Sending text messages has become a common method of communication among teenagers, adults, and more recently, medical professionals. Physicians are discovering that texting provides a quick and efficient way to communicate with colleagues, patients, and office or hospital staff. A recent survey by QuantiaMD of 38,000 physicians found that approximately “83 percent of physicians own at least one mobile device and about one in four doctors are ‘super mobile’ users who leverage both smartphones and tablet computers in their medical practices.”
As patients and healthcare providers increasingly use mobile devices to communicate with each other, concerns are raised about the security of electronic protected health information (e-PHI). The Health Insurance Portability and Accountability Act (HIPAA) Security Rule allows healthcare providers to communicate electronically with patients, but it also outlines standards to protect individuals’ e-PHI with appropriate safeguards to protect confidentiality, integrity and security of e-PHI. The following identifies security issues raised by texting of PHI between healthcare providers or provider and patient and how unsecure texting may violate the HIPAA Security Rule and create liability for healthcare providers.
As a general rule, texting of PHI by healthcare providers is strongly discouraged. Texting, or traditional short message service (SMS) messaging, is non-secure and non-compliant with HIPAA because data stored on personal mobile devices is not encrypted and is usually stored within the computer memory or on a smartphone SIM card or memory chip. The lack of encryption and the easily accessible storage methods allow any e-PHI communication on a mobile device to be retrieved and shared by anyone with access to the mobile device. This means that messages containing PHI can be read by anyone, forwarded, remain unencrypted on phone company servers, and stay forever on the sender and receiver’s phones.
Another reason why physician-patient texting is discouraged is that standard texting/SMS limits the message to 160 characters. This limited text field may cause critical information or options to be eliminated. According to a recent policy statement from the American College of Physicians and the Federation of State Medical Boards, physicians should understand text messaging is “not analogous to e-mail because of its abbreviated format and the greater possibility of missed messages.” Physicians are urged not to use text messaging even with established patients “except with extreme caution and with patient consent.”
HIMSS Analytics publishes the results of the 3rd Annual HIMSS Analytics Mobile Survey, examining the use of mobile devices in provider patient care improvement initiatives. For the first time this year, the survey questions were modified to closely align with the six areas of the mHIMSS Roadmap, a strategic framework for providers to implement mobile and wireless technologies.
The roadmap sections encompass key areas of consideration healthcare organizations should focus on when developing and implementing a mobile strategy within a healthcare organization: New Care Models, Technology, ROI/Payment, Legal & Policy, Standards & Interoperability and Privacy & Security.
The survey findings offer examples of the progress made and hurdles that providers face when integrating mobile technologies into their facilities to improve patient care. Respondents indicated that the top benefit to having mobile technologies in their facilities was increased access to patient information and the ability to view data from a remote location. Funding limitations topped the list for barriers. Many providers are also still early in their adoption and implementation of mobile technology. For example, 69 percent use a mobile device to view patient information while only a third (36 percent) use mobile technologies to collect data at the bedside.
“The mobile health market is one of the fastest growing areas in the health IT space. We recognize the growing importance of mobile technologies and its impact to transform the delivery of patient care,” said David Collins, senior director of mHIMSS. “The survey reflects mobile technology as a transformational tool, as demonstrated by nearly all of the respondents supplying mobile technology to clinicians. This is a great example of how providers are integrating mHealth into today’s healthcare workflows. There is still work to be done by formally embracing mobile implementation strategies and measuring ROI.”
Guest post by Barbara Casey, Senior Executive Director for Healthcare Business Transformation at Cisco.
Imagine taking your car in for a routine service, only to be told you’ll need to visit five or six more garages on your own to procure an accurate assessment and treatment of the problem(s). In our current healthcare climate, this disconnected and complicated process is what most patients experience in assessing and treating their health conditions. Many of the most compromised patients, those that are elderly, co-morbid or chronically ill, are alone in their experience, left to connect the dots from cardiologist to radiologist to primary care. Layer in the emotional experience of, for example, being told you have stage four cancer and it’s difficult to focus on, let aloneremember, what the oncologist or surgeon says to do next. Yet, the onus falls solely on the patient, family member or caregiver to create continuity in the care experience.
So, as healthcare professionals, how do we help patients navigate the continuum of care when they are seeing an array of physicians and specialists in currently disconnected care settings? We need to treat the patient more like a true customer, which means upgrading the tools and methods we use to interact with them to be more intuitive and user-friendly so we touch base with them on a more regular basis.
Take for example the retail industry—Amazon and Netflix invest in complex algorithms to understand us better as individuals. As online businesses, they have enough information to recommend the next Father’s Day gift or determine if we prefer science fiction to drama. Can we apply that same logic to healthcare? Wouldn’t you want your own doctor and healthcare network to know you as well as Amazon does—for example, the medications you take, what you’re allergic to and the surgeries you’ve had—so they can recommend what you need to do next to advance your health and wellbeing?
It’s our obligation as technology experts and partners to those in the healthcare industry to find the answers and provide patients guidance in what they need before they need it. So in the end, patients can make the choice about how to approach their health can make the choice. After all, where else would you want to be known more intimately as an individual than in your own healthcare network?
mHealth, video and collaboration tools offer an opportunity to create a true continuum of care and a more seamless patient experience. Communication tools which integrate voice, video and data can also help deliver healthcare more effectively and efficiently. If these mechanisms are in place, the patient is more in control of where, when and how to communicate with care providers. She has the choice of how she wants to connect and communicate with her caregiver—the only question is will it be live in a doctor’s office, via video from her home living room, from a desk chair at the office, or from the path where she’s fulfilling a lifelong goal to hike the Appalachian Trail?
Guest post by Garrett Taylor CEO of Uplift Comprehensive Services.
My organization, Uplift Comprehensive Services (residential services) is fully involved in “mhealth.” We use mobile high-definition video conferencing, which allows our doctors and clinicians to care for patients in geographically remote areas of North Carolina, and gives them full access to electronic health records and an easy way to collaborate each other. Along the way, we’ve improved patient service, enhanced productivity, and cut travel and office costs.
By combining video conferencing technology with a bring your own device (BYOD) mobile strategy, Uplift saves at least $500 for each scheduled physician visit. The thousands of dollars we save each year can be used instead to find grant opportunities for better patient care.
It’s not as hard as you might think to use video conferencing in a mhealth strategy. What follows is an explanation of Uplift’s mobile video conferencing approach.
Uplift Comprehensive Services has been in business for 12 years, covering 15 counties across North Carolina. We offer community-based assistance for children, adolescents and adults, with services substance abuse prevention to mental health treatment. Our treatment options include multi-systemic therapy, outpatient therapy, and medication management, among others. Continue Reading
Patients are not the only ones who will become more engaged as mobile devices continue to infiltrate healthcare; physicians, too, are reaping the so-called rewards.
As the debate continues to rage about the efficiencies created when EHRs are used in a practice setting, there seems to be little argument as to whether tablet PCs, smart phones and even applications like Skype actually improve the business of communication and interaction with patients and their physician partners and physicians with their colleagues.
A physician whom I very much respect, Dr. David DeShan, is one such physician who communicates with patients and colleagues via Skype from his mission outpost in Moscow, Russia.
Spending weeks at a time in Russia each year, he also maintains his status as a partner and practicing physician at a growing OBGYN clinic in Midland, Texas. As an early adopter of the virtual visit, DeShan is able to maintain contact with his patients if they need a consult, and he’s also able to maintain his connection to his practice so he can check labs, review diagnosis and provide counsel to his practice mates should they request it.
By his own admission, he works a full-time practice schedule from abroad in addition to his full schedule as the leader of a major international mission. By partnering Skype and his EHR, DeShan is essentially a full-time practicing physician without a need to be restricted by the brick and mortar location of his practice. At the same time, he’s able to dedicate himself to his medical mission work in Russia and serve individuals throughout the world’s largest country in places that would never receive even the most primitive of care without him and his network of medical volunteers.
But, I digress. I’ll save DeShan’s story for another day.
The point I’m trying to make is in support of CDW Healthcare’s article “Momentum Surges for mHealth,” which cites a recent IDC Health Insights observation that shows clinicians use more than six mobile devices in the care setting each day.
Accordingly, as the mobile world continues to open new opportunities in all aspects of life, physicians, like all of us, know that they will come to rely more on these devices to practice, communicate and collaborate.
Clinicians and practice leaders continue to embrace the devices in the care setting, and they expect practices to allow them in their work. When technology delivers upon its promise and actually makes life easier, it is obviously going to be supported and used, like DeShan has done with Skype.
The technology helps him bridge gaps and essentially eliminate a half-the-world-away gap between himself and his practice. But, in some places, there are policies in place to inhibit this type of care offering. (Policies in opposition to this type of approach should be considered archaic and simply regrettable.)
The CDW piece goes on to state that according to a University of Chicago School Medicine study, providing tablet PCs to residents actually reduced patient wait times in hospitals. Likewise, the study found that the same residents did not have to look for an open computer for medical charting and actually allowed the residents to spend more time with patients.
Novel concept. Technology working as promised. Not so unbelievable when spelled out so clearly as this.
As I said, mobile health will continue to grow in popularity. If internal policies are not supported and encouraged, you’ll quickly find yourself in a BYOD environment, which is not such a bad thing.
In fact, if it develops or if you’re unable to support your own internal mobile device initiative, set some rules and let it bloom.
According to CDW, “You need to establish and enforce policies for mobile users including setting up passwords, separating personal from corporate data on devices … and you need to educate users on how to securely use mobile devices.”
When managing a population that’s more likely to use or own a mobile device like a tablet PC than the rest of the consumer population, the infiltration is well underway so it’s time to begin reaping your mobile rewards.
