Smartphones Present Both Risks and Opportunities for Hospitalists
The near-viral adoption of smartphone technology in hospital settings has made headlines recently, raising concerns about distracted physicians, data security breaches, infection hazards from bacteria on devices, and even misplaced devices. Critics also note the problems will be multiplied as electronic health records gain traction and become even more linked with handheld devices.
Russ Cucina, MD, MS, a hospitalist and medical director of information technology at the University of California at San Francisco (UCSF) Medical Center, says these issues aren’t new, and they’ve been successfully addressed in other industries for years.
Peter J. Papadakos, MD, professor of anesthesiology, surgery, and neurosurgery at the University of Rochester in New York, wrote in Anesthesiology News in November about the dangers of “electronic distraction” from mobile devices.1 He told The New York Times: “You walk around the hospital and what you see is not funny,” in terms of professional staff texting, surfing the Web, and playing games.2 “My gut feeling is lives are in danger.”
In December, John Halamka, MD, chief information officer at Beth Israel Deaconess Medical Center in Boston and chair of the U.S. Healthcare Information Technology Standards Panel, commented on a multitasking medical mishap involving a resident who answered a text message about an upcoming party during rounds.3 He noted that BIDMC doctors and nurses at have purchased more than 1,000 iPads and 1,600 iPhones with their own funds. Because of increased risks for interruptions and inadvertent disclosure of protected health information, Dr. Halamka recommends that hospitals carefully consider best practices and implement policies and technologies to mitigate those risks.
In November, CIO.com called mobile devices “the dominant technology tool in American enterprise,” but also labeled them a “security minefield.”4 Amcom Software of Eden Prairie, Minn., recently produced a white paper, “Six Things Hospitals Need to Know about Supporting the Adoption of Smartphones,” with recommendations for integration, redundancy, and escalation in their use.5 And the Schumacher physician management group of Lafayette, La., has incorporated smartphone applications for its emergency physicians, with similar technology expected soon for its hospitalists.6
“To me, a lot of this discussion in medicine is 18 to 28 months behind the times,” Dr. Cucina says. “Perhaps it’s novel to Dr. Papadakos, but we’ve had the problem for some time. Everyone is using smartphones in the clinical environment. Everybody has one. The computers we have at work get a lot of use for personal business. It’s happening; we have arrived. Now, how are we going to deal with it?”
Other industries have placed technological or administrative limits on using company devices for personal use. At UCSF, bandwidth limits were placed on access to the online video service YouTube—with unintended consequences. “There is a lot of good clinical content on YouTube that could be used for patient education at the bedside,” Dr. Cucina admits.
Given the technological imperatives, Dr. Cucina says, it makes less sense for clinicians to carry two smartphones—“one to call your spouse, one to call up Epocrates. But if we’re all going to carry converged devices, how do we use them appropriately?” It also is important to be clear on what they do well, such as retrieving clinical information, but not inputting complex charting or expecting security, privacy, and guaranteed message delivery.
Ultimately, Dr. Cucina says, new technology brings into focus issues that have long been part of medicine. “The obligation to honor patients’ privacy goes back to Hippocrates. And we’ve had infection control issues with stethoscopes since they were invented,” he says, adding the issues—and solutions—are less technological than administrative and behavioral.
