Reining in the herd: mobile devices in mobile hospitals

It might be technology that belongs back in its supposed heyday of the 1980s and that should have since been swamped by alternative devices, but the old-fashioned pager still has a role to play in healthcare – the acute care sector, in particular – and it doesn't seem likely to be leaving us soon.

In fact, there is the distinct possibility that sales of one-way communication devices like pagers may even grow in the short term, according to Michael Clarke, senior healthcare consultant with mobility specialist Amcom Software.

Mr Clarke told an industry webinar this week that when he first looked at smartphone adoption and mobility trends in healthcare when new devices started to become available, he “jumped the gun” and predicted the number of pagers used would decline reasonably rapidly, mainly due to the capability to do two-way communication easily through smartphones.

“What we are actually seeing is the same amount of pagers, maybe even a slight increase in pager sales in healthcare,” Mr Clarke said. “That is because as more facilities roll out mobility strategies, they are actually seeing that paging still very much serves a purpose in healthcare for people who only require one-way communication.

“They require fast, robust, reliable technology for the quick delivery of important information. What you’ll find during a mobility roll-out is that it is reliant on [external hardware, WiFi and telecoms providers]. Pagers will still form a key part of all mobility strategies.”

The webinar was aimed at hospital and healthcare facilities that are looking at introducing a mobility strategy. Some organisations like Melbourne's Cabrini took the plunge some years ago, most have developed an ad hoc approach and allow limited use of mobile devices, and yet others have not yet overcome the many challenges facing large organisations like hospitals – including security and patient privacy – to develop their own strategy.

However, that is beginning to change, even in the slow-moving public sector. “We’ve been contacted here in Australia recently by some large regional facilities in Victoria and Western Australia, a couple of redevelopments just outside Melbourne and some new hospitals in Queensland and in WA, and also a state-of-the-art aged care facility here in Perth as well,” Mr Clarke said.

Many clinicians will use mobile devices despite what hospital policy says. Mr Clarke gave the example of an emergency department physician who had a patient present with an unknown skin condition. Unable to contact the on-call dermatologist, he took a photo of the patient and texted it to a colleague.

While accepting that it was a breach of hospital policy, the doctor said he'd have no hesitation in doing it again, as his primary concern was the wellbeing of the patient.

So while clinicians are demanding to use mobile technology, and indeed are doing so whether approved of or not, for hospital managers and IT departments, there is still a balance to be found between meeting the requests of doctors and ensuring security and reliability.

Clinicians also don't want to feel weighed down by carrying many different devices, Mr Clarke said. “A lot of them complain about having to carry a pager, a DECT phone or a WiFi handset, maybe a voice badge or a duress badge and then they have their own smartphone in their pocket.

“This is true particularly for the junior medical staff who have probably had a smartphone in their hands all the way through med school and throughout their entire training, and it is also very true for a lot of VMOs who operate through different sites.

“They don’t like the idea of having to go through the IT or communications department at each facility to pick up a communications device for that particular site. They want to be able to have a single device, with all of the relevant information on that device.”

So, how do hospitals “rein in the herd of mobile devices and bring order to the field?” Mr Clarke said. “Obviously there is no single correct answer, but we work with many hospitals in this field and we’ve been able to put together a roadmap for designing and deploying a full mobility strategy, right the way from setting up a plan through to the end-user adoption.”

The strategy (pdf) includes steps such as:

  • Define your users
  • Determine which applications/systems your users will need
  • Identify which devices are in use at your organisation
  • Establish who will pay for devices and mobile or data plans
  • Maximise your coverage
  • Consider your disaster response procedure
  • Roll out the product in your IT/ telecoms departments first as a trial, and
  • Join a user group.

In terms of defining users, it means asking who needs to use what device in the different departments throughout the hospital, not just clinical. “It is asking who has pagers, who has Wi-Fi phones, who has DECT handsets, are there any other mobile communications devices in use,” he said. “It means looking at what sort of devices will be appropriate for different workflow.

“It is also important to determine which applications or systems users will need. Once you determine who the users are you can then determine which applications they might need access to. Some staff might need access to drug references for instance, other staff might need access to your directory look-up information, other staff might need access to on-call information, whereas others might need access to electronic medical records or alerts from clinical systems.

“When determining what users need access to there is an important step to determine which communication network should be utilised. For instance, do they need two-way communications or interactions with other systems? If it’s just a one-way communication needed then are there networks available to serve that purpose?”

While doctors in particular are often seen as the driving force in the move to mobility, there are plenty who are not convinced of its worth, and many other clinicians who are not particularly IT savvy. Hospitals must remember to publicise the benefits of a mobile roll-out, and get champions on board to do peer-to-peer communication, Mr Clarke said.

“You have to communicate the value,” he said. “Highlight the benefits to clinicians in terms of less time spent tracking down staff, confirming messages have been delivered, the ability to message anyone in the organisation from a mobile device, and security and traceability.

“You also need to look at who is going to pay for what. Determine what your organisational policies are as far as who is paying for what. Do you allow an authorised collection of devices on site or are you going to adopt a bring your own device policy?”

On the issue of BYOD, Mr Clarke said this may be a better option than issuing approved devices to staff, even if it means having to deal with integrating internal software with multitudes of devices and operating systems. People also tend to take better care of their own property than that issued by their employer.

“It is a question that I often get asked and I’ve asked a couple of customers: do staff take better care of their own devices? We get so many reports of staff dropping their devices in the toilet or being water damaged or broken.

“I've asked this question of several hospitals and the feedback was an out and out yes. They said that since they had adopted a bring your own device strategy, there had not been any reports of any breakage or damage to devices that the staff had provided themselves.

“Their opinion was that yes, staff do take greater care of their own device.”

The biggest challenge for hospitals wanting to execute a mobility strategy was the difficulty in setting up for the many different devices that are available today, he said.

“And also monitoring the changes and trends in technology is quite difficult. Technology changes quite quickly and there are many different types of devices that are in use, so trying to get set up and aligned with the business and roles within the hospital is quite difficult.

“It should be seen as an ongoing practice – don’t expect that this is something that you can just do as one-off exercise. You can’t just write a mobility strategy, deploy it and then forget about it. It is very much something that needs to be considered and maintained on an ongoing basis. You need to stay on top in of any changes in technology but also in legislation.”

Amcom's guide to developing a mobility strategy can be downloaded here.

Posted in Australian eHealth

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