Enterprise Provider Apps (2 of 2) – 10/12/11

Last week I wrote a post focused on mobile EMRs (mEMRs) as a start for a series on enterprise provider apps. I’m not terribly thrilled with the current mobile offerings nor do I think that an EMR, in any form, is what is needed to improve patient care.

This week I’m covering mobile, and I’m going to focus on the newer smartphone offerings, for enterprise communications and direct patient care. Some of the players are new while others are established in the enterprise but expanding to include smartphones in their offerings.

Clinical Communications

If you’ve spent time in hospitals, you know that alerts, alarms, pages, overhead pages, etc are quite the ubiquitous experience. I personally came to ignore them because there were too many and most didn’t have anything to do with me. For other people, especially nurses, I don’t know how message fatigue doesn’t set in very quickly.

A side note: I think this over-messaging is sort of like sending patients 10 reminders a day to take meds, eat right, exercise, record weight, or whatever else is a part of their treatment plan. That’s for another post though.

The reason for all the messages and alerts in hospitals is that there is just a lot going on. Codes, bed alarms, patient issues, lab/imaging results, witnesses, consults. Combine that with the use of multiple messaging platforms (lights, pagers, overhead, VOIP phones) and it is a horrible system.

The need to unify text and voice in a fast and easy way makes touch-based smartphones a great choice. The main competitors I know if in this space are Voalte (newer, started with smartphones), EXTENSION (Cisco partner or subsidiary, not sure which?), Amcom (doing clinical communications for a long time), and Vocera (also been around for a long time).

Amcom, Vocera, and EXTENSION, because of its ties to Cisco, have a lot of integration already in place in the enterprise, giving them a bit of a lead on the new player Voalte. That hasn’t seemed to stop Voalte from getting from pretty big deals though.

Below are videos of the offerings from Vocera, Voalte, and EXTENSION, in that order.

Nursing / Data Collection / Barcoding

The job of a nurse is not easy. Working with difficult patients, feeding patients, cleaning patients, and sometimes dealing with difficult families and physicians is not an enviable list of work todos. Tools that make part of a nurses shift easier are great.

A company I’ve been reading about recently is PatientSafe Solutions. It offers PatientTouch, an iPod Touch (same as a smartphone really) platform for messaging, calling, medication adherence with barcode scanning, vitals collection, patient assesments, and checklists (I’m not sure they are trying to replace nurse notes and signout checklists). This has the potential to replace a lot of different devices and notes that nurses have to use during the course of a shift.

The device also comes with a handy case that looks relatively secure and a bit bulky. Something I’ve wondered about is infection control with smartphones that weren’t really built for it. I couldn’t find anything on infection control on the PatientSafe site but Googled “infection control smartphones” and found these smartphone towelettes.

By the way, am I the only one that can’t stand seeing the same bright smiling nurses and doctors on vendor websites? I did notice my favorite fake doctor’s hair color was changed to red on this site at least. Either way, please stop using the stock healthcare images!


What does enterprise mobile mean for patient care and providers?

If you’re a healthcare enterprise then a primary objective should be caring for patients, ideally providing quality care with compassion. As pessimistic as I am sometimes about the state of healthcare, reform, and the motivation of patients to own and improve their own health, I still believe the overwhelming majority of providers (docs, PAs, nurses, techs, etc) truly care about patients.

So do any or all of these mobile tools, including the mEMRs covered last week, really have the potential to improve the care of patients? For the majority of these I think they do have real potential to improve the care and experience of patients.

I should start by saying that I’m of the opinion that EMRs/mEMRs, with all the specific requirements around meaningful use, don’t really do much for patient care and primarily serve as a medical legal tool. Having structured, integrated clinical data on patients is helpful for historical info, analytics, and public health, but I don’t think the care of a patient, whether in an office or a hospital, is improved by documenting visits or notes in an EMR. And all the EMRs available today certainly don’t help with provider efficiency.

The only positive thing I can say about EMRs compared to paper-based charting, based on discussions with resident friends that are heavy EMR users, is that EMRs enable clinicians to put off charting until they get home. This is nice for two reasons: 1) Residents can sometimes have dinner with their friends and family and 2) The hours put in charting at home aren’t usually logged so they don’t go towards work hour restrictions (this is only nice for the hospitals).

Now that I’ve said my piece about EMRs, I do think that providing a clinician with mobile access, say over a smartphone or tablet, to certain clinical data, in particular lab results or radiology results, is a great way to educate and engage patients in care. This isn’t really an EMR but a tool that extracts and makes information in the clinical record viewable and engaging. I know a lot of the mobile EMR vendors play up this type of feature in their ads.

Most of healthcare delivery, or the hands-on portion with the patient, is done by nurses so tools for direct patient care, namely vitals collection, barcoding, and messaging, have huge potential not only to improve the clinical care of patients through more timely collection of data, faster response, and less errors, but also to improve the experience of the patient while in the clinic or hospital.

What’s more, a happy nurse makes for a happy hospital floor. Giving nurses something that is seen as “cool” and maybe even “fun” to use has the potential to go a long way for a nurse working an overnight shift.

Enterprise Smartphones Going Forward – It’s the Platform

One of the other big thing I like about smartphones or tablets in the enterprise is that you are equipping staff with a computer that fits in their pockets, granted tablets require very big pockets. In addition to direct patient care and messaging, that mini, connected computer can provide access to:

  • Interactive educational content for providers. Voalte signed a reseller agreement with Epocrates and I could see other content partners, all of which now have mobile offerings, like UpToDate and 5-Minute Clinical Consult being integrated, just to mention a couple.
  • Interactive educational content for patients. Companies like GetWellNetwork and Emmi Solutions come to mind. Discharge education and planning tools would also work well. Also, for end-of-life issues a mobile, interactive version of Five Wishes would be perfect to engage both patients and families.
  • Legal forms for patients. Companies like iMedConsent and others provide digital consents for patients.

I think content and tools for patients probably require the larger, tablet form factor and wouldn’t really work on a smartphone. I’m sure there are more of these types of services that nurses and doctors could rattle off.

I think the nice thing about being a Voalte or a PatientSafe or one of the others that provide the hardware is that they then “own” the platform. Voalte took additional steps this weeks to assure its place in mobile enterprise management by launching Voalte Connect, a mobile device management offering that enables remote management and securing of mobile devices in the enterprise. Well done.

A note about Steve Jobs

As everybody is aware, Steve Jobs died earlier this week. As much as the crowds as the Apple Store tend to annoy me and Apple’s partner policies are sometimes ridiculous , I am a big fan of Apple products. I have an iPhone, iPad, and Mac Book Pro. I use Apple products for everything from professional work to kids games to television. On top of that, I’m a massive Pixar fan, though Cars 2 was a huge disappointment.

It’s hard to really argue that Steve Jobs has had a major impact as he’s helped build organizations and products that many people use on a very regular basis. Last time I was in the Apple store there was an iPad tutorial session going on with about 10 pupils, all of which were above the age of 60 clicking away on their shiny new tablets. What’s more, my kids, all 5 and below, leave finger prints on every TV and computer screen they touch because that is how they think you control/manipulate them. I know Jobs and Apple didn’t invent touch-screens, but they certainly played a big role in bringing them to the mainstream.

His organizations have also challenged a lot of their competitors to build better products, whether it be operating systems, mobile devices, content distribution, or cartoons. Building companies that are focused on usability works and for Apple it has resulted in them finding their way into mainstream industries like healthcare. It’ll be interesting to see how Apple does without Jobs, as it has been so closely tied to his vision and persona.

Travis Good is an MD/MBA involved with health IT startups.


  • Travis,
    Thanks for recognizing nurses as a critical part of the care team and need for new tools and technologies to support them at the point of care.

    And for your hats off to Steve Jobs for his passion for making useful and usable tools that users love – hopefully our industry will be inspired.

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