Mobile devices are enforcing its use in all aspects of life, health care is one major area where mobile device could enhance operations, or improve quality and efficincy. Here is a presentation I gave at HIMSS which may be useful to you if you are considering using mobile device in your health care discpline.

1. Use of Mobile Device in Health
Care Setting
Samir Sawli, PhD
Jaime Bland, MSN, RN, PMP, CPHIMS
Sidra Medical and Research Centre
Doha Qatar

2. Do you want to go Mobile?
• Do you want to extend the boundaries and
efficiency of care at your organization?
• Do you want to make health information
accessible to your staff and consumers
• Then we share the same objective

3. SIDRA Medical and Research Centre
Sidra Medical and Research Center (Sidra) in Doha, Qatar,
will be a state-of-the-art, all-digital, academic medical center.
Sidra will encompass three essential missions:
• World class patient care
• Medical education
• Biomedical research
We did market search and best practice research and ended
up with a discussion paper which will be published after
HIMSS 2010

4. Objectives
• Describe, at high level, elements of planning a
mobile health strategy.

5. Corner Stones for Mobile Health Strategy
• Organization Goals Objectives and Strategy
• Enterprise Architecture
• Gather Business requirements taking into consideration:
 People (Patients, Physicians, Nurses, Allied Health professionals, Support staff)
 Process workflow benefits
 Technology
 Hardware options
 Applications ,what and where to use a mobile device
 Benefits of using mobile technology
 User adoption
• Risks
 Privacy and Security
 Incident management
 Infection Control
• Cost and Return on Investment (ROI)
• Integration
• Policies and Procedures
• Testing
• Training
• Go live plan
• Wish list of providers

6. Strategic Information Systems Plan
Strategic Information Systems Plan Defines
• Mission
• Goals
• Objectives
• Technology needs
• Infrastructure
• Priorities
Mobile health strategy should be aligned with
Organization's IT strategy

7. Enterprise Architecture
• Enterprise architecture is the organizing logic
for business processes and IT infrastructure
reflecting the integration and standardization
requirements of the firm’s operating model

8. Enterprise Architecture Framework
Data, Function, Network, People, Time, Motivation

9. Applications

10. Gathering Requirements Take Into
Consideration
• Process
• People
• Technology

11. Process: Benefits of Using Mobile
Technology
• Increase efficiency by making information readily
available to health care providers at their finger
tips
• Accessibility to Electronic medical record and
ability to place urgent orders
• Enhance communication through messaging and
audio/video communications in regards to
patient’s condition
• Provides audit trail, meeting JCIA requirements

12. People
What the Patient may use it for
• Scott Eising from Mayo clinic said: “in our research into mobile health
consumer, we found that people are looking for action oriented
information” .Consumer will not use mobile device for in depth research
using PDA.
• To access their PHR/EHR to view or update their health information
• To control a chronic disease like diabetes or ulcerative colitis
• For Medication adherence and compliance. Help patient log and time his
medications. Some applications can send reminders to patient to adhere
to the prescribed dosages, times and rotation sites in case of injection.
• Smart phones coupled with sensors are used to Monitoring of vital signs
like temperature, heart rate, blood sugar and activity. Results are
transmitted to monitoring authority who may call the patient or initiate an
intervention, or trend the results over time.

13. People
What Physicians may use Mobile device for
• Most often physician will use mobile device for Drug
Clinical reference alerts and awareness from FDA
, CDC, example FDA Recalls
• Drug Dose calculators and interactions
• Medical Reference (help avoid drug errors by 3 errors
/month, and save around 20 minutes per day according to a
study by Brigham and Women's hospital)
• Receive Blood test result with alerts to abnormal results
• To track and monitor patients (receive Fetal heart rate
monitoring , ECG wave, Hemodynamic values, Mobile PACS)
• To earn CME’s and listen to lectures and Webcast

14. People
Nurses Use Mobile Device for
• Nurses are using mobile computing device in
the rounds, for communication and for drug
administration
• Drug Dose calculators and interactions
• Receive Blood test result with alerts to
abnormal results
• To track and monitor patients

15. People
What support staff may use Mobile device for
• Laboratory and radiology technicians are gradually
replacing pagers with handheld devices to receive
requests and chart completion
• Support staff are using handheld devices for
warehouse inventory, delivery of supplies, and
mounting up medication dispensing machines
• Throughout the healthcare facility handheld devices
are enhancing efficiency through event messaging
example, communication with housekeeping, case
managers, blood bank, discharge planners and code
team

16. Technology Software Market Screening
• By Feb 2010 5805 health and fitness applications
were available in the APP store
• 73% of APPS were developed for end-user or
patient while 27% were developed for health care
providers
• While APP store is leading the market of Health
related applications developers are making
applications for other operating systems

17. Technology Adoption
• According to MANHATTAN RESEARCH the
number of Physicians who own SMART
phones will increase from 64% to 81 % by
2012
• Universities are encouraging use of handheld
device through giving medical students
handheld device during their medical study
(Columbia University Medical School)

18. Hardware options
• Lets define
1. Cell phone- Provides Voice communication and SMS over 3G wireless
network
2. Feature Phone: have in addition to voice communication and sms, some
media tools like camera, games, and MP3/MP 4 players
3. Personal Digital Assistant or PDA combines featured phone functions
with web browsing and organizer and email.
4. Smart Phone: Run on specific operating system like windows
mobile, Iphone operating system, Blackberry operating system, symbian
and Linux. The operating system allows installation of downloadable
applications
5. Tablet PC is a complete computer contained entirely in a flat touch
screen that uses a stylus, digital pen, or fingertip as the primary input
device instead of a keyboard or mouse example C5 , and H1

19. Health Care IT Architecture

20. Technical considerations
Signal Interference
• In England, then NHS (National Health Service) issued
report DB9702, Electromagnetic Compatibility of Medical
Devices with Mobile Communications. In that 1997 report,
• only 4% of handheld transmitters (all types) cause any
interference at a distance of one meter (3 feet) due to
inadequate shielding
• The risk of interference from a cell phone device is no
greater than other handheld communication devices, in
fact there is less interference than portable radios.
• Further tests and trials are needed to recommend the right
device for the right health care setting

21. Technical considerations
• Fall and break of the handheld device require
fully rugged devices and or case to prevent
break
• Durability of the battery and suitable
recharging options is another concern to
address by technical staff

22. Gathering Requirements
Category Subcategory Requirement
Patient Disease control Ability to track Blood
Sugar level
Physician Medication Prescription Ability to look up drug
interaction
Nurses Medication Ability to look up drug
administration information
Technical Integration Ability to integrate with
the organization portal

23. Risks
• Misinterpretation of data ,images and waveforms
due to clarity of display
• Communication failure due to connectivity
• Device failure due to battery depletion and fall
breakdown of the device
• Device loss or theft which constitute security
breech concern
• Privacy and security breech of information
• Nosocomial infection to patient and staff

24. Security Considerations
• Privacy invasion through wireless transmission
of patient care data
• Device theft and loss of patient and corporate
sensitive information

25. Privacy and Security Standards
• International Organization for standardization (ISO)
• Federal Information Security Management Act (FISMA)
• Health Insurance Portability and Accountability Act
(HIPAA)
• German Leach-Bliley Act of 19999
• PCI Processing Rules
• UK Data Protection act of 1998
• European Union Data Protection Directives

26. Threats and Vulnerability
• Identify threats
• Identify vulnerabilities
• NIST ICAT vulnerability database
– http://nvd.nist.gov/
– Likelihood determination
• Impact analysis

27. Risk Management
• Risk Assessment
• Risk Mitigation
Train all stake holders on process of reporting
incidents
• Evaluation and Monitoring

28. Infection control
• Hand held device constitute a major concern from spreading
infection to patients and staff in the absence of strict infection
control policies, decontamination measures and practices
• A multi-disciplinary team of experts at Johns Hopkins University
School of Medicine has created a seven-foot-tall, shower cubicle
device that can automatically sanitize hard-to-clean equipment
such as computer keyboards and cell phones in just 20 minutes
• The SUDS (self-cleaning unit for the decontamination of small
instruments) invention disinfects noncritical equipment better than
manual cleaning
• Another strategy to contain the risks of infection is the
implementation of a RTLS (Real Time Locating System) tag to track
and record trails movements of devices and patients wirelessly.

29. Cost and Return on Investment
• Mobile devices and infrastructure is relatively
costly
• Project 5 years return on investment
• Emphasize problems and their cost in the
absence of the mobile technology
• Project maintenance and upgrades of mobile
technology (Batteries, replacement of device)
• Present plan to executives seeking approval and
budget

30. Policies and Procedures
• Gather a team from stakeholders
• Gather existing policies and procedures
• Involve users and first line supervisors
• Consider privacy and security standards
• Place policy development on Project plan
• Define technical access controls
• Define data access controls for access and
authentication
• Once Policy is final, teach it to users at all levels

31. Integration
• Electronic Health Record, CIS
• Enterprise Resource Planning ERP
• Web Portal
• Messaging tools and software
• Communication Software
• Business Intelligence

32. Testing Mobile Technology
• Gather testing team
• Unit testing
• System testing
• Load or volume testing of concurrent users
• Integration testing
• Log errors
• Report errors and deficiencies
• Track resolution of errors
• Map results to contractual requirements

33. Training Plan
• Super user (Nurses, Physicians, allied health)
• Patient
• On going training plan
• On line training material
• Attractive content using multimedia
• Training environment

34. Go live plan
• Preparation of infrastructure
• Interfaces
• Training
• Support at the point of care and not only
behind command center desks
• Helpdesk
• Pilot Mobile technology solution

35. Mobile Device, Wish list of providers
• Function as communication device, between the health care provider and the
patient, and between the health providers themselves
• Function as source of information for drug dosages, compatibility and formulas
• Reader for RFID, BARCODE and finger print especially upon delivery of care
• Basic charting tool, compared to desktop advance charting tool
• Well connected to health information system, health care portal and community
• Be light weight easy to carry in the scrub pocket or hospital gown
• Durable if fell down on any surface solid or liquid
• Long battery life, does not need frequent charging
• Reasonable cost in case we lost it
• Easy to use
• Elegant looking
• Small size
• Infection resistant, does not spread organisms around
• Safe to use in any environment especially intensive care areas and operating
rooms

36. References
•
• Rothschild, J.M., Fang, E. Liu, V., Litvak, I., Yoon, C., Bates, D.W. (2006) Use and
Perceived Benefits of Handheld Computer-based Clinical References, JAMIA
2006;13:619-626
• Wireless Devices and Electromagnetic Interference in Hospitals, Urban Myth?
Retrieved 22 January, 2010 from
http://www.pdamd.com/features/interference.xml
• Gilfor,J.M. (2001) Report on Electromagnetic Interference in Hospitals, Retrieved
from http://www.pdacortex.com/EMI.html
• McCormack, J. (2009) Healthcare Goes Mobile: Mobile Devices and Infection
Control: Do You Have Game? Retrieved 22 January 2009 from
http://www.healthcaregoesmobile.com/content/mobile-devices-and-infection-
control-do-you-have-game
• CPHIMSS study guide
• http://dictionary.sensagent.com/enterprise+architecture/en-en/