Unsatisfied with the applications on the market for linking disparate information systems, a CIO chose to build a new front end so medical staff can access data with mobile devices

How iPads and iPhones are changing health care

Build or buy?

That’s a question hospital chief information officers face when they want to extend mobile technology into their institutions.

The answer, IT and medical professionals were told at a conference in Toronto on mobile healthcare Wednesday, is that it depends on the circumstances.

Toronto’s Mount Sinai Hospital decided to build a new front end for its systems when it chose to let doctors use Apple iPhones to access patient data, attendees learned, while a southern Ontario health district ran a trial giving diabetes patient access to their medical information largely using existing technology and getting vendors to donate services.

“There is no one-size fits all” was one of the messages from the two-day event, as several case studies proved.

The conference examined ways in which healthcare providers are turning to the latest tablet computers and smart phones to give medical staff and patients better access to electronic health records.

At Mount Sinai, for example, vice-president and CIO Prateek Dwivedi said he was stunned to learn when he joined the 427-bed institution three years ago that its electronic records system linked to 66 applications.

Doctors and nurses were still wedded to paper. They also didn’t want to spend time learning new technology.

So in 2009 his applications development staff built a new front-end to all the applications in three months for accessing almost all hospital applications on an iPhone. The goal was a tool staff needed no training on.

Or, as Dwiveldi put it, “We know we failed if someone has to pick up an instruction book.”

Now called VitalHub, the interface lets staff access much of the material that would be on a patient’s chart such as vital signs, alerts and lab results in real time, plus users can send text message and email colleagues.

(While developers learned the staff’s processes by following them around, Dwiveldi admitted they weren’t asked for input on the design. “Sometimes,” he explained, “you go with your feelings.”)

For security, no information is stored on the device.

To fund further development the hospital spun VitalHub into a private company early last year in hopes of selling it to other hospitals. Earlier this week Toronto’s MaRS Centre became the latest seed investor in the startup, putting in $300,000. Dwiveldi said two unnamed Ontario hospitals have signed up and may be announced in two months.

VitalHub is in its third version now, still in pilot stage at Mount Sinai. Eventually the hospital hopes to equip all of its 1,300 nurses and 345 doctors with iPhones.

Dwiveldi turned aside a suggestion that Mount Sinai was “re-inventing the wheel” in getting into software development. We couldn’t find an off the shelf system that linked multiple systems in an intuitive way, he said.

“This is what we believe will help our clinicians save time, which they can spend with their patients rather than technology,” he said.

Dale Porter, senior vice-president and CIO of the Ottawa Hospital, told the conference his institution had a similar attitude when it decided to equip doctors with Apple iPads last year: “If there aren’t off-the-shelf solutions, we will build them.”

By the spring of this year the institution expects 2,000 staff will be toting the tablets.

By contrast Ontario’s Waterloo Wellington Local Health Integration Network (LIN), which oversees hospitals covering a wide area including the cities of Guelph, Kitchener and Waterloo, found a way to give diabetes patients better access to their medical data to improve their treatment largely using existing technology.

Called “Health-e-Connections,” the pilot project was aimed at finding out what happens when technology is injected into a healthcare process between a medical team and a patient, said Dale Maw, senior manager of the LIN’s eHealth program.

“We gave them some electronic tools, we enabled physicians and patients to share information back and forth and enabled primarily family health teams to access data and acute care information,” Maw said.

Some of that was aided by the linking of a number of electronic health record databases from nearby hospitals, which was part of the project. Part of the work was done by software suppliers used by a number of participating institutions.

Patients used an existing medical portal for diabetic patients run by the Canadian Medical Association for access and uploading information such as daily glucose tests. Healthcare team members could then closely monitor the patients’ progress and give recommendations.

Doctors had the ability to upload their files on a patient to a database where the individual could get at it. “There was a lot of resistance to letting that genie out of the bottle,” Maw said. The project “allowed our care providers to test this in a non-threatening way.”

The project not only included 500 diabetic patients ended in September and is being evaluated by area healthcare providers.

“It isn’t primarily about technology,” Maw stressed in an interview, “it’s primarily about being patient-centred.”

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