QUOTE OF THE WEEK: "We need to bring the exam room to where the patients are." - Dr. Jay Sanders, telemedicine pioneer

 

Mobile technology is on the cusp of creating unprecedented change in the U.S. healthcare industry. Despite its potential for improving communications and workflow, the pace of mHealth (as the new field is known) has been slothful compared with other industries. However, the scenario is slowly changing, pitting healthcare's complex and costly rigors against the technology's increasingly widespread acceptance and use.

Information privacy and security concerns loom large as impediments. Despite these hurdles, will mobile technology —from texting to imagery sharing in telemedicine consultations and mobile access to electronic health records—keep progressing? Will it reduce costs and improve clinical results by instantly lending health-enhancing information at defining moments? Will patients routinely discharge from the hospital with apps linking them to their providers? Will mobile healthcare ultimately live up to its promise?

The answer lies in how motivated organizations are to invest in technology and training. Much depends on whether there is adequate return on investment (ROI), which includes increased consumer satisfaction. Healthcare providers are notoriously slow to measure technology ROI. For every major academic medical center with massive resources and sophisticated systems, there are thousands of small hospitals and clinics continuing to rely on costly, error-prone manual paperwork, outdated administrative procedures and basic computer hardware and software capabilities. But with competition intensifying, administrators must satisfy patient and clinician expectations, and mobile technology is already a fundamental part of most Americans' lifestyles.  Tech industry giants like Google, Samsung, and Apple have all announced ambitious health care integration plans with mobile devices this year.

The aim of making patient information accessible on mobile devices is to boost the efficiency and quality of care delivery with more timely, potentially life-saving treatment interventions. This is a tall task given a convoluted environment regulated by stringent privacy and security compliance guidelines. Healthcare institutions continue to grapple with how best to adopt mobile technology and transform care in an industry that has been especially resistant to change.

Taking the current temperature on this issue are researchers from Healthcare Dive and Spok, who surveyed almost 250 senior healthcare service providers about mobility in their healthcare systems. Most were administrators, but physicians, nurses and clinical staff represented nearly two in 10 respondents to the survey; nearly one in 10 respondents were information technology (IT) professionals. Most of the respondents' organizations were fairly large, ranging from 100 to 500-plus beds.

Healthcare organizations' most common use of mobility (59%) is for mobile access to electronic health records (EHRs). This is followed closely by paging (55%), secure texting (42%), and telemedicine consultations with other providers (35%). By far, healthcare organizations' most common uses of mobile technology to communicate with patients are email (60%) and the online patient portal (55%). Next comes text messaging (32%), with mobile apps and telemedicine consultations at 23%. Its use for home monitoring is below 20%.

As for staff clinicians, nearly two-thirds of healthcare organizations issue mobile phones to them, and most (53%) also issue laptops. About four in 10 organizations issue pagers to clinicians, and 35% issue tablets. Only 13% of organizations don't provide some type of mobile device to clinicians at this point in time.

Nearly three-quarters of healthcare organizations expect to expand the use of mobile technology in the next year, and just shy of 50% are increasing their budgets for it. However, perhaps because of uncertainty over Obamacare's upcoming second year of health insurance exchanges, nearly one-third of organizations don't know whether their budgets for mobile technology will increase in the next year.

Hospitals are starting to outgrow their isolated brick and mortar facilities predicated on heavy inpatient volume to becoming focused more on outpatient services and remote health management intervention. The Affordable Care Act (ACA), by covering previously uninsured Americans and expanding Medicaid, was intended to provide better access to primary care services and reduce unnecessary emergency room use. But many hospitals have documented more ER crowding since the ACA's exchanges initiated coverage in 2014. As a result, hospitals are competing to become (or remain) part of exchange plans' increasingly narrow networks, participating in new care delivery models such as accountable care organizations and trying to comply with ever-changing reform regulations. All this uncertainty could put implementation of mobile health on hold.

For complete survey results: Survey report 2014

QUOTE OF THE WEEK: “At one time, I hated the iPhone – but that was only before I used one for the first time.” – Chris Pirillo

SMARTPHONE AFFECTION OR ADDICTION?

Last night I caught a tech report on the evening news about Smartphone use. A survey taken at USC (University of Southern California) found that female students are engrossed in their Smartphones a whopping average of 10 hours per day; male students, 8 hours per day. When asked if they considered themselves addicted to their phones, 80% agreed, admitting it emphatically like members of an Alcoholics Anonymous support group.

As a writer and one who fervently observes social behavior in public settings, I can’t help but notice what happens when groups of young people congregate in a coffee shop, a nightclub, even on a park bench. It’s as if they agree to congregate for the purpose of keeping company while each is self-absorbed with their phones. And it’s not like an “excuse me, I need a moment to check for messages,” it often lasts for a lengthy duration that consumes the lion’s share of time spent with their friends sitting across from them. This is not just a random occurrence.

Smartphone use can get very heavy with other demographic groups. In a study of 1,600 managers and professionals, Leslie Perlow, PhD, the Matsushita professor of leadership at the Harvard Business School, found that:

• 79% of smartphones users grab their phones within 15 minutes of waking up;
• 56% check their phone within an hour of going to sleep
• 48% check over the weekend, including on Friday and Saturday nights
• 51% check continuously during vacation
• 44% said they would experience "a great deal of anxiety" if they lost their phone and couldn't replace it for a week.

As telling as those numbers are, they seem outdated. WebMD writer Susan Davis confesses, “I check my smartphone compulsively. And the more I use it, the more often the urge to look at it hits me - in the Orthodontist's office, walking my kids to school, in meetings, even while making breakfast. Sometimes it is in my hand before I even know what I'm searching for. Sometimes I tap the screen absent mindedly, looking at my email, a local blogger, my calendar, and Twitter.”

The all-consuming preoccupation begs the question - why? When I notice people having the need to text while they're driving a car or riding a bicycle, they obviously know that they're putting their well-being and that of others in peril. We really have to explore what is so compelling about this medium to engage in life-endangering conduct.

"A true addiction entails a growing tolerance to a substance so you need more to get ‘high,’ uncomfortable symptoms during withdrawal, and a harmful impact on your life,” says David Greenfield, PhD, a psychologist and author of Virtual Addiction: Help for Netheads, Cyber Freaks, and Those Who Love Them. “Computer technologies can be addictive, he says, because they're ‘psychoactive.’ That is, they alter mood and often trigger enjoyable feelings.”

These technologies have spawned a growing niche along with new jargon in the clinical setting. “Email, in particular, gives us satisfaction due to what psychologists call ‘variable ratio reinforcement.’ That is, we never know when we'll get a satisfying email, so we keep checking, over and over again. It's like slot machines…We're seeking that pleasurable hit." Smartphones, of course, motivate us to seek additional social “placebos” (texts, selfies, videos, Twitter feeds, and news updates, in addition to email) anytime and anywhere.

Is such behavior healthy? Does spending a big chunk of time immersed in a virtual environment significantly compromise real time connection to the physical world, rendering it as peripheral? Does a technology designed to simplify our lives and enhance our people connections lead to an erosion of in-person social interactions and skills?

Writer Sarah Coppler still wrestles with the dilemma: “About six months (ago) I switched from a smartphone to a basic cell phone service plan. I sold my Android through EBay and thought I would never look back. I was a smartphone addict! All day, from the time I woke and to the time I went asleep, my smartphone was within an arm’s reach. Each time it dinged I felt compelled to check the new message and then lingered to view more by clicking on the various apps. I found myself not seeing anything around me but what was on my tiny handheld screen. Lately, I have been getting a hankering for a smartphone, thinking that having easy access on Wi-Fi spots throughout the city would be nice. But, I’m concerned if I get one. Will it take me back down that slippery slope and the world will become again the size of my palm?”

QUOTE OF THE WEEK: “I like to call in sick to work at places where I’ve never held a job. Then when the manager tells me I don’t work there, I tell them I’d like to. But not today, as I’m sick.” ― Jarrod Kintz

SHOULD EVERYONE GET PAID SICK LEAVE?

Most of the world thinks it’s a healthy idea. Paid sick leave is provided in almost 150 countries, and 66% of those sanction one month or more. They include many of the wealthier nations, e.g., Switzerland, Sweden and Singapore.

The specifics vary, but the general rule is if a doctor certifies that someone is ill, they do not have to work to receive their pay. Of course, the system is subject to abuse when some workers take the day off on the pretext of being sick. But those who are truly sick are seldom productive and are much more vulnerable to workplace accidents. More importantly, they could easily compromise the health of their co-workers and customers, causing greater harm. Paid sick leave for people who are genuinely sick is widely regarded as a worthy one. The problems start when workers come to see it as an entitlement that they can add to their holiday allowance – whether or not they are really sick.

I prefer the broader concept of PTO (Paid Time Off). It would be better to give each employee a number of paid personal days that can be used for sick leave (certified by a physician or not), study leave, or other absences for personal and family reasons - for whatever they need. And employees should not be tempted to lie about whether they are sick or not.

What about incentivizing a program, rewarding people for having no sick days to reduce the probability of people taking days off sick when they are not sick? It can be a paid bonus at Christmas - a good motivator. Add paid personal days or bonuses for employees who enroll in wellness programs for fitness, weight reduction, stop smoking plans, etc. A proactive approach becomes a shared responsibility of both employee and employer.

What are your thoughts on the issue? Should people have to verify they are sick to get paid? Should people be able to take paid sick leave when a member of their family is ill? Should there be a maximum period? Should pay be proportional, or the full amount? Should this matter be the responsibility of employees, employers, or government?