Imagine that you’re a doctor at Pediatric Associates’ clinic in Bellevue, Washington, a high-income, highly educated city just down the road from Microsoft’s worldwide headquarters in Redmond. You flip through the paper chart preparing to see your first patient of the day. Ready, you knock once on the examining-room door and enter briskly. The eight-year-old patient is playing Angry Birds* on his touch-screen tablet, a gift for his recent birthday from his father, who at the moment is tapping intently on his own smartphone. They look up, see your paper file, and simultaneously think, “huh?”
In fact, Pediatric Associates doctors have long since given up paper charts for laptops and smartphones. And the practice, with over 80 providers, continues to embrace other ways to better meet their patients’ expectations, including the offering of more information to patients online.
“Our patient demographic is such that web access to personal health records and apps for managing their care is expected,” said Brock Morris, CIO of Pediatric Associates, which has seven clinics just across the lake from Seattle. “Gone are the days where you can market ‘quality patient care’ by itself to attract new patients and retain your current base. Now web and mobile apps are expectations.”
The latest version of Pediatric Associates’ digital transformation was a pilot project where a handful of its doctors tested an innovative mobile app, Greenway PrimeMOBILE*, to access its Greenway PrimeSUITE* electronic health record (EHR) solution on Windows* 8 tablets. Overall the pilot was a smashing success, and Morris doesn’t hedge when looking ahead to the use of PrimeMOBILE on Windows 8 tablets by doctors he supports.
“We will continue the pilot indefinitely at this point and have every intention of utilizing PrimeMOBILE in full production as the functionality improves through development,” he said.
Reaping the Rewards of Technology in Healthcare with a Government Assist
Technologists from an array of fields have long been excited about the possibility of IT transforming healthcare delivery. In the past, though, these high hopes have been dashed for various reasons, including hospital bureaucracies, independent doctors wary of technology and resistant to change, and technologies themselves that didn’t quite measure up. But the experience of Pediatric Associates with Greenway suggests that many of these obstacles are being eliminated.
Today, the federal government, the largest purchaser of healthcare in the United States, provides incentive programs for clinics and hospitals seeing Medicare and Medicaid patients to demonstrate “meaningful use” of certified EHR technology to improve patient care. To get the maximum incentive payment—more than USD 60,000 per doctor over five years—clinics and hospitals had to begin participating by 2012, according to the Health Information Technology for Economic and Clinical Health (HITECH) Act, which became law in 2009.
ABOVE Patient overview screenshot from PrimeMOBILE* Windows* 8 app.
“Relative to other professions, medicine has in general been an early adopter of technology for healthcare delivery in terms of devices and procedures, but a later adopter of technology for the documentation of and process of healthcare delivery,” said Dr. Josephine Young, the chief operating officer at Pediatric Associates. “With the advent of ‘meaningful use’ and the changing expectations of patients, there has been a significant increase in the ability and willingness to accept and integrate technology into healthcare at all levels.”
Any historic resistance by doctors to give up their paper charts and pens has long been worn down by the proliferation of mobile devices into all nooks and crannies of life, especially as older doctors retire and are replaced by younger doctors, many of whom already use social networking tools to communicate with their patients.
Even before the pilot of Greenway’s Windows 8 app, Pediatric Associates doctors carried around laptops and tablets to access PrimeSUITE* when out of the clinic or doing rounds at local hospitals. And of course, like nearly all professionals, most Pediatric Associates doctors and staff routinely check their corporate e-mail on smartphones.
Young said it’s possible to think of a future where healthcare delivery is decoupled from the doctor’s office altogether. It’s a future that sounds more than passingly similar to a bygone era when doctors made house calls.
“Use of mobile devices for care delivery and medical chart access allows for patient care to take place where and when the patient needs it,” she said. “This allows for the ability to explore care delivery outside the traditional doctor’s visit in an office setting, enhancing the possibility of telemedicine, improved inpatient care, and the creation of a more complete medical chart by including information from all points of care.”
This future is arguably that much closer thanks to the unique combination of portability and full-featured software of Windows 8 tablets and other devices. Consider, for example, that many Ultrabook™ devices weigh just over three pounds, making them easy to carry around. Featherweight hardware is useful to doctors spending time in the hospital on rounds or otherwise away from their home clinics for hours at a time. The battery life, usually five hours or more on a single charge, also supports such wandering, as does the ability to quickly recharge. The Lenovo X1 Carbon* Touch, one of the Ultrabook devices that Pediatric Associates is experimenting with, ships with RapidCharge* technology that recharges to a 50-percent battery in just 30 minutes.
The choice of inputs on Windows 8 tablets is useful, as well. Pediatric Associates doctors are mostly concerned about weight and have been less focused on touch screen or stylus inputs, Morris said, mostly because of their need for free typing of clinical notes. On the other hand, clinical staff who deal with templated tasks such as patient intake relish the touch screen and stylus and now often request tablets.
Based on what he’s seen so far, Morris, who’s responsible for the tech needs of a practice employing more than 300 people and managing 250,000 patient visits per year, calls Windows 8 “a versatile all-in-one device and OS option to meet multiple user needs.”
From iOS* and Android* to Windows 8
Greenway’s first foray into mobile touch-screen apps were versions of PrimeMOBILE for iOS and Android, beginning in 2011. But even as the company monitored comments posted on iTunes* and Google Play* and responded with updates to their iOS and Android versions, they kept one eye on what was undeniably the biggest operating system news in 2012—the anticipation and eventual release of Windows 8.
Interest in Windows 8 at Greenway stemmed mostly from the fact that PrimeSUITE, responsible for most of its more than USD 130 million in annual revenue, is a Windows application. (PrimeMOBILE provides a mobile touch screen means of accessing PrimeSUITE.) The company navigated a successful initial public offering in February 2012, raising about USD 80 million but also taking on all the pressure to grow that comes with being a public company required to answer quarterly to investors and analysts. When Intel and Greenway began talking about creating a Windows 8 version of PrimeSUITE, the Georgia-based company jumped at the chance to work with Intel, a world leader in computing innovation.
“In just eight weeks, our guys have already reached parity with our iPad* app, which has been available for two-and-a-half years,” said Tony Gerena, director of provider services development at Greenway in Carrollton, Georgia. “That speaks volumes to the ease of developing on [the Windows 8] platform and the tools that are available to us, such as Visual Studio. We have been really pleased, and we’re excited about what’s next.”
Gerena said Greenway’s effort to release PrimeMOBILE on various touch-screen devices is just the beginning. On the horizon: integration with Bluetooth* clinical devices.
“This will be huge as we build out PrimeMOBILE for use in home health and emerging care,” he said. “We want a doctor to be able to capture data from Bluetooth-enabled clinical devices like a glucometer, a weight scale, or a blood pressure monitor and have it automatically populate the chart on his tablet while he is in the room seeing the patient.”
The Security and Manageability Benefits of an all Microsoft and Intel Environment
The story unfolding at Pediatric Associates shows how Windows 8 tablets can be especially useful in extending existing, centrally managed Windows-based applications. The practice has been using a handful of Greenway software applications since at least 2009, not just for EHR but also for practice management and billing, and to offer online bill-pay to patients.
Key to any healthcare IT application is the notion of protected health information (PHI). PHI is any information about health status, provision of healthcare, or payment for healthcare that can be linked to a specific individual. Under the U.S. Health Insurance Portability and Accountability Act (HIPAA), PHI in 18 categories—from names and phone numbers to web URLs and Internet Protocol address numbers—must be treated with special care.
ABOVE Screenshot of patient appointment schedule from PrimeMOBILE* Windows* 8 app.
The security, especially around BitLocker* (the full disk encryption feature that has been part of Windows since Vista*), has significant benefit specifically when relating to the securing of PHI on mobile devices,” said Morris.
For Greenway, protecting patient privacy was mostly a matter of basic design considerations when building the app. When a doctor signs into PrimeMOBILE, the app fetches the data from PrimeSUITE’s API. When PrimeMOBILE is closed, that data is deleted.
“PHI never persists on the device, only minimal configuration information,” said Gerena. “One thing we’re looking at in the next few months is offering offline capabilities with PrimeMOBILE. We’re now exploring how to persist PHI data on a tablet in a secured fashion.”
For now, though, doctors will benefit the most from Greenway’s move into the world of Windows 8 software. Consider this scenario: Doctors can access the new PrimeMOBILE app on a tablet for a quick and cursory look at data while seeing a patient or taking a quick hallway break. Later, back at their desk with their tablet docked, they can easily toggle to the full Windows version of PrimeSUITE that they are used to navigating with a keyboard and mouse.
It’s a use case that holds much appeal—not just for doctors but also for IT administrators who worry about device management and security. Connecting a Windows 8 tablet to an existing Windows-based network enables administrators to manage security with Active Directory*, a well-developed Microsoft technology for assigning and enforcing security policies for all computers and installing or updating software.
“Using Active Directory is important for Pediatric Associates, I believe,” said Gerena, who added that because the LDAP directory service is not available to devices running Windows RT*, this type of management and security is available only in an all-Intel-based environment.
Indeed, for those familiar with traditional Windows security and manageability features, from automatic updates to built-in antivirus protection, Windows 8 offers a safe and familiar environment to move into the world of touch-screen devices.
Gerena said the key for developers is to forget the hype around capacitive touch screens and other bleeding-edge hardware features and instead focus on users and their workflows. “Ultimately, it’s what is relevant and not what’s cool or how much data you can put on a screen that matters most,” he said.
As for relevance in healthcare, doctors need an easy way to access and navigate a patient’s full updated medical chart, especially when on rounds. Anyone who’s ever been involved in a hospital stay knows it’s not uncommon for a doctor to enter a patient’s room and ask questions, even basic ones, that the patient and family members can’t answer. Worry, pain, sleep deprivation, or the general disorientation of being in a hospital can easily overshadow one’s common sense. An app such as PrimeMOBILE can help ease some of the stress in these situations.
Greenway made sure that messaging is convenient in PrimeMOBILE, which is a benefit to doctors, who need to be able to easily share information. It also allows a doctor to quickly flick through recent patients when she recalls, during a coffee break, that she hadn’t yet ordered lab work for a patient seen an hour ago. And nurses and support staff, who often must manage the deluge of paperwork that’s part of most modern healthcare settings, need relief in the form of simple electronic templates utilizing checkboxes and other touch-friendly forms of input. PrimeMOBILE provides these, as well.
The net result is an app that is highly useful to the audience it’s designed to serve. And this audience is happy and seems to want more.
Kids-first Use Cases
Morris said that the whole experience with the recent pilot of PrimeMOBILE at Pediatric Associates is part of a future that will center on mobility and that will continue to draw inspiration and innovation from the consumer expectations to be able to access their own personal data. “The consumerization of IT, and more specifically healthcare IT, is moving in the direction of being able to access clinical information any time, anywhere, and on any device.”
This means that use models for new hardware and software might first be pioneered by that eight-year-old staring down at his touch screen as he waits in the examination room for the doctor and only later migrate to the doctor’s own day-to-day activities at the clinic.
Imagine yourself once more as that Bellevue doctor, only now you’re flicking through patient information on a tablet before you knock. At a glance you take it all in: recent medical history, date of the last visit, information about prescriptions, even an overview of the insurance plan. Satisfied, you give three quick raps at the door and go in.
You greet the patient and his father, both of whom look up from their screens and notice your tablet. You tap the screen with your stylus and then flip it up and rotate it to expose the keyboard for note taking during the office visit.
“Any questions before we get started?” you ask.
The boy’s father shakes his head no, but the boy peers beseechingly at the tablet.
“Does that thing run Angry Birds?” the boy blurts out.
“Sure, and Fruit Ninja* too, but usually not here in the office,” you say. “I see you had your birthday last month. How do you like being eight? Ready to talk about some ways that can help you stay healthy and strong?”
For more information on EHRs, Greenway, PrimeSUITE, and PrimeMOBILE, visit their site.
About the Author
Geoff Arnold has been writing about science and technology for over 10 years. He has written for The Dallas Morning News, Physics Today, and Physics World. In addition to working in media relations at Michigan State University and Stanford, he worked as a correspondent, columnist, and freelancer for the SD Times and Software Test & Performance. Geoff lives in Portland, Oregon.