Healthcare was one of the first industries to adopt the iPad when it launched in 2010. At the time, many doctors simply brought their personal iPads into their offices and/or hospitals. In doing so, they were at the forefront of the consumerization movement that has since swept through almost every profession.
Nemours, the largest health group focused on pediatrics in the US, has been at the forefront of the mobile revolution in healthcare. Nemours, which was established by a trust of industrialist and philanthropist Alfred DuPont, provides a range of children's health services across four states (Delaware, New Jersey, Pennsylvania, and Florida) and offers care to 250,000 children each year.
Give its history of innovation -- it built one of the first children's health websites (KidsHealth.org) in 1995 and was the nation's first pediatric health organization to completely integrate electronic health records (EHRs) across all of its provider locations and specialties in 2000 -- it isn't surprising to find Nemours at the forefront of the mobile revolution in healthcare.
Over the past two years, Nemours has migrated roughly 1,500 BlackBerry users to iPhones, iPads, and Android devices. It has developed many internal apps (plus one public health app) to streamline and improve quality of care. In one of the most innovative and ingenious uses for iPads in healthcare I've ever seen, Nemours is actually building iPads into the walls of its hospitals to improve patient care and safety.
Earlier this week, mobile management heavyweight MobileIron presented a live webinar with J.W. Hagan, the mobile device administrator at Nemours, that offered insights into the organization's journey of consumerization and mobility. There were several key themes that Hagan and MobileIron shared that easily apply to any health care or services provider, as well as to most other organizations struggling to manage the transition to effective use of mobile technologies.
Moving away from the BlackBerry
One of the biggest transitions that Nemours undertook was supporting the desires of clinical and administrative staff to replace their BlackBerries with iOS and Android devices. When the iPad launched in 2010, Nemours had about 2,000 BlackBerries in service across its facilities. Today, it has just 500. It has 1,300 iOS devices and 20 Android devices. The mobile devices are split pretty much down the middle between handsets and tablets.
One of the concerns of longtime IT veterans about replacing the BlackBerries with iPhones, iPads, or Android devices is device and data security. RIM's BlackBerry Enterprise Server (BES) offers over 500 configuration or restriction policies that IT can set.
In healthcare, which is bound by stringent privacy and security regulations like HIPAA, security concerns are typically weighted more heavily than in almost any other industry. According to Hagan, by partnering with MobileIron, Nemours was able to meet its HIPAA requirements fairly easily. It focused on five core tenets that form the basis of HIPAA requirements and privacy/security in general.
- Use mobile management to ensure needed restrictions or configurations remain in place
- Require full device encryption
- Require a passcode (ideally a secure one that is more complex than a simple four digit PIN - Nemours requires a six character passcode) and configure devices to lock automatically when being actively used
- Put controls in place around cloud services (Hagan used the example of Apple's iCloud and its Photostream feature that syncs photos across user devices)
- Rely on app design guidelines that ensure content stored on the device is secure
The trouble with Android
One of the concerns that is often mentioned about Android is that because the platform is fragmented with different types of devices running different OS versions, that it can be hard to ensure that Android devices meet baseline security requirements.
Different organizations approach this challenge in different ways and one of the more common choices is to offer different levels of access to network resources or sensitive data based on the Android versions of different devices.
Nemours chose to handle Android using a different and arguably more secure option. It only approves specific Android devices that have been vetted as secure and manageable to meet its security and privacy needs. That means devices running Ice Cream Sandwich or better and that do not have an SD card slot (a memory card could be swapped out of a device and copied to a PC). That essentially means only Galaxy Nexus devices at this point.
Since Nemours doesn't offer a BYOD program and all devices used by doctors, nurses, and other staff members are bought and managed by Nemours directly, enforcing this requirement is fairly easy. Hagan notes that Nemours will probably move to a BYOD model at some point, which could require revisiting its Android management approach.
Speeding along with app development
Once iOS devices began replacing BlackBerries, Nemours was faced with the desire for mobile apps. The first request was for a directory app that could allow users to locate contact and resource information within the organization - functionality that had been enabled on the BlackBerry. The company developed a custom app that pulled data from various backend systems to provide contact and location information about employees as well as about different facilities and conference rooms. The company's development team also added in navigation abilities so that users could get travel directions if needed.
Hagan said that once the team finished its first app, its members were eager to work on others. To date, they've create a handful of internal apps including one for IT support tickets and a patient survey app. It has also branched out into public health apps available in Apple's App Store..
The survey app helped ensure quality of care for hospital patients. Rather than patient surveys being requested after discharge, conducting them during in the hospital on an iPad ensured prompt and accurate responses. A similar program at Duke University saw strides cancer programs that used a similar technique.
Beyond its internal apps Nemours also uses public apps including apps from its EHR vendor (Epic) and Citrix that offer secure access to patient charts and other data.
The iPad as an appliance in patient care
Directory, help desk, and survey apps are important ones, but they aren't always the most innovative. The latest effort of the development team at Nemours is definitely innovative. In fact, it won an app contest at MobileIron's M2 user conference.
That app is a patient status and special needs display that is designed to replace the use of cork boards, door knob hangers, and dry erase boards used by many hospitals to identify patient details like whether a person needs help getting out of bed, has drug allergies, is on a specific diet, if the patient has been recently transferred from ICU, and whether visitors need to check-in with nurses before entering the room.
By putting all of this information into a kiosk-style display app that is managed externally, Nemours is ensuring that any crucial information (and some less crucial but comforting details like if it's a child's birthday) is easily visible in a uniform format. The app even includes a clean button designed for maintenance staff to note the state of a room. The iPads running this display app will be mounted near the door to each patient room and function as a data appliance.
Although the concept is pretty simple, it is also ingenious and innovative. The app takes a small piece of the hospital experience that is often implemented poorly and replaces it with a far better option. Realistically, this simple app could save lives by helping prevent hospital errors.
Planning and communication are key
In the end, the biggest advice that Hagan had for IT professionals in the healthcare field as we as in other industries is that planning and communication are key factors in developing an effective mobile strategy. He particularly emphasized that such initiatives often require members from different IT teams like development, security, and support divisions and that mobility touches virtually every workgroup in an IT department. As a result, mobility specialists need to be part of discussions about upgrades and transitions that aren't always mobile focused. Hagan used the example of an Exchange upgrade and how that can impact mobile management tools and mobile devices or apps.
He also noted that effective communication with users is another key point to success and that communication can be done using different channels like an internal blog or email list. One key point Hagan made is that communication can and should be targeted at specific populations in an organization. Issues affect just iPhone and iPad users don't need to be sent to all employees, for example.
In the end, Nemours is innovating and making all of its operations more efficient and effective with mobile technologies. It is also demonstrating that innovation doesn't have to mean something on a grand scale - simple solutions to everyday needs can go a long ways.
A recording of the webinar will available from MobileIron's resources page in the near future (free registration required).