionals for IOS based iPhones. In 2012, this application was redesinged to be platform independent, encryption policy was added to ensure data security and provided integrated management of Legacy EMR and a mobile solution. The patient list was organized by themes and its main feature was EMR history retrieval. The new architecture design process had four steps: Server and its architecture, Screen layout and story board making, Screen UI design and development, Pilot test and step by step by step deployment.

The Mobile architecture: consists of Mobile server and Mobile device.The server receives information from the EMR system matched with search parameters which is then converted into information to be displayed on specific mobile device. This mobiles solution was first pilot tested for two month and later deployed in four Severence Hospitals[69]

Cloud Based EHRs: Cloud based EHRs are on the rise in todays health care world. Even though there is still uncertainty and resistance towards cloud services, many small physician practices are leaning towards the cloud. Some important considerations to note when moving towards a cloud based EHR are hardware, usability and cost of ownership. This type of EHR is easier to update than onsite EHRs. [9]

In January 2015, due to a recent KLAS study, ZH Healthcare (ZH), a leading provider of open source Health IT solutions, announced the release of BlueEHS, the first Electronic Health Solution (EHS). BlueEHS will provide a “customizable on the cloud” design that allows users to enable or disable modules that may not fit the provider’s need. The basic system will be offered to providers at no cost.[10]

Entrada health

There is availability of high quality speech-to-text services with efficiency and intelligence tools “in the cloud.[11] Also, there is maturation of connectivity technologies, such as HL7 and integration engines. [11]

Entrada Health of Nashville, TN (www.entradahealth.com) has developed a mobile-enabled Smart System powered by SayIt™ voice recognition technology from nVoq (www.nvoq.com) of Boulder, Colorado. This smart system has been flexibly built to work with the leading smartphone platforms. The system uses the highly accurate voice recording capabilities available within mobile devices as a “virtual keyboard” and then builds an intelligent workflow around the data management process. Instead of attempting to replicate the entire user interface for a given application, such as an EMR, the system minimizes the amount of device keystrokes required for data capture by focusing primarily on clinical narrative unique to each patient such as SOAP notes. Voice data is captured, converted to text and then synchronized with the appropriate business application, which typically resides either on a client’s desktop or in the cloud. [11]

drchrono

With technology pushing us into a new era of healthcare, it appears that many hospitals and privately owned physician institutions are switching to EHRs. This has been a breakthrough from previous years, but the change is still happening. Now, programs such as drchrono take the EHR and make it accessible through a mobile device such as iPhone or iPad through a specific tailored app. The remarkable functionality of drchrono is that it provides benefits not only for physicians, but also for patients. [12]


Physician Benefits

In present time, it seems as if physicians always give the five-minute consultation when evaluating a patient. They come in, introduce themselves, go over the patient's problem briefly, give a diagnosis and prescription if necessary, and then move on to the next patient. It can be concluded that time is a very key aspect of a physician's daily practice. Therefore, it is logical to hypothesize that a physician needs to find ways to cut time in any scenario so that he/she may spend more time with a patient. This is where the benefits of drchrono play a key role.

The first benefit implemented by drchrono is the ability to have speech-to-text support. Essentially, a physician is able to tap on the screen and begin to speak; the program will then analyze the audio sample and turn it into text. [13] With specific M*Modal technology implemented into the application, medical language is easily turned into accurate text. [14] A functional tool like this eliminates the barrier between older physicians who struggle with using physical or electronic keyboards.

Another benefit directly derived from drchrono is the ability of customizing templates on the system. [15] Many traditional EHRs used in hospital settings are inundated with extra material which is irrelevant to many physicians. With template customization, a physician who specializes in neurology can specifically set forms that are only relevant to his practice. Other material such as cardiovascular, pulmonary, etc. can be removed completely from the application in order to have better user-interface functionality.

Patient Benefits

One of the most frustrating things for a physician can be when a patient either arrives late or completely misses a scheduled consultation. One of the main reasons this tends to happen is simply because the patient forgot. With the drchrono application, patients can also benefit from the software. The application has the capability of allowing a patient to receive automated patient reminders. [16]

When a patient arrives at the clinic, logging on to their personal drchrono account will speed up the visit. Once logged in, a patient is able to check-in and fill out any necessary forms online. These forms will then be stored directly on the patient’s account for future use. [17] Tools like this make a patient’s visit more friendly and provide a reason for greater patient satisfaction.


Future trends

Apps that help in the management of chronic health conditions,such as diabetes,obesity,&heart disease, are needed and are eagerly awaited.[18] Mobile device hardware and apps are expected to continue to improve, bringing additional and enhanced benefits to clinical practice.[19] Future mobile apps are expected to include even larger databases, as well as CDSS prompts that will aid in the clinical decision making. There is also need to develop standards for mobile apps so that they can integrate seamlessly with H.I.S capabilities,such as EMRs and patient monitoring systems.[20] [21] As the use of medical devices and apps expands, more educational health care programs are expected to incorporate them into medical curricula. At the same time, establishing standards and policies within health care institutions will be necessary to ensure ethical and transparent conduct.[22]

In September 2013, the FDA released long-awaited guidelines concerning regulation of mobile device apps, announcing that the agency will evaluate apps that are “used as an accessory to a regulated medical device; or transform a mobile platform into a regulated medical device.” The FDA has chosen to exercise only enforcement discretion for apps that are deemed to pose less risk, such as those that inform or assist patients in managing their disease without providing treatment suggestions, or simple tools that allow patients to track or organize health information or interact with their EHRs.[18] [23]


References

  1. 1.0 1.1 http://intecit.com/industry-solutions/healthcare-it/mobile-devices-and-electronic-medical-records-emrs-anytime-access-and-convenience-for-patients-and-doctors/
  2. Boulos MN, Wheeler S, Tavares C, Jones R. How smartphones are changing the face of mobile and participatory health care; an overview, with example from eCAALYX. Biomed Eng Online. 2011 Apr;10:24.
  3. Chase J. IPads and other drugs. Medical Marketing & Media: The Interactive Guide.
  4. Moodley A, Mangino J, Goff D. Review of infectious diseases applications for iPhone/iPad and Android: from pocket to patient. Clin Infect Dis. 2013 Oct;57:1145–1154.
  5. Wallace S, Clark M, White J. ‘It’s on my iPhone’: attitudes to the use of mobile computing devices in medical education, a mixed-methods study. BMJ Open. 2012 Aug;2:e001099.
  6. 6.0 6.1 Davies, Michael A.M. "Wearable Tech Can Extend Clinical Analytics." InformationWeek. N.p., 12 Aug. 2014. Web. 19 Sept. 2014 http://www.informationweek.com/healthcare/mobile-and-wireless/wearable-tech-can-extend-clinical-analytics/a/d-id/1297924
  7. Will Apple Watch revolutionize health care? Three reasons to be cautious. http://www.advisory.com/daily-briefing/blog/2014/09/will-apple-iwatch-revolutionize-health-care
  8. BodyMedia FitBit Official Website http://www.fitbit.com/story
  9. Physicians Divided on Cloudbased EHRs http://www.ihealthbeat.org/insight/2013/physicians-divided-on-cloudbased-ehrs
  10. ZH Healthcare (ZH) Releases New Electronic Health Solution (EHS), Becomes Provider’s Answer to Health IT. http://www.prweb.com/releases/2015/01/prweb12444585.htm
  11. 11.0 11.1 11.2 http://entradahealth.com/resources/case-studies/voice-enabled-mobile-workflow/
  12. drchrono https://www.drchrono.com/about_us/
  13. drchrono products https://www.drchrono.com/products/ehr/
  14. mmodal http://mmodal.com/products-and-services/speech/
  15. drchrono clinical forms https://www.drchrono.com/features/clinical-forms/
  16. drchrono patient benefits https://www.drchrono.com/
  17. drchrono onpatient https://www.drchrono.com/products/onpatient/
  18. 18.0 18.1 Tam C, Sharma A. Mobile medical apps: to regulate or not to regulate? American Pharmacists Association. Available at: http://www.pharmacist.com/mobile-medical-apps-regulate-or-not-regulate.
  19. Mickan S, Tilson JK, Atherton H, et al. Evidence of effectiveness of health care professionals using handheld computers; a scoping review of systematic reviews. J Med Internet Res. 2013;15(10):e212.
  20. Mosa AS, Yoo I, Sheets L. A systematic review of health care apps for smartphones. BMC Med Inform Dec Mak. 2012 Jul;12:67.
  21. Divali P, Camosso-Stefinovic J, Baker R. Use of personal digital assistants in clinical decision making by health care professionals: a systematic review. Health Informatics J. 2013;19(1):16–28.
  22. Misra S, Lewis TL, Aungst TD. Medical application use and the need for further research and assessment for clinical practice: creation and integration of standards for best practice to alleviate poor application design. JAMA Dermatol. 2013;149(6):661–662.
  23. Mobile Medical Applications. FDA. Available at http://www.fda.gov/medicaldevices/productsandmedicalprocedures/connectedhealth/mobilemedicalapplications/default.htm