The Good, the Bad and the Ugly of Mobile Devices in Healthcare | Zebra Blog

Mobile Devices Can Greatly Benefit Healthcare. They Can Also Be a Liability If You Make This One Mistake.

Patients’ health, safety and overall care can be compromised by consumer-grade smartphones.

A nurse uses a clinical smartphone to call another care team member in a hospital hallway
by Chris Sullivan
February 03, 2020

Healthcare team members must be able to communicate with one another in real time, at all times, to provide the highest quality of patient care. They also need real-time access to patients’ electronic medical records (EMRs) and the Internet of Things (IoT) medical devices used to monitor patients’ health – at the point of care. Yet, hospitals lacking a clinical mobility solution inadvertently tether staff to the nurse’s station for data input and retrieval on desktop computers. Even a more portable solution, such as a wheeled work station left in each patient room, can delay clinicians’ actions since they must relog into a new computer each time they go to a new room and start working from that room’s assigned cart. Plus, care team members field incessant phone calls, patient alerts and medical device alarms and are constantly interrupted by patients, physicians, phlebotomists and pharmacists. And that’s not a bad thing. Constant communication, whether human-to-human or technology-to-human, is the key to providing the best patient care.

That’s why a 30-40 percent increase in clinician mobility adoption is anticipated globally over the next couple of years, as I explain in this video. In fact, 98 percent of physicians, 97 percent of bedside nurses and 96 percent of pharmacists expect to be using mobile devices in some capacity by 2022, according to Zebra’s Global Healthcare Vision Study. That doesn’t even account for the radiologists, phlebotomists, paramedics and other care team members who will be fully “mobilized.”

However, mobile technology – like any technology – can either help or hurt your cause. For example, if you’re using a consumer-grade mobility solution that’s not designed with healthcare professionals’ input and certified specifically for healthcare applications, you will find that clinical mobility can reduce productivity, disrupt patient interactions and potentially lead to mis-informed care decisions and, thus, unnecessary medical tests or treatments.

It can also cost you exorbitantly more.

VDC Research Group confirmed in its Total Cost of Ownership Models for Line of Business Mobile Solutions report in December 2018 that consumer device acquisition costs may be lower than enterprise-grade devices, but consumer devices end up costing 50 percent more over a 5-year period. That same report revealed that the failure rate for consumer mobile devices is 2.9 times higher than that of rugged devices due to the costs associated with managing mobility at the enterprise level. For example, you need to be able to monitor the health of all mobile devices at all times and take preventative measures to reduce the risk of clinician downtime. However, visibility into consumer-grade device performance is often limited, even if a Mobile Device Management (MDM) solution is in place.

The lifecycle of consumer devices also tends to be shorter in hospital environments due to constant hazard exposures and disinfection requirements. This can lead to more frequent device replacement, which then requires resources to procure, configure, secure and deploy new devices. More frequent device failures can also lead to a breakdown in communications among care team members and become disruptive to patient care as previously mentioned.

Considering that healthcare leaders are laser-focused on reducing operating expenses and overall resource burdens, technology decision makers must use the total cost of ownership (TCO) to assign “value” to mobile devices and their entire mobility solution, not the upfront cost. That is the only way to simultaneously maintain cost control, achieve widespread operational efficiency and improve patient outcomes.

However, the “value” and TCO of mobility are not exclusively measured in financial terms. The ability to help improve clinician productivity and reduce preventable errors at the point of care can prove to be one of the most valuable “benefits of ownership” for purpose-built clinical mobile devices when compared to consumer-grade devices. So too can the extreme ease of configurability, proactive manageability and enhanced security that comes standard with purpose-built clinical mobility solutions.

Don’t believe me? Just ask the staff at Truman Medical Centers and Nemours Children’s Health System.

Both of these healthcare systems replaced their consumer devices with hospital-grade handheld computers for the same four reasons:

1. Dependability – Doctors, nurses, pharmacists and even phlebotomists rely on mobile computers to do their jobs. They use them to scan wristbands to confirm patient identity prior to lab work, medicine administration and other care actions and retrieve and update patient records at the point of care. Mobile computers also provide real-time clinical decision support via human and technology-derived intelligence regarding radiology and lab results, current vital signs and more. (Assuming they’re interoperable with health information systems, medical devices and the nurse call systems, which in modern healthcare environments is practically a mandate.) So, if even a single care team member’s smartphone is not working for any reason, then the risk of mistakes can rise.

For example, something as simple as poor voice call quality can cause miscommunications, which can lead to poorly-informed decisions and actions by those left to make a call about the best next step at the point of care, especially in time-sensitive situations. And clinicians who are given devices that lack a built-in barcode scanner will have to utilize manual data entry methods, which can lead to errors in a patients’ records and result in wrong care decisions and actions. Along those same lines, if the device does have a built-in scanner but the scanner is unreliable – if it struggles to read damaged, dirty or light-ink barcodes, for example – then clinicians will likely revert to manual data entry to speed the process along.

And I think you can appreciate the potential harm that could be done if a nurse misses a patient alarm or medical device alert due to a mobile device issue, whether it’s the result of an unsupported app, the device being dropped and breaking or a dead battery that’s causing the phone to be recharged at the nurse’s station at that particular moment.

On the flipside, arming clinicians with reliable mobile computers can save lives. For example, Nemours reports that adverse reactions to blood transfusions have been detected and stopped quickly thanks to early detection and better staff communication. And simple texts to the nursing staff pointing out lead placement or rhythm changes have resulted in much-needed interventions.

Along those same lines, giving clinicians a touchscreen device that can be used without having to take off latex gloves can give them back the extra few seconds needed to save a life in a critical situation, as can giving them devices with push-to-talk or one-button dial capabilities to allow for immediate consultation with providers.

In other words: a reliable clinical mobility solution equipped with the right tools is key to effective care actions and eliminates the risk of dangerous workarounds that can be detrimental to patient outcomes.

2. Disease control – A recent study revealed that 94.5 percent of healthcare worker mobile phones contained bacterial growth, some of which are known to cause nosocomial infections. They must be disinfected frequently with cleaning solutions that are far more potent than at-home disinfecting wipes. Therein lies the problem with consumer devices: it’s a known fact that they take far longer to disinfect than hospital-grade devices – and the truth is that they can’t tolerate constant contact with the industrial-strength sanitizing chemicals required in healthcare.

As Kassaundra McKnight-Young, a Senior Clinical Informaticist for KC one Health Innovation Alliance and a PRN Registered Nurse at Truman Medical Centers, explained in her recent blog, it used to take clinicians 10 minutes to disinfect one of the many consumer smartphones in their shared device pool due to the alternative “work around” cleaning protocol that had to follow (compared to the one-minute it now takes to thoroughly disinfect the purpose-built clinical smartphones they’re using). While everyone will agree that 10 minutes would be better spent on patient care, the time burden isn’t the biggest concern when it comes to consumer device disinfection; it’s the increased likelihood that clinicians will skip steps in the cleaning processes and the implications of non-compliance on disease control.

And, despite marketing efforts by some consumer-grade device manufacturers to depict their devices as “rugged,” their housings can’t be disinfected without possible corrosion. In fact, enterprise-grade smartphones and mobile printers are the only types of devices confirmed to tolerate frequent cleaning with isopropyl, ethyl alcohol and possibly even bleach or contact exposure to other fluid contaminants commonly found in healthcare settings, such as ammonium, hydrogen peroxide, blood and other bodily fluids.

For example, clinical smartphones are intentionally designed with smooth and covered housing surfaces to minimize bioburden build-up that would otherwise take place in crevices and seams with consumer-grade devices. And the design of healthcare mobile computers, such as Zebra’s TC52-HC, was taken a step further to utilize only disinfectant-ready, non-nylon-based medical grade plastics that can be disinfected with over 30 approved and publicly documented healthcare cleaning agents. That is not something you’re going to find with most enterprise-grade mobile devices, much less consumer devices.

Hard to believe? Darrel Hicks, a nationally-recognized expert in infection control, published this paper to help set the record straight on “how your mobile devices affect the 21st century healthcare environment.” He talks about which devices can actually be disinfected safely and which can’t as well as the ideal cleaning frequency and process, debunking several common misperceptions along the way (such as the idea that microfiber wipe downs are sufficient).

Download the mobile device disinfecting guide for free now:

Separating Myth from Reality: Cleaning and Disinfecting Mobile Devices

3. Device management – Speaking of business impact, consumer devices have proven to be a minefield for IT teams to monitor, manage and secure. On the other hand, enterprise mobility management (EMM) platforms and original equipment manufacturer (OEM) device management tools make it simple to configure, deploy, maintain, recover and even lockdown devices remotely. For example, operating system (OS) version control is critical to maintaining a secure mobility solution, particularly in healthcare where protecting patient privacy is a top priority. However, consumer device management – including the timing of an OS update – is often dictated by MDM solutions, which means there can be delays.

 

However, enterprise device OEMs such as Zebra offer expanded device management services that allow for real-time visibility and analysis of devices and zero-day configurability OEMConfig is one example. Another is VisibilityIQ™. The difference between these services and an MDM-only approach (which is all that’s available with consumer devices) is that you gain advanced analysis capabilities and single-screen, granular-level visibility into the health of all of your mobile devices at all times. You can immediately locate devices, confirm their condition and utilization, remotely triage and proactively manage everything from OS updates to new feature implementations.

4. Data security – Healthcare providers are subject to the same data protection mandates as any other enterprise organization, regardless of the hospital or practice size. In fact, in some regions of the world, additional laws have been introduced to protect patient privacy. In the United States, healthcare providers are obligated to abide by the strict security rules defined within the Health Insurance Portability and Accountability Act (HIPAA) outlined in this HIPAA Journal article, while those in the European Union are held accountable by new GDPR standards.

Yet, data security is complex and it can be easy to violate regulations if you don’t have the right encryption, EMM and OEM tools available to manage device security settings – which most consumer devices don’t.

I can’t speak for all enterprise device OEMs, but I can tell you that Zebra integrates multiple layers of security and uses a number of tools to harden Android™ OS devices used in data-sensitive environments such as healthcare. For example, our devices have FIPS 140-2 validated cryptographic modules to maintain patient health information confidentiality and integrity as well as cybersecurity prevention tools that help to prevent software bug hacks. We allow for remote lock and wipe of lost or stolen devices and automatic locking of idle devices. And we enable you to set application permissions that prevent users from downloading unauthorized applications that could present security weaknesses or enable uploading of sensitive data to unauthorized servers.

Of course, in clinical settings, multi-user log-on is essential to enabling a single pool of devices to be used by multiple care team members in a shift setting. But so is being able to fully control what each worker can access via log-on credentials, which isn’t necessarily possible with consumer devices. Nor is the ability to restrict user and application access to hardware (such as the integrated camera, GPS and Bluetooth) as well as the built-in web browser or an email client – another “benefit of ownership” with purpose-built clinical smartphones.

We also issue security alerts through our LifeGuard for Android OneCare Service, push security patches via OEMConfig– many of which we offer beyond the life of what OS providers will independently offer – and give you the ability to remove OS features that access servers outside of a network. (FYI - many applications built into the consumer version of Android communicate directly with the cloud and pose a security breach risk.)

Another benefit of working with an enterprise-exclusive solution provider such as Zebra is that we work with customers’ internal security organizations to assess vulnerabilities and troubleshoot in specific areas of need. Can consumer device manufacturers offer you the same high level of collaborative security support? It’s definitely something you should ask.

In other words, your New Year’s Resolution should be to re-assess your current mobility solution to see if it is truly safe, secure and reliable enough to use in clinical settings, without compromising on your risk tolerance.

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Editor’s Note: Tune back into Your Edge in the coming weeks to learn how you can determine a mobile device’s risk rating for healthcare applications.

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Chris Sullivan
Chris Sullivan is the Global Healthcare Practice Lead for Zebra Technologies and is responsible for the strategy and marketing functions for the Healthcare vertical business.
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