Better care team communication? - there’s an app for that

It’s tough to remember a time before your bank had an automated teller machine (ATM) or when you couldn’t check your bank account online, because it was over 40 years ago that the financial services industry began to implement ATMs.  But you would not choose a bank today that does not offer these services; in fact, there are no regional or national banks without them.

As the health care industry plunges headlong into the digital age, the adoption of new technology by providers and health delivery organizations (HDOs)– electronic medical records (EMR), email, texting – will no doubt accelerate. There will be a time in the future when you won’t remember when a patient did not use email to contact the doctor or when doctors could not communicate with each other easily via smartphones or tablets.  Some of those tools are available now, but adoption lags innovation. While numbers vary rather widely, recent surveys of physicians indicate that 75% still do not fully meet “meaningful use” standards for their EMRs despite millions of federal dollars pouring into the marketplace. Another study finds that 72% of physicians are using smartphones in their practice with predictions for 80% by the end of 2012.  These numbers should be interpreted with some caution, however.

Although it is common to read research predicting nearly universal use of smartphones within the next few years, most of these surveys do not reveal their methodology or response rate. If only 20% of those surveyed respond, we should view such generalizations about current or future use with some skepticism. Most likely, respondents who are the most enthusiastic about technology are the ones who return the survey or respond online about their use.  This caution is not meant to deny the reality of the digital revolution in health care – but it should make us all more careful about declaring the use of these tools among providers a “digital done deal”.

To be honest, we need to acknowledge that there are a number of real barriers and challenges to more prevalent use of smartphones, tablets and mobile apps among nurses and physicians.  One of the most obvious barriers is the cost of technology itself, as well as the cost of securing and integrating new tools into existing technology platforms.  Smartphones and tablets are not cheap, and while many providers may already own one of these tools, they may use it mainly for personal reasons because of the second major barrier – security.  While it is appealing to imagine a primary care physician transmitting a photo of a skin rash to a specialist colleague via the smartphone as she stands at a patient’s side, or emailing the results of an MRI for another opinion about a complex case, or texting a colleague with an urgent question and getting an answer nearly instantly –the only way that this type of communication can happen more broadly is if the technology is encrypted and secure and integrates well within the IT system of the current work environment. 

Many providers may already use their smartphone at work, but there are real consequences for violating Health Insurance Portability and Accountability Act (HIPAA) privacy and security requirements about this use of unsecured communication.  For example, according to the Health Information Technology for Economic and Clinical Health (HITECH) Act 2009, health care organizations found guilty of data breaches can be fined upwards of $1.5 million per incident and even be required to notify the local media if the breach involves more than 500 patient records. About a quarter of data breaches originate from mobile devices including smartphones.

There are also more subtle barriers to the widespread use of mobile technology in the workplace – trading the familiar for the new. Most health care workers are comfortable with the use of pagers at work, even though these devices have their limitations. The pager is a staple of every health system and moving to new technology means persuading busy practitioners that the change will be worth it. However, as these practitioners become accustomed to the advantages of smartphones and tablets, being able to both transmit and receive messages on the same device, will reduce the use of the pager even more.

For physicians and nurses that have become so accustomed to the efficiency and convenience smartphones bring to their personal lives, it can be a difficult transition to then rely on antiquated pager systems in their professional life. Dr. Sean Kelly, Chief Medical Officer at Imprivata and practicing ER doctor, recently walked me through how these outdated systems can inhibit bidirectional communications and collaboration among care teams, ultimately slowing down patient care when it matters most.

“When a patient comes into the ER with chest pains, an electrocardiogram (EKG) can help determine whether the catheterization laboratory (cath lab) needs to be activated. When the on-call cardiologist’s opinion is needed before mobilizing the cath lab, it might require the ER doctor paging the cardiologist, waiting for the call back, faxing the EKG and waiting for the call back before treatment can continue. Anything that makes this process more efficient can mean better care for the patient. HIPAA compliant text messaging, like Imprivata Cortext, is one way to enable more efficient communications and improve real-time care collaboration,” said Sean Kelly, M.D.                           

The future of mobile technology holds tremendous opportunity for saving time and money, reducing errors, and enhancing collaboration. Industry analysts estimate that there are forty to fifty thousand health care apps available today to the broader public, but probably only five thousand are targeted to health care professionals. Many of these health care apps offer innovative new ways to link smartphones or tablets to devices that can diagnose or monitor BMI, heart rate or even blood pressure. And some can offer a single source of entry to messaging, data collection, as well as information sharing. What if these tools could help you communicate better and more efficiently? There’s an app for that.


Linda Bergthold is a health policy consultant and researcher with over twenty-five years of experience. Her PhD is from the University of California where she was a Pew Health Policy Fellow. She has done health care research at UCSF and Stanford and worked for several health benefits consulting firms. She currently works as an independent consultant and blogs for the Huffington Post and