Global Health:Wireless systems are transforming healthcare through fast access to data
By Andy Shaw:
Are mobile healthcare technologies at long last ready for the real world? Certainly, there was an impressive array of Canadian and American expert presenters at the ‘8th Annual Mobile Healthcare Summit’, held earlier this year in Toronto. And they testified that, yes, after decades of dreamy pilot projects, mobile technology can and is now doing real, day-in-day-out, productivity-boosting, cost-saving healthcare work.
The Mobile Summit’s two-day program promised to lay out evidence that untethered devices can indeed now:
• enhance care delivery
• optimize workflow
• minimize medical errors
• cut costs
• control privacy and security risks
• improve planning, and
• strengthen infrastructure.
An impressive list, no doubt. But after so many years of mobile technology not winning many battle stars on all those fronts, you could forgive some Summit attendees for remaining skeptical.
“Frankly, I came to this conference to find out if mobile healthcare is still pretty much a myth, or if there is now some real magic in it,” volunteered Dan Coghlan, the vice-president of finance and information management for Providence Care, a specialized provider of mental health and geriatric care in Kingston, Ont.
Conference chair and keynote speaker, Dr. John Mattison of California-based Kaiser Permanente, immediately pointed out some magical applications of wireless technology. As Kaiser Permanente’s chief medical information officer and also its assistant medical director, Dr. Mattison has been developing and implementing for two decades now innovative mobile technology solutions for America’s largest health management organization (HMO) and the nearly nine million health plan members the HMO looks after.
Perhaps most widely known as the founder of HL7 clinical document architecture, the international standard for medical data interchange, Dr. Mattison has been instrumental in developing the likes of a text messaging system and a smartphone app so KP members can book appointments on the fly. Most recently, he’s been co-ordinating a country-wide project to introduce iPads into Kaiser’s patient and out-patient workflows.
“The mobile opportunity has opened the door for some of the most disruptive healthcare technologies of our time,” said Dr. Mattison in his opening remarks. “For example, at Kaiser Permanente we’ve taken steps to connect doctors and their patients directly with each other via email. So starting this morning as I speak, for instance, there will be approximately 25,000 doctor-patient email exchanges before this day is out. Those kind of exchanges at Kaiser Permanente are taking off like wildfire.”
Dr. Mattison proffered some other remarkable numbers that got the Summit off to an optimistic start. In the next five years, he said, another one billion more people will have internet access, swelling the ranks of the 2.2 billion folks estimated by Internet World Stats to have access now. Many, if not most, will be using mobile smartphones as their tool of entry.
That could well be good news for Dr. Patricia Mechael, the executive director of the United Nation Foundation’s globe-girdling mobile health organization called mHealth Alliance, headquartered in Washington, D.C. At the Toronto Summit, Dr. Mechael was quick to the dais when introduced – all the more admirably so since she was visibly pregnant.
“Patricia for the past 15 years has been helping women and children, among others in Africa, the Middle East, Asia and in developing countries all over the world, for much of the time using eHealth and mHealth technologies,” said Dr. Mattison in his introduction.
Dr. Mechael graciously began her presentation with a compliment to her hosts: “It’s an honour to be here because Canada has been a lighthouse for us in terms of using technology. In the work we do, we regularly look at Canada to see what we can apply to developing countries.”
But Mechael soon added that we in the developed countries may now have something to learn in return from how extensively developing countries are using cell phone technology to advance healthcare in their hinterlands.
“I’ve been researching the subject for about the past 11 years now. And the way cell phones have evolved and emerged in developing countries has brought new meaning to the way people access health services; how they access health information; and how they interact with each other,” said Mechael.
“In Africa, Asia, and Latin America there’s almost now a ratio of one-to-one cell phones to people,” said Mechael. “And that’s not something even the most optimistic telecom companies would have predicted ten years ago. But what they and really all of us missed was that people in those regions made the cell phone a personal priority, not because they wanted more and better information, but because they simply wanted to communicate with others. They wanted to feel connected.”
And health authorities are evidently learning fast how to take advantage of that need.
“In effect,” said Mechael, “they are reaching out via their cell phone systems and giving their people a virtual healthcare hug.”
“There is a persistent problem in developing countries of a high infant mortality rate,” said Mechael. “But motherhood is such a complex issue. It cuts across education, nutrition, and healthcare.”
So both better information about, and better access to, healthcare are crucial if more infants are to survive. To that end, the mHealth Alliance in Washington is a partner in the MAMA program.
“It’s the Mobile Alliance for Maternal Action,” explains Mechael, “and it focuses on the use of interactive voice recognition, text messaging, and the global web as conveyors of information to pregnant women. MAMA is starting up first in Bangladesh, South Africa, and India.”
But as Mechael points out, MAMA is not alone in efforts to make mHealth serve the under-served. “The Harvard School of Public Health is working with the health ministry of Tanzania and looking at the use of mobile technologies in decision support. They are creating algorithms for case workers in the field so that they can make informed decisions on the spot about the cases they are managing.”
Specifically, the calculated set of rules in their cell phones will better equip remote Tanzanian caregivers to diagnose and deal with the likes of childhood illness, malaria, and diarrheal diseases so common in developing countries.
“In a way, those decentralized health workers are being given a sort of peripheral brain,” observed Mechael.
Developing countries are also taking a world lead in using mobile technology for improved disease and epidemic outbreak tracking.
“China does a lot of that kind of tracking now on the heels of its avian flu and SARS outbreaks,” said Mechael. “More recently, cell phones are being used to track the cholera outbreak in Haiti.”
On a more global scale of tracking, is an initiative called RapidSMS.
“It’s an open source SMS-based reporting tool developed by the UNICEF innovations group for use in the developing world and it’s now being used in a wide range of countries, but especially in Africa,” explained Mechael. “It was first put to use for nutrition tracking in Malawi (where 22 percent of children under age five are underweight), but now it’s being used to track 14 reportable diseases in Uganda with other countries to follow.”
RapidSMS has made disease tracking data transmission much of it over mobile technology not only more accurate but exponentially faster. What used to take up to three months to collect data from a paper-based system can now be done in two minutes, or 64,800 times quicker.
Magical you might say.
There’s something majestic, if not magical, about another text-based system supported by Mechael and the mHealth Alliance called “SMS for Life”.
“It is a supply chain management system and medical supply chains are a big problem in developing countries,” said Mechael. “I had a personal experience when I was working with a clinic in Uganda. A severely dehydrated child came in who really only needed a five-cent rehydration treatment. However, the clinic had stocked out of the treatment and so the child had to be transported to another clinic for what amounted to a $150 dollar treatment.”
Currently SMS for Life is is striving to save some of the 660,000 people worldwide who die from malaria.
In its initial 21-week pilot program, Mechael reported that SMS for Life reduced malarial drug stock-outs from 26 percent down to a near-zero 0.8 percent. The application is now being applied to other supplies, including diagnostic tests and blood supplies in sub-Saharan countries where there’s little telecommunication except by cell phone.
The African sub-Sahara is a long way both geographically, culturally, and healthcare-wise from the Toronto suburb of North York, where Sandy Saggar goes to work every day as director of information technology and clinical informatics for North York General Hospital.
And yet both have a problem in common with much of the rest of the world – medication errors. As Mr. Saggar told his audience at the Mobile Health Summit, the three-site, 613-bed North York General Hospital chose to tackle medical errors with the help of Motorola Solutions. They are using a wireless LAN network linking a plethora of point-of-care mobile devices including medication carts, laptops, cell phones, and other handheld devices on which caregivers can submit data. “They are all part of an initiative we began rolling out in 2008 called “eCare”, which includes an advanced electronic medical record; standardized, evidence-based care, clinical decision support, and safe prescribing and medication administration, all aimed at improving patient outcomes.”
The effort has won North York General a HIMSS (Healthcare Information and Management Systems Society) Stage 6 ranking for its EMR readiness, making North York just one of three Canadian hospitals to gain that exalted level. That achievement is built on two powerful point-of-care applications that rely on mobile devices: one computerizes physician entry of orders and the other is a bar-code based, medication admin system. Together they serve to significantly reduce medication errors.
Saggar explained that the system positively identifies a patient before any medication is administered, catching a potential error before it becomes one: “In its first year of operation, after the go-live at North York, our eCare solution helped catch and rectify more than 1,300 instances in which patients could have been given the wrong medication.
But if there is now such magic in wireless and mobile technologies, they don’t come without risk. That was made clear early by Dr. Khaled El Emam, PhD. Dr. Khaled wears many hats, including that of an associate professor at the University of Ottawa’s Faculty of Medicine, and of the Canada Research Chair at the Children’s Hospital of Eastern Ontario (CHEO). But partly from earlier work at Germany’s renowned Fraunhofer Institute, he is known worldwide for the public health techniques he has researched and developed for making health data anonymous and for keeping a watch on disease outbreaks.
“Mobile devices can improve your organizational efficiency and enhance patient care, certainly,” Dr. El Emam told his Summit audience. “However, privacy and security risks are a reality that needs to be top of mind when considering your organization’s next mobile health initiative – especially when physician-owned devices are involved.”
Dr. El Emam went on to cite several reliable studies of breaches in healthcare privacy and security.
“The first study you should note is an American one that showed over half the healthcare security and privacy breaches it examined were the result of either the loss or the theft of a mobile device,” said El Emam. “And another similar survey showed that loss or theft of mobile devices had compromised the security of over two million patient records.”
And those compromised records come at a heavy cost. “In most healthcare jurisdictions now there’s a reporting procedure that must be followed whenever there is a privacy or security breach of confidential healthcare information,” said El Emam. “It’s not cheap to notify thousands of patients, of course, and then there are the inevitable litigation costs. Also the organizations responsible for preventing such breaches are usually penalized severely.”
El Emam pointed out that Massachusetts General in Boston, one of America’s most respected hospitals, had nonetheless been fined $4 million for a bad breach of its records.
“The average across multiple studies is that for compromised records, the cost to the record-keeper ends up between $200 and $300 per record,” said Emam. “Now you have a figure that you can use to calculate how much you want to spend on risk mitigation, considering the number of records you hold.”
El Emam said his research, done with the aid of privacy commissioners throughout North America, the FDA in the United States and others in the know, suggest there are about a dozen risk mitigating safeguards you are best to spend your money on if mobile devices are going to be at the centre of your new eHealth strategy.
Among the basic and important ones are:
• set things up so you allow remote access to your data rather than allowing data to be stored on mobile devices. So even if the device is lost or stolen, there is no breach.
• put automatic locking on remote devices so that they are inaccessible after only a few minutes of non-use, as aggravating as that might be to the caregivers using the device who must then re-enter their passwords.
• be aware that even a person’s date of birth and postal code can tell a less-than-ethical lawyer, insurance investigator, blackmailer, or other snoop, who that person is from publicly available records.
• make sure that you can delete data remotely from your mobile devices, so that whenever a device is reported lost or stolen you can tell the IT department to press the kill switch and wipe out any data or internet access capabilities on the device, no matter where it is.
• make sure all your devices are encrypted all the time, even if they are big desk tops, especially ones on the ground floor near a window. That makes it easy for thieves to do a smash-and-grab.
• ensure you institute a well-understood policy that any loss or theft of a mobile device is reported immediately. The first thing you want to do with any breach, of course, is to close it.
“These are all very basic, seemingly obvious things to do, I know, but it is amazing how often we find among those using mobile technology in healthcare that they are not being done,” said El Emam.
Source: Canadian Healthcare Technology