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Jason Holt, technical lead for Cisco collaboration, in a session on collaboration technologies in healthcare at Cisco Live 2018.

Mobile healthcare apps now deliver on improved patient care

Lauren Horwitz

by Lauren Horwitz

Managing Editor, Cisco.com

With the mobile healthcare app Mobile Heartbeat built on top of Cisco collaboration technology, hospitals can improve patient care.

Communication is the backbone of quality medical care, but aging systems and strict healthcare regulations like the U.S. Health Insurance Portability and Accountability Act (HIPAA) can make new technology even more difficult to implement.

But today, mobile healthcare apps are ushering in change, and breaking down information silos. Mobile applications for healthcare enable doctors and nurses to communicate securely via text or phone about patients in accordance with HIPAA and to gain easy access to electronic health records—all while using familiar technology via smartphones.

Secure and compliant mobile healthcare apps signal a major stride for the industry. Previously, even if doctors and nurses wanted to communicate with smartphones about patient cases, HIPAA compliance made that impossible. As a result, communications were slow and fragmented.

“Slowness is the enemy of innovation,” said James Webb, vice president of professional services at Mobile Heartbeat, an application that enables clinicians to use a single system to communicate with one another about patient care.

The global mobile healthcare app market is valued at $28.32 billion in 2018 and expected to reach $102.35 billion by 2023, according to Research and Markets. A recent Jamf survey found that 47% of organizations plan to increase the number of mobile devices in their organizations over the next two years. And 96% of healthcare IT decision makers said that implementing a mobile device initiative boosted patient satisfaction.

“If you haven’t started thinking about policies to enable [mobile] experiences in your health system, you’re a bit behind the curve,” said Jason Holt, technical lead for Cisco collaboration, in a session on collaboration technologies in healthcare at Cisco Live 2018.

"Ninety-six percent of healthcare IT decision makers said that implementing a mobile device initiative produced a positive impact on patient satisfaction."

Holt noted that healthcare organizations are clamoring for new technology, such as mobile apps, to improve communication and workflow. Holt noted that 80% of organizations today, and 98% in four years’ time, will employ mobile healthcare apps.

At the same time, healthcare organizations need to do so while being HIPAA-compliant and secure. In some cases, clinicians may introduce apps on their own, a practice known as shadow IT, bringing with them security vulnerabilities.

“There is a problem inherent with . . . shadow apps. They aren’t compliant,” Holt said.

Making healthcare mobile

A healthcare operator based in Nashville, Tenn., wanted to address communication gaps about patients while using HIPAA-compliant technology.

“[The clinical community] told us they needed a device to communicate about many different aspects of patient care — not just messaging,” said the hospital operator’s chief nursing informatics officer.

As a result, the hospital operator could adopt collaboration capabilities that made patient care more efficient, including easing communication between clinicians, accessing lab results, integrating with hospital nurse-call systems and more.

The healthcare organization operates 180 hospitals and serves 27 million patients a year, so it needed technology that could scale. It turned to the mobile healthcare application Mobile Heartbeat, which integrates closely with Cisco Unified Communications Manager, a unified communications application for video, phone calls and messaging, to bridge that divide. Currently, the healthcare provider has employed Mobile Heartbeat in 75 of its hospitals, with roughly 1,000 users on average at a facility.

One of the main features is dynamic number reassignment. This capability makes it easy for doctors and nurses to make calls to one another or other key numbers, such as the lab, without requiring them to commit phone numbers to memory.

"Analytics are king, especially in healthcare."

Irwin Lazar, research leader, Nemertes Research

Instead, Mobile Heartbeat publishes well-known numbers in a directory, and “those are the only numbers [users] need to know,” Holt said. When a number is dialed, UC Manager uses an application programming interface, or API, to re-route the number on the back end, without requiring any action from a user. “It happens on the fly,” Holt explained.

Additionally, identity is no longer tethered to a device but rather to user profiles through Windows Active Directory. As a result, nurses can use any device available to them in the nursing station rather than having to switch batteries between phones.

“The configuration follows the clinician, not the device”, Holt said.

Mobile Heartbeat's tagline for improved workflow efficiency is “15 minutes to 15 seconds,” said Mobile Heartbeat’s Webb. A clinician who wanted an update on a particular patient, for example, in the old system, participated in a “very difficult game of phone tag,” he recounted. This might involve calling the switchboard or other intermediaries, leaving a message, then waiting for a callback from an available nurse.

With Mobile Heartbeat, doctors can look up the patient and find a caregiver through the directory, then reach an available nurse via text message, phone call or video chat. Reducing that phone tag from 15 minutes to 15 seconds, multiplied across the network, equals a huge time savings throughout the hospital.

Further, Mobile Heartbeat brings its analytics into a data warehouse, enabling the hospital network to analyze the effects of workflow changes on patient care. Clinicians then use the data findings to help individual hospitals “optimize workflow . . . in a continuous process of improvement,” Webb said.

“Analytics are king, especially in healthcare,” said Irwin Lazar, research leader in collaboration technologies at Nemertes Research. “If I can move to a model where I have at my fingertips background on that patient . . .  I can spend less time on the phone and possibly arrive at a more accurate diagnosis.”

Adopting mobile healthcare apps

But introducing new technologies will fail without users ready to embrace the change. In the case of the healthcare provider, it soon learned that nurses, with much to gain from workflow changes, were on the forefront, advocating for mobile healthcare apps.

“We got them onboard [by] making it as easy as possible [to communicate] and have the groundswell across the nursing staff that put pressure on the physicians to get on board,” Webb said.

"We got them onboard [by] making it as easy as possible."

James Webb, VP of professional services, Mobile Heartbeat

"If you replace the existing workflow with one that is more complicated, you’ll find that adoption is low,” Lazar said. 

At the healthcare provider, one barometer of success is how entrenched Mobile Heartbeat is in daily process. “If it breaks, [clinicians] don’t know how to go back to the other way,” Holt said. “It’s become so ingrained.”

Ultimately, medical professionals are doing their jobs more efficiently, and that has translated into a better patient experience.

“People are getting better, quicker care,” the chief nursing informatics officer said.

"People are getting better, quicker care."

Chief nursing informatics officer, healthcare provider

Tips for bringing mobile healthcare apps online

While hospitals like the healthcare provider in Nashville, Tenn. have encountered success deploying mobile healthcare apps, implementation and configuration of devices and the network environment can be challenging. Here are a few considerations if your organization is considering mobile healthcare apps:

1. Device and network testing. James Webb of the mobile healthcare application provider Mobile Heartbeat acknowledged that healthcare mobile apps require substantial preplanning and testing to ensure that the configurations and architecture work.

“You might think this sounds pretty easy,” Webb said. “It gets a little more difficult when you’re talking about [deploying] 100,000 devices.” Configuration involves several steps of researching mobility plans for smartphone providers, configuring devices with mobile device management software, spending time configuring wireless settings, then testing all the configurations against an organization’s network with a sample of devices.

“It’s a pretty in-depth task,” Webb said, but emphasized that the hospital network has worked to create a scalable, repeatable process that has enabled it to roll out Mobile Heartbeat to 75 hospitals with roughly 1,000 users per facility.

2.  Wireless access points planning and testing. Cisco consulting engineer Charles Bisel also warned that wireless environments like hospitals require careful surveying both before and after implementation to ensure that wireless access points have been placed properly. If access points are misplaced, location tracking can be off.

3.  Using standardized configuration and auditing. Bisel encouraged the use of scripts to deploy a configuration as well as templates to go back and audit the configuration later. “It will save you many hours of troubleshooting later on,” he counseled.

4.  Signal-coverage issues. A proliferating number of smartphones and IoT devices can tax a network. Gain capacity by making cell sizes smaller; Bisel said, and converting 2.4 GHz radio signals into 5 GHz.

5.  Consolidate Service Set Identifiers (SSIDs). Bisel also noted that, as more devices become connected in healthcare environments—wearable devices, smartphones and other medical equipment—network density increases. It’s also critical for network engineers to think about how to bring these devices online without inundating the network with endless SSIDs. “You can combine and consolidate,” Bisel said.

6.  Consider channel selection and roaming. Bisel said it’s important to plan out channel placement so that smartphone performance isn’t unduly affected .He suggested designating certain areas for channels that dampen smartphone performance—areas that might not generate much smartphone use.

7.  Bandwidth for guest users. Customer satisfaction is important, and hospitals shouldn’t forget about guest users; they are often the principal consumers of Wi-Fi access. Bisel said it’s possible to maintain quality of service for guest access without starving bandwidth for core devices.

Lauren Horwitz is the managing editor of Cisco.com, where she covers the IT infrastructure market and develops content strategy. Previously, Horwitz was a senior executive editor in the Business Applications and Architecture group at TechTarget;, a senior editor at Cutter Consortium, an IT research firm; and an editor at the American Prospect, a political journal. She has received awards from American Society of Business Publication Editors (ASBPE), a min Best of the Web award and the Kimmerling Prize for best graduate paper for her editing work on the journal article "The Fluid Jurisprudence of Israel's Emergency Powers.”