Mobile Technology Helps Physicians Coordinate Care

For most physicians, coordinating care with other doctors and staff can be a time-consuming, back-and-forth, error-prone process.

But for pediatrician Wendell Wheeler of South Park Pediatrics in Chicago, an EHR user of nine years who purchased his iPad and iPhone in January 2011, it's as easy as making a few taps with his finger.

Armed with his mobile gear, Wheeler can open patient charts at anytime, anywhere, and do everything from advising patients on medications and sending prescriptions to pharmacies, to communicating with outside physicians about specific patients.

"It's a nice extension [to the EHR]," says Wheeler. "I've been using Amazing Charts for nine years. I went into private practice and I wanted something that would make it easier for me to keep up with my patients and [my iPad and iPhone] have done that."

Wheeler's use of mobile technology to collaborate and communicate with his healthcare peers is representative of a shift in the way many physicians are practicing medicine. And it's a shift that will only continue to expand. In addition to CMS' meaningful use incentive for EHRs, new initiatives under the Patient Protection and Affordable Care Act - including the much-publicized accountable care organization (ACO) initiative that rolled out in April - call for greater communication between physicians. Additionally, a growing number of technology vendors are rolling out mobile versions of their EHRs that allow physicians to do everything from video chat with patients to send charts to hospitals utilizing different systems.

"If you think about healthcare IT, about a world where healthcare IT is being delivered in real time, you can see how mobile devices play a larger role, because physicians have a mobile device wherever they are," says Albert Santalo, founder, president, and CEO of cloud EHR provider CareCloud.

In the future, mobile collaboration between physicians is expected to deliver even more benefits, though it requires some considerations.

Rise of the mobile physician

As with the general public, the use of electronic communications among physicians has picked up steam over the last several years.

For starters, the number of physicians who use the Internet has increased. According to our 2011 Technology Survey, 74 percent of hospital-owned and 66 percent of independent practices out of a pool of 1,013 respondents said their practice has a website. Nearly 40 percent of respondents said their practice uses e-mail to communicate with patients.

But the biggest, most obvious catalyst for the growth of electronic communications in the practice is CMS' incentive program for EHRs that launched in July 2010, offering providers who demonstrate "meaningful use" of an EHR up to $44,000 under Medicare, or up to $64,000 under Medicaid. In 2010, 48 percent of 597 respondents to our annual technology survey said their practice had a fully implemented EHR. That number jumped to 55 percent in 2011.

The timing of CMS' regulations couldn't have been more serendipitous for the mobile electronics industry. In April 2010, Apple released the first version of the iPad tablet, which is still, to date, the most popular tablet brand among physicians. Per our technology survey, 20 percent of respondents (including physicians and practice administrators) own a media tablet, and 54 percent own a smartphone. So it's no surprise a growing number of EHR providers are offering mobile device access through these gadgets.

For physicians, using mobile devices makes stuff such as e-prescribing and looking up medication information easier.

"I've seen physicians go from Palm Pilots to having mobile phones, and vendors are making sure they have everything they need to treat a patient," says Mary Griskewicz, the senior director of health information systems for Healthcare Information and Management Systems Society. "Many physicians have iPhones today, and many are moving toward Android [smartphones]."

The changing face of care coordination

When physicians think of collaboration and coordinating care with their peers, many envision faxing medical records back and forth and calling other doctors. Though this is still being done, a growing number of physicians are opting to coordinate care through electronic - as well as mobile - means. In addition to the increased use and sophistication of technology, there are a couple of other factors that are driving this shift.

For starters, physicians are perhaps some of the busiest professionals on the planet. They're often under tremendous cost pressure from their practices and payers to squeeze as many patients as possible into a day. But when the day ends for most people, it doesn't end for physicians. Using technology helps physicians make quick decisions anytime, anywhere about a patient's care.

Hillsborough, N.J.-based family physician Richard Corson obtained his Cerner EHR four years ago, and as the EHR vendor extended its access to mobile phones and cloud environments, he started taking advantage of the ability to access his data from any location. Though Corson only uses his Android smartphone to access his Cerner EHR when there is no laptop available, he likes having the option of always being near his data and able to manipulate it.

"The EHR is going to be an integral part of how medicine will be practiced in the near future, and one of the great things about it is its mobility," says Corson. "I was … recently on an airplane from Salt Lake City to Newark, and I was communicating with my office, doing refills and such."

And thanks to the healthcare reform law, new regulations are also incentivizing physicians like Corson to embrace collaboration. In early 2011, under direction of this law, CMS called for the establishment of ACOs, organizations that share the responsibility for cost and quality care received by patients in exchange for a share of savings they achieve for the Medicare program.

Corson expects to be coordinating care outside of the office even more in 2012, as he recently applied to be part of the patient-centered medical home initiative led by the American Academy of Family Physicians, centered on collaboration between physicians to provide chronic disease management for specific patient populations.

"That's one of the main pillars of the patient-centered medical home: coordinating care with other physicians," he says.

What's next

Physicians who've already hopped aboard the mobile collaboration bandwagon can't say enough about the benefits they enjoy.

"It's been very nice," says Wheeler, who uses his iPhone and/or iPad at least twice a week to coordinate care. "I can pull up a patient's notes, their allergies, their medications, and I can write a note and sync it up when I get back to the office. I can open it up in 15 seconds and it gives me full demographics including telephone number and pharmacy number, and all of the notes from every visit."

Wheeler now has more time for patients and says he feels less stressed.{C}

Benefits like these are what Joel Andersen, chief marketing officer of Lumeris, formerly ClearPractice, is banking on.

A little more than a year after ClearPractice launched its signature mobile EHR, which is tailored to the iPad, the company has changed its name and direction. One of its goals is to create products that help physicians improve mobile coordination.

"Our strategy has changed a little bit, really, around accountable care," says Andersen. "For accountable care to work, you're going to need to engage physicians in new ways so they can do a better job of coordinating care for patients, or episodes of care for a specific patient."

As such, Lumeris's latest product, still in production, is a "physician engagement solution" that combines the company's signature EHR with tools to collect and share data/information from across the continuum of care. Though Lumeris is primarily targeting hospitals because they are leading the formation of ACOs, the product is designed to be compatible with most major EHRs used by practices.
"It's a system that takes information from all these disparate systems to create what we call a 'single version of the truth,'" says Andersen. "It's an intelligent health information exchange … an integrated platform as a service that includes specifications to decode and exchange information in a meaningful way."

CareCloud also has a stake in the mobile EHR game, and is developing products to help facilitate mobile care coordination - but not just for doctors to communicate with each other.

"There will be physician-patient collaboration in all this," says Santalo. "You'll be able to do video, voice, chat, sharing of records, and stuff like that."

Santalo sees mobile tablets being especially helpful to mental health professionals, who will be able to talk to patients in different care settings, such as schools or prisons, from their office or another location.

Potential considerations

Mobile collaboration's benefits - making life easier and less stressful and allowing physicians to do a better job of caring for patients because they can coordinate care anytime, anywhere - aren't cost- and consideration free.

A number of issues need to be addressed by providers looking to do anything mobile, from accessing their EHRs to collaborating with physicians at off-hours. For starters, there's the compatibility issue. Applications used by Physician A have to support whatever smartphone platform is being used by Physician B. And some older EHR technology isn't readymade for all mobile platforms.{C}

Then, there are the security issues. Per HIPAA, personal health information that is digitized must be encrypted or otherwise secured before it is sent across the airwaves. In addition, you have to make sure checks and balances are in place so the wrong user can't access given data.

"It's one thing to set up an app to allow physicians and other caregivers to access the data, but you have to restrict what data and what data elements the user(s) can see," says healthcare technology consultant Marion Jenkins. "So you would have to manage and authenticate users and their devices."

Finally, don't forget to consider the cost.

Media tablets run upward of $500 upfront, plus additional data-plan charges depending on how you will use the device to go online: A wireless operator's data plan can run $25 per month and up. The same goes for smartphones: Even with a two-year contract, a smartphone can cost $200 or more a month, and that doesn't include monthly service charges.

However, having mobility could be well worth the money if you value certain benefits.

"Mobile devices allow you to manage admission and discharge of patients, more aptly coordinate ancillary service offerings," says Andersen. "Physician-to-physician communication around a unified medical record, that's the holy grail, where one doctor and another doctor can coordinate the transition of care from one doctor to another."

In Summary

Here's why mobile collaboration is the way of the future:

• Use of technology is on the rise. Twenty percent of practice professionals own a media tablet; 44 percent own a smartphone.

• Mobile devices can eliminate time-consuming communication by physicians via faxes and phone calls.

• New initiatives under the Affordable Care Act call for greater communication between physicians.

• More technology vendors are rolling out mobile versions of their EHRs, allowing functions like video chat.

Video Interview on Mobile Technology

To learn more about the pros and cons of coordinating care through mobile technology, watch our video interview with CareCloud's Albert Santalo and physician/consultant David Lee Scher. Visit http://bit.ly/mobiletechvideo.

Marisa Torrieri is an associate editor of Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

This article originally appeared in the April 2012 issue of Physicians Practice.