Wednesday, June 9, 2010

Update on the Mobile Device Strategy Project

As promised in my recent about about our mobile device strategy project, here is the finished report from the 30 days of analysis completed by our intern, Ankur Seth.

A few take home lessons:

It's clear that leading practice is to use 2D Bar codes to identify patients, medications, and labs. 3D Bar codes are not widely deployed in outpatient or inpatient areas in the US.

Devices are evolving rapidly and anything you buy today will be obsolete quickly. It's best to avoid device or vendor lock-in if possible, using standards-based or modular components that enable rapid replacement of the infrastructure.

There are many different use cases and requirements in different workflows - Emergency Department, ICU, Ward and Clinic.

There is not a one size fits all solution.

The recommendations in brief are:

Attempt to stay device neutral through the use of web-based or other thin client technologies. For example, Apple has committed to train our developers to create iPod/iPad applications that are just front ends for our underlying web-based applications. We could do the same for the recently announced Dell Streak, Google Nexus One , HP, and RIM mobile devices.

Put bar code reading equipment in each Emergency Department bay and ICU room, since these areas are limited in number and generate a large volume of lab samples.

Make bar code printers available at the bedside in the ED and ICUs, since any workflow which uses centralized printing or batch printing of labels at registration can cause mislabeling errors.

For the ward locations, make mobile printers available on carts so that labels can be printed at the bedside without buying and supporting 500+ printers.

Application and infrastructure ‘fit’ into the user work flow is important and is the major factor affecting the adoption of mobile devices in clinical settings.

Our next step to followup on this study is to test various devices and printers, evaluating usability, supportability, and cost in various clinical locations.

I hope you find this report useful. Comments are welcome.


Michelle W said...

I'm trying to understand this sentence: "Apple has committed to train our developers to create iPod/iPad applications that are just front ends for our underlying web-based applications." Does that me you this app is basically a giant link that browses to this location, or that the Apple app's interface is populated by fields from the web-based applicatin? Either way, that sounds like the sort of strategy more developers will go to as Droid and potentially other mobile systems become more popular, challenging Apple's hold on the market.

Oh, and thanks for two words contributed to my bingo card: I hadn't heard of this "game" until your blog post last week, and decided to try an HIT-flavored one today.

John Halamka said...

Both strategies are possible - an application frame that calls web content or creative use of style sheets that populate an app interface. We'll learn more later this Summer.

Jeff Brandt said...

Mobile devices especially mobile phones such as iPhone and Android are becoming ubiquitous in Healthcare. Using 2d and 3d barcode reader on these devices is one of the most cost effective way to utilize this technology.

Jeff Brandt

Unknown said...

You may wish to address the recent dust up between Apple and Adobe over Flash. We are very enthusiastic about the Adobe Flex technology and are moving our Java-based web applications to Flex (runs on the Flash player in the browser). The Flash browser plugins (browser penetration is 98%) does way more than just multi-media - it runs Flex apps, which brings back rich client robustness to a web-based app. Steve Jobs has thrown the gauntlet down by refusing to support Flash on all i* mobile devices. He has also quietly changed the App store rules to deliberately exclude Adobe-based apps. I believe this may backfire on him, particularly with the rapid rise of other mobile (app) platforms (e.g., Android). I'm a huge Mac fan and I love my iPhone, but Steve is unfortunately starting to act like Bill by employing Microsoft-style tactics, namely employing FUD (fear, uncertainty, and doubt) about Flash. I think anyone that marries themselves to the i* mobile platform (iTouch, iPhone, iPad) is taking a risk because Flex/Flash isn't going anywhere and the other platforms support it.

In subtle ways that are not clear to many, I think Adobe is a major player in all this, and if you haven't checked out Flex as a web application development platform, you may want to. It will be on all the other mobile platforms, running on the Flash player.

John K.

Medical Quack said...

I am in total agreement with the use of bar coding and the movements and development of 3D bar codes is pretty exciting. I have my own little campaign on going over at the "Quack" trying to develop some enthusiasm for their use and whenever I get this "brain swell" on how they could be used, up comes another post:)

With all the recalls we have today I would like to see the ability of the public to be able to scan a drug/device and get the real time information. I had one Mom on Twitter that said she had to check 7 J and J products with their recent recall notices and she would have liked to have been able to use her phone to check.

Besides being useful there's an element of "fun" to using your phone as a scanner too and in my opinion, it servers as an excellent tool to engage consumers with a bit of Health IT and helps open interest in other areas of what a patient/consumer can do. I had some comments too from some hospital CIOs too on how they liked the idea of combining RFID and bar coding too. It's just a real winner all the way around.

The recently approved prostate cancer drug Provenge relied a bit on their bar coding to get FDA approval for safety as all blood samples are tracked from step on all the way through so we don't have any mix ups with patient samples.

Anyway from the consumer end if the FDA could have a synchronized data base of the Tags used by drug and device companies I would this their compliance monitoring would be a bit easier too. MSDN and Microsoft Gov gave the write up a whirl being I focused on their product, Tags but there are other 3D technologies out there too. This link is a summary of what my "brain swells" came up with.

Now for the fun part, you can make your own 3D tag just to play around and see what it looks like. A developer created a very simple mash up with Twitter, one click. All you do is enter your Twitter name and click and a 3D bar code is generated, simple.

You need to download the Tag software to your Smart Phone, open up the program and point and aim as your phone becomes a live scanner. The Tag you created takes you to your Twitter feed on the phone browser. Anyway, it's a fun and simple way to take a look at a 3D code and see what it's all about.

Sorry to be so wordy here but I get that way when I see some really simple to use technologies become available and hope it was ok to add my 2 cents here. There's quite a few more brain storms I came up with for their use and the one summary item link has some videos and other interesting information.

Caston Thomas said...

Great analysis, Ankur! Thank you for posting the results, Dr. Halamka.

One of the futures that I am watching closely is what I call the "peripheralization" of mobile computing at the point of care. Clearly, there would be a great application for Bluetooth connected printers & barcode (or RFiD) readers integrated into an iPhone or iPad. (Currently, (and to the best of my knowledge) Apple restricts its developers from using the Bluetooth ports for communication purposes.

The impact of smart device technology will revolutionary to the workflow and communication processes at the point of care. For instance, imagine combining a checklist with an application similar to the "bump" application on the iPhone that would facilitate information exchanged as a part of the "repeat back" process used at shift change.

Unknown said...

I was wondering which wireless networks most hospitals use: 802.11a, 802.11b, or 802.11g? Also, is there already a platform for bluetooth connectivity?