When Ottawa Hospital wanted to implement a new computerized physician order entry system it was faced with a choice: Tune the software for desktops and workstations and then adapt it for smartphones and tablets, or go exclusively mobile from the onset.
Canada's largest hospital, in fact, claims it's the first in the world to implement a mobile electronic order entry system for physicians, according to Glen Geiger, MD, chief medical information officer.
Ottawa's move toward mobile-first represents nothing less than a sea change in how healthcare applications will be designed in the future.
What 'mobile first' really means
Hospital CIOs and administrators who want to drive adoption of patient-facing and internal applications need to consider a number of facets that are de facto requisites today. A touch-screen interface, legibility on a 4-inch screen, a drop-down menu, text that can stand up to viewing in bright sunlight, and even voice recognition are must-have features for any modern healthcare app.
But 'mobile first' means more than having a user-friendly interface. A mobile first strategy refers to the idea of designing a product or service for a mobile application prior to adapting it for desktop workstations, according to Dipak Patel, Accenture’s managing director of patient access capabilities.
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Prior to embarking on its mobile first strategy, Ottawa Hospital, which has more than 1,000 beds and 1,300 physicians, had PCs in nursing stations, bolted to the wall in the hallways and on carts.
The problem with that setup was doctors wasted a lot of time going to a workstation to input orders. If physicians had the device in hand, they could conduct ordering at the patient bedside and always be able to access records.
Today, the hospital has "extremely high" electronic ordering on a native mobile application. Besides adding incremental value compared to everything else the hospital tried, Geiger said, they discovered that staff preferred mobile to the existing infrastructure — and now those PCs on wheels are highly under-used.
The business case for mobile first
A mobile first strategy doesn't come cheap, of course, at least not for a large facility like Ottawa Hospital.
Geiger estimated that implementing the mobile first strategy cost somewhere between 5 million and 10 million Canadian dollars. Included in the costs were the purchase of 3,000 to 4,000 iPads, upgrading the wireless infrastructure in three facilities to insure stability of access, and ongoing development activities for the devices.
The business case for mobile first is predicated on the notion of soft dollars, saving physicians' time. Hospital officials also decided they would not train nursing staff to enter orders for physicians, again reducing training costs and time.
"There is an efficiency play, alerts, updates, lab results, updates from a colleague, all these events deploy mobile as the best way to reduce missed or late communications," said Mark Bard, CEO of Digital Insights Goup.
One of the biggest challenges Ottawa had to overcome was help desk access. Typically, fixed assets have an asset number, and when a trouble ticket is generated the help desk sends someone out to resolve the issue. Not so with mobile.
"The help desk couldn't rendezvous with the doctor," Geiger said.
Instead, Ottawa resolved the problem by setting up mobile depots around the hospital where a user could drop in to change a password, get an update or fix a frozen screen.
And while much of what Ottawa has done thus far benefits doctors, mobile first also means putting patients first and physicians second. Why? As healthcare organizations begin to look at patients as consumers — indeed, paying customers — an application sent by the provider to the patient becomes the first order of business, according to Greg Caressi, senior vice president of healthcare and life sciences at Frost & Sullivan.
What’s more, major players like Kaiser Permanente are unwilling to wait for healthcare software developers to catch up and, instead, are creating their own mobile first applications for scheduling appointments, prevention tips and access to lab reports.
Accenture estimates that by 2019 self-scheduling alone will skyrocket to 59 percent of all appointments, and if that happens, it will deliver $3.2 billion back to hospital systems.
This value can be attributed to things such as freeing up time for schedulers to spend on the phone with the people who actually need to talk to a live person to schedule an appointment, or ensuring that patients show up because they were able to schedule it for a day and time that works best for their calendar, Accenture's Patel said.
There’s that choice again
Back at Ottawa, the next challenge Geiger and his team are going to tackle is outfitting all the nurses with mobile devices, which has its own set of issues. The iPads are too large and there is no fully developed mobile nursing application that meets their needs.
But Ottawa has decided that having nurses drag around a 100-pound computer cart is not an efficient use of their efforts.
In most cases they will be issued smartphones and other devices as necessary. While iPads are issued to individual doctors, the nursing staff will have to share the iPhones, signing them in and out.
"It's a whole management infrastructure that we don't have," Geiger explained. Then again, the mobile CPOE system required new management infrastructure and Ottawa was able to establish what it needed and garner benefits in short order.
"We focus on mobile work flows for staff and not duplicating that for the workstation," he said. "We had to choose."
Ephraim Schwartz is a freelance writer based in Burlington, Vt. Schwartz is a recognized mobile expert and columnist, having spent 15 years as Editor-at-Large for InfoWorld, half of them covering the mobile space. Prior to that he was Editor-in-Chief of Laptop Magazine.
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