Physician smartphone popularity shifts health IT focus to mobile use
■ Doctors' embrace of such devices puts them at a disconnect with hospitals that rely on desktop-based health technology.
With physician smartphone use nearing a saturation point, doctors are in an unfamiliar position when it comes to health information technology -- demanding that others adapt to their needs, rather than the other way around.
Physicians' rapid embrace of mobile devices -- well beyond the rate the general population uses them, as measured by several surveys -- has caught many involved in health information technology off-guard. That's particularly true of hospitals, which report being besieged by physician demands that electronic clinical information systems be available through their BlackBerrys or iPhones.
"Five to 10 years ago they were saying, 'If only my docs would be using computers,' " said C. Peter Waegemann, vice president for development of the mHealth Initiative, a Boston-based organization that promotes mobile technology in health care. Now hospital executives bemoan the fact that doctors are "using these smartphones all the time ... and I don't know how to integrate it," he said.
If numbers reported in late July from market research firm Spyglass Consulting Group are any indication, nearly every physician in the country is using a smartphone. Its survey of more than 100 physicians, taken in February, found that 94% use smartphones for personal and professional use, including at the point of care.
Even if that number seems high, other surveys bear out that many more physicians are using smartphones than are not. Manhattan Research, in its annual "Taking the Pulse" study of physicians and health care technology, reported in late April that 72% of doctors use smartphones personally and professionally, with that number expected to jump to 81% in 2012. By comparison, less than 20% of the general adult population in the United States uses smartphones.
"In 2010, the conversation has shifted away from whether physicians are online to understanding the degree to which digital content is changing the way physicians practice medicine," said Meredith Ressi, vice president of research at Manhattan Research. "Professional use of smartphones and online user-generated content are no longer early-adopter activities of a tech-savvy few -- these types of activities are the norm for the majority of physicians today."
Experts say that like many people, physicians bought smartphones originally for personal rather than professional use. But the reason for smartphones' professional popularity, compared with desktop-based health technology, is fairly simple: Smartphones allow mobility, and desktops don't. This is critical for health professionals who don't spend their days sitting in one place.
"Doctors have indeed found a tool that naturally fits with their lifestyles and workflow needs, and the future is going to need to include mobile integration with [EMRs] and other clinical applications," said Brian Ahier, who holds the title of health IT evangelist for the Mid-Columbia Medical Center in The Dalles, Ore. He is also a health IT blogger.
Disconnect with hospitals
Gregg Malkary, managing director of Spyglass Group and author of that organization's study, said smartphones are ideally suited for physicians and the way they work. But physicians face one major obstacle: using their smartphones to connect with existing clinical applications, such as electronic medical records at their local hospitals.
George "Buddy" Hickman, executive vice president and chief information officer at Albany (N.Y.) Medical Center, recently surveyed fellow members of the College of Healthcare Information Management Executives on smartphone use. Of the 52 hospitals that responded to his survey, only 18 said they allow smartphones to access the hospitals' EMRs and other clinical tools.
Even those facilities that support smartphones have their limits. For example, only six of the 18 hospitals in Hickman's survey that support smartphones support more than one device, which poses a problem because physicians are not settled on just one. In Spyglass' survey, 44% of physicians used iPhones and 25% used BlackBerrys.
Hickman said hospital security policies also can stifle smartphone use. Hospitals that support smartphones generally have policies on passwords and automated timeouts, which lock the phone down after a few seconds of being idle.
Following those policies can make the phones less convenient and more cumbersome, Hickman said. Therefore, even if a hospital supports smartphone use, many doctors decide to use their phones for tasks not tied to the hospital.
Some hospitals have bought smartphones for their affiliated physicians and use them instead of pagers to communicate with doctors. In those cases, however, experts said hospitals tend to buy just one brand of smartphone, which might be different from the brand physicians use personally and professionally. Still, many hospitals report that they are beginning to investigate how they can allow access to their systems from multiple kinds of mobile devices.
Just because physicians' smartphone use gives them more control in the technology discussion doesn't mean they have control of the technology itself.
The Spyglass survey found that physicians feel overwhelmed by the volume of communication they receive on a daily basis. Malkary said smartphones actually can contribute to the problem, not help it, especially for older doctors unaccustomed to managing so much data at once. Part of the problem is the lack of automated tools to manage the varieties of incoming messages. Another issue is that even though physicians might have smartphones in their pockets, heavy patient loads still mean that messages aren't going to be checked as they come in.
Waegemann said app developers could help overcome these barriers.
For example, there could be an application that would allow e-mail dictation to save time, or an application that would file incoming messages by their importance or urgency. Waegemann said developers need to step up and make these tools available so that physicians can start using the devices in a way that makes them more efficient.
Experts say smartphones need to become an integral part of care delivery. Most suspect it will happen -- but when, they're not sure.
"One day we may be able to say, 'Happy doctors? Yup, there's an app for that,' " Ahier said.