Tuesday, April 27, 2010

The Future of Digital Medicine: Smartphones Will Replace the EHR As the Workhorse Informatics Device In Clinical Care Settings

As a former New Yorker, the Disease Management Care Blog has always had an abiding respect for the Big Apple's taxi drivers. That increased considerably after it left its wallet in a Manhattan cab and it turned up in Virginia a year later - in the possession of an individual allegedly involved in organized crime. This and other evidence of the cabbies' shrewd business acumen makes the DMCB wonder why Hizzoner required that they start using hybrid cars. If they're such a gas-conserving and money saving no-brainers, the DMCB figures the cabbies would have figured out a way to get them on the streets all by themselves.

Which brings the DMCB to smartphones and healthcare. How can this be, you ask? Read on.

Thanks to the Covering Health blog and their link to this report from the California HealthCare Foundation (CHCF), the DMCB not only got to delight in the new term 'techfluentials,' it learned that these little electronic mini-slabs have remained remarkably recession proof. They're now in use by 42% of consumers. Even more impressive, however, is their uptake among supposedly tech-wary physicians. Fully two thirds of providers currently possess smartphones and that's projected to exceed 80% by 2012.

There are over 5000 iPhone health-related apps and about a third have been designed for physicians and other providers. They include medical and drug reference libraries, dosage calculators, clinical alerts, decision support tools, viewers for lab and radiology reports (including the x-rays themselves), communication portals designed for patients as well as physicians, patient status monitors (for example, in the emergency room and labor suite), continuing medical education (CME) tools and the means to access a patient's personal health record (PHR)

In the meantime, the Feds continue to promote a stubbornly expensive and unwieldy electronic health record (EHR). With their usual complex web of financial and regulatory sticks and carrots, Washington's bureaucrats remain fixated on the big boxy multifunctional and proprietary personal computer-based systems with screens and keyboards populating every clinic room and hallway.

In contrast to that orthodoxy, the DMCB agrees with it's colleague Vince Kuraitis. He predicts the EHR will evolve into a PC-centric platform of distributed cross-functional and plug-and play devices. Yet, thanks to the California Foundation report, the DMCB wonders if things may become even more complicated than that. It could be that the handheld smartphone, not the screen and keyboard, turns out to be the central hub of digital care. In other words, the iPhone won't be slaved to PC-based EHR systems, it'll be vice versa. What's more, there won't necessarily be a desktop or a hallway. In fact, the clinic's boundaries may turn out to be even more fluid than we ever anticipated.

And it's all happening without Federal intervention.

Which brings the DMCB back to the New York City cabbies. Despite the best intentions of the Mayor, there have been problems, suits and delays. The DMCB also recalls reading that the involvement of NYC government in the first place may have ironically led some cab companies, pending better understanding the law, to delay buying any hybrids.

And, despite similarly good intentions extending back through several administrations, Federal meddling in the promotion of EHRs have also caused many physicians to delay the purchase of an EHR. Unlike the NYC cabbies, however, the docs have had another smaller, nimble, cheaper and remarkably functional option. It's the smartphone, which may have been partially spurred by the continuing travails of the Fed's love affair with the EHR. It seems that while providers have been waiting for Dr. Blumenthal et al to clarify just how good the EHR can be, physicians have apparently turned to the next best thing.

In fact, based on CHCF's report, it may be turning out to be the better thing.



Stephen C Schimpff, MD said...

You make a good point about the use of smart phones. It is a very disruptive technology and will change medical care delivery substantially. There are other disruptive changes coming as well such as the need for care coordination by multi-disciplinary teams, a more patient-centered approach rather than our current provider-centered way of doing business, the use of simulation for procedural training and others. Pleas see my invited post at the Harvard Business Review http://blogs.hbr.org/cs/2010/04/disruptive_changes_are_coming.html

Jaan Sidorov said...

Dr. Schimpff makes a good point. There's an astonishing mix of changes underway, some of which are known, some of which are destined to fail, some of which are being targeted by government intervention and some of which have consumer value and/or a business case. Bets involving big sums of money by entrepreneurs are being made as I type this, but if I had the money, I'd bet smartphones and "short" the Federal version of the EHR.

I took a look at the post at HBR. Well worth the read.