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Mobile applications in present day are part of our everyday lives, many times this is the first thing we check when we wake in the morning and it’s the last thing we check before going to sleep. With the rise of technology, application software has grown exponentially, helping corporations expand in hopes of maximizing efficiency. The healthcare field is no exception to this as they also look to leverage mobile applications for better workflow, best practices, and increased efficiency while protecting and securing patient confidentiality. By attempting to achieve these conditions, a healthcare organization hopes to improve on patient satisfaction and overall outcomes.
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The exponential growth of technology in today’s world has led to increases in efficiency and production through many different avenues, including mobile applications. Due to the fast-paced nature that is the healthcare industry, mobile applications have found a niche by providing platforms for healthcare professionals to continue productivity while in motion. Important tasks such as healthcare record management, consultations, referencing, and assistance with clinical decision making all are just a handful of mobile applications ready for usage.
While most healthcare professionals can see the benefits of adopting mobile applications as a tool to increase efficiency and improve on overall patient satisfaction, some are hesitant to implement daily usage of mobile apps. This paper examines the use of the applications in further detail, including overall functionality and purpose as well as benefits and drawbacks pertaining to mobile applications.
Mobile Device Usage
The evolution of technology in the healthcare industry can be viewed in parallel to the development of technology worldwide. For example, health information management systems (HIMs) relied heavily on paper recording, constrained to the technology of that timeframe, up until the early 1970’s when a handful of advancements in technology helped jumpstart the development of HIMs moving forward. Some of these advancements included the creation of Eclipsys by the Lockheed corporation in 1971 touting a computerized physician ordering system for El Camino Hospital California, as well as The Regenstreif Institute in Indianapolis creating the Regenstrief Medical Record System in 1972(Angela, 2019).
As personal computers became more prominent in the 1980s, both hospitals and small practices were able to afford and invest in systems that would eventually start the modern age of health care technology. With processing power increases as well as portability factors, mobile devices have essentially combined computing power and communication into a single device. Other functions such as high-resolution cameras, portable web searching, GPS tracking have proven to be invaluable traits of mobile devices in the healthcare field. In order to augment the raw capabilities of mobile devices, mobile applications are constantly being created, modified, and added into an already vast pool of options a HCP can choose from.
Defining mobile applications.
A mobile application is a piece of software developed to run on device in order to achieve a purpose. (Wallace, Clark, & White, 2012) As technological advancements continue to occur, mobile applications attempt to match and maximize the increase in hardware improvements through software developments. In July 2008, Apple started the app race with the launch of their Apple Appstore forcing their competitors to follow-suit soon thereafter. (Payne, Wharrad, & Watts, 2012) Users can browse for healthcare related applications in the medical category, and as recently as 2011 Apple has further segmented this category into an “Apps for Healthcare Professionals” field (Lewis, 2013). Two years later in 2013, Apple further divided this field into specialized subcategories including EMR, medical education, imaging, personal care etc. (“Apple helps MDs cut thru medical apps clutter”, 2011).
Improving technology coupled with application developments set the stage for a number of uses for mobile applications in the healthcare field, most of which can be grouped together into the following five categories: administration, health record maintenance and access, communication and consultations, information gathering, and medical education (Ventola, 2014). These five categories will be further discussed in the following section.
A major component of the day-to-day in any business is how the organization stores and maintains information. The ability to take and dictate notes, recording audio and photographs, and a way to organize, store, and retrieve this information is key in running a successful enterprise. Apps such as Notability allow users to perform all of the above, all in one self-contained and easy to manage interface. Cloud storage has also found it’s place in the healthcare field as it allows users to be able to access, update, and request information remotely as long as one has an internet connection. This also proves useful as multiple clinicians can retrieve information simultaneously, leaving less lag time between cooperating teams within a facility. Services such as Dropbox and Google drive are popular options, however service in particular seemingly complies within both the Health Insurance Portability and Accountability Act (HIPPA), as well as the Health Information Technology for Economic and Clinical Health (HITECH) Act (“Welcome to Box Support”, n.d.). Another key aspect tied to this category is time-management, how an organization uses time as efficiently as possible through scheduling appointments, meetings, and even scheduling calls. Though most mobile devices have applications built into its operating system that can sufficiently handle all of the scheduling aspects listed above, others such as ZocDoc adds more functionality such as enabling patients to schedule an appointment with any available clinician as well as being able to view appointment information (Ventola, 2014).
Health record maintenance and access.
Proper patient recording, storage, and retrieval are also vital in any healthcare organization. The ability to create, update, and access patient’s electronic health record (EHR) and/or electronic medical record (EMR) on a mobile application allows attending physicians the ability to pull pertinent data from past visits quickly which may aid in quicker decision-making. Mobile applications in this category are often not stand-alone applications, rather they are an additional feature that adds to the functionality and usability of the overall system. Epic Systems, a healthcare software company has combined efforts with Apple to develop an application compatible with their systems, allowing scheduling, billing, and clinical support (Ozdalga E., Ozdalga A., & Ahuja, 2012). Another application, PatientKeeper Mobile Clinical Results allows clinicians to view patient records on either Apple or Android devices, giving the freedom to choose which platform works best (Mosa, Yoo, & Sheets, 2012).
Communication and consultation.
Health care systems are often spread out among different departments and sometimes different facilities, making communication an important aspect in a successful model. A dedicated application is not necessary to fit in this category as most mobile devices allow for voice calling, text messaging, video conferencing, and emails however there are clinical communication applications on the market that simplify communication among clinicians (Mosa, et al., 2012). One study cited an improvement on communication between HCPs and nurses in inpatient departments (Ozdalga E. et al., 2012). In another survey conducted, more than 80% of participants surveyed stated the use of text, telephone, or email to communicate with other clinicians regarding patient care. Participant’s citied text messaging to be more a more efficient way of communicating in comparison to telephone calls or in-person meetings (Wallace et al., 2012). Studies also show that texting or calling colleagues on mobile devices reduces lag-time in comparison to paging them, which can be critical in life-threatening cases (Mosa, et al., 2012).
Searching and gathering information on a mobile platform has proven to be useful to many HCPs given they are constantly in motion. The ability to view medical textbooks, journals, literature, medical news, and drug reference guides all online has become the norm for most HCPs. One survey of medical school students showed that 60% of the participants used mobile devices to access medical journal websites, and 74% viewing medical news as well (Wallace et al., 2012). Mobile applications for various medical journals such as the New England Journal of Medicine, The Lancet, and BMJ, are currently offered on both IOS and Android devices, however a paid subscription is necessary to view content (Yoo, 2013). Medical searching applications also exist for HCPs to aid in inquiries. Applications such as PubSearch, PubMed on Tap, MEDLINE, UpToDate, Epocrates, Johns Hopkins Antibiotic Guide, and Database on Tap are all options offered in both IOS and Android platforms (Mosa, et al., 2012).
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Continuing medical education (CME) and training are aspects of a HCPs career that are often overlooked, but they are vital nonetheless. Assessments tests, board examination preparation, electronic learning and teaching, and viewing case studies are all aspects of medical education that have been transformed by mobile applications. Applications such as QuantiaMDs mobile CME app offer a user interactive approach to viewing and sharing case studies (Ozdalga E. et al., 2012). A survey taken polling medical school students believe mobile educational resources have a positive educational effect, while 75% faculty and 95% of residents polled also agreed. Mobile applications can also be useful for training purposes, such as Touch Surgery are also available to simulate surgery exercises (O’Neill, Holmer, Greenberg, & Meara, 2013).
Benefits of Mobile Application Implementation
Mobile device usage in conjunction with streamlined applications aid HCPs in making quicker decisions with a higher success rate. Hand-in-hand with quicker more efficient decisions, a rise in patient satisfaction and overall patient outcomes has increased, alongside better data tracking and accessibility (Wallace et al., 2012). As a result, secondary visits and length of stay have been reduced (Mickan, Tilson, Atherton, Roberts, & Heneghan, 2013). This section will discuss other beneficial aspects in further detail.
As with other models, health care systems seek to run as efficiently as possible, reducing errors while providing the best possible outcome to its customers. Implementation and usage of mobile applications has shown an increase in HCP efficiency and work practices (Mickan, et al., 2013). Areas such as patient documentation with fewer errors, and quicker access to patient records have all increased workflow patterns (Mickan, et al., 2013). Physicians surveyed have cited improved coordination of care, as well as faster access to resources (Mickan, et al., 2013). Physicians noted that less time retrieving and searching patient records which ultimately freed up more time for direct patient care (Mickan, et al., 2013).
As mobile application usage increases and becomes the norm, convenience is a factor that is crucial in its success. HCPs attribute a number of conveniences to using this platform including portability, fast access to information and resources, flexible forms of communication, and the growing number of mobile applications that add to the functionality of the device (Wallace et al., 2012). Being able to access information at the moment it is needed as well as the plethora of books, guides, reviews, assessments only add to the allure of using mobile devices and applications in the healthcare field (Wallace, et al., 2012). Being able to carry this information in a pocket-sized device while having a properly functioning application to retrieve information has proven to be an invaluable tool (Divali, Camosso-Stefinovic, & Baker, 2013).
Expanding application development.
As with any software, application development based on user feedback is crucial in making updates that will lead to a better developed application. Since the initial inclusion of the medical category in the Apple app store (Lewis, 2013), application developers have added a vast number of new apps including patient education, nursing, and patient monitoring apps (Lewis, 2013). Newer applications such as DrawMD: Urology, iSpineCare, and Medical French are point of care apps that are meant to be used at the bedside of a patient (“Apple helps MDs cut thru medical apps clutter”, 2011), all of which are being updated as feedback is given.
Drawbacks of Mobile Application Implementation
Due to the nature of a mobile device being as portable as possible, yet still retaining functionality, some HCPs cite this as a drawback to using mobile applications (Divali, Camosso-Stefinovic, & Baker, 2013). Other notable constraints include slow download speeds, issues with inputting data due to small virtual keyboards, and overall viewing size (Divali, et al., 2013).
Application choice overload.
Another aspect previously mentioned as a strength is application development and expanding selections, however this too may be viewed as a downside to implementing applications in the healthcare workflow. A study by Epocrates found that medical professionals have difficulty finding the right application to suit their needs (Payne, et al., 2012), while another study found that medical students cited losing interest in applications because of the limited material a singular app contained, citing needing to use more than one application to retain interest (Payne, et al., 2012).
In order to keep patient confidentiality secure, the Health Insurance Portability and Accountability Act (HIPPA) of 1996 was set into motion, leaving all health care systems subject to following these guidelines (“Health Information Privacy”, 2019), including mobile applications. Cloud-based sharing of data is convenient and has many advantages, however most of the major cloud services are not HIPPA compliant and therefore not suitable for exchanging patient information (August, 2013).
Mobile Application Trends
With the number of mobile users increasing, curious trends are starting to form in regards to mobile applications in healthcare. Prevention and management of chronic conditions such as obesity, diabetes, and heart disease are issues that could be monitored through mobile applications (Ventola, 2014). Applications that support caregivers is also a trend that may be explored soon, hopefully providing better communication among patients, caregivers, and physicians (Ventola, 2014). On the patient end of mobile applications, as devices continue to evolve the functionality between hardware and monitoring systems will continue to grow. Pairings such as the apple watch and its 911 emergency alert system allow for seamless medical attention given a certain medical emergency arises (“Use Emergency SOS on your Apple Watch”, 2019).
Mobile device and application usage have begun to make an impact on the healthcare field through a wide range of applications and functionalities. Many HCPs find the pairing to be an invaluable toolset that will aid in providing better overall patient care (Wallace et al., 2012), however there are some skeptics that are reluctant to fully embrace the trend of using mobile applications in the workspace ((Wallace et al., 2012)). More research is needed to adequately weigh the benefits and drawbacks of implementing mobile applications, developing best practices, and ensuring the quality of work is enhanced while protecting patient information. This will ultimately lead to an improvement on patient outcomes and satisfaction (Ventola, 2014).
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