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'''Mobile Technology to Improve Hospital Staff Communications'''

Use of '''Mobile Technology (MT)''' including smartphones, tablets, and other handheld devices in hospital settings has increased drastically as a means to improve clinical workflow and communication.(1) The adoption of MT in the clinical setting is crucial to improve communication amongst hospital staff and to improve patient safety. The current archaic communication devices, such as pagers, which have been used since the 1950s, lack the ability for rapid communication needs required by clinicians to provide optimal patient care.(2) 



'''CONTENTS

'''1.	Why Coordinated and Efficient Communication is Essential to Patient Care'''

'''2.	Healthcare’s Current Inefficient Communication Technology'''

'''3.	Benefits of Mobile Technology for Hospital Staff Communication''' 

'''4.	Concerns about the Use of Mobile Technology in Healthcare'''

'''5.	Future Research Required'''

'''6.  References'''


'''Why Coordinated and Efficient Communication is Essential to Patient Care'''

''Patient Safety:''  Coordinated hospital staff communication is difficult to achieve because patient care is delivered by multiple staff at different times and from different locations.  Communication breakdown in the hospital is one of the leading causes of medical errors.(3) In fact, miscommunication is the most common cause of preventable death or disability during a patient’s hospital.(2)  

''Cost Savings:'' 
There are also significant financial implications to communication failures within the healthcare system. For example, the estimated cost of communication inefficiency to a 500 bed hospital is $4 million annually.(4) Ultimately, lack of rapid and effective communication between healthcare providers negatively affects all key stakeholders - patients, providers and administration.


'''Healthcare’s Current Inefficient Communication Technology'''
 
''The Archaic Pager:''    Hospitals still rely primarily on the pager for communication amongst clinical staff.  It is estimated that the use of outdated communication technology such as pagers and fax machines costs hospitals $5.1 billion annually in lost productivity.(10) One study found clinicians waste an average of 46 minutes per day waiting for patient information, with the pager noted as one of the main sources of the delay.(10) The American Society of Anesthesiologists surveyed 4000 Anesthesiologists about their use of smartphones and pagers in the Operating Room and Intensive Care Unit. Forty-five percent of them reported that pagers were responsible for delays in communication compared to only 31% of smartphone users. These reductions in communication delays were also associated with a reduction in the risk of medical error or injury.(5)

''Inadequate Protection of Patient’s Health Information:''    Patient privacy is also at risk with the use of pagers. The Health Insurance Portability and Accountability Act (HIPPA) was written to protect patients’ health information. Hospitals and can incur fines as high as $1 million for violating HIPPA compliance. Ironically, one of the most ubiquitous communication tools in healthcare, the pager, is not HIPPA compliant.(6) Patient information is frequently transmitted to alphanumeric pagers. Clinicians often receive pages with the patient’s name, chief complaint, and current location displayed openly for anyone to view if the pager is not in the possession of the intended recipient.  Ultimately, the pagers lack the synchronous workflow that healthcare providers require to provide patients with the most efficient, safest, and high quality care possible. 



'''Benefits of Mobile Technology for Hospital Staff Communication'''

''Increased MT Usage:''   There has been a significant increase in the number of physicians using their smartphones to communicate with other healthcare staff.(2) In a survey of 6000 primary care and internal medicine physicians in 2013, 89% stated they used smartphones to communicate with other hospital staff.(9)
 
''Efficient and Coordinated Communication:''  Clinical care requires rapid communication and real time responses between health care providers who may not be in close proximity in order to provide the best potential for better patient outcomes. It has been shown that the use of MT decreases response times between healthcare staff as well as decreases the failure to respond to communication completely.(7)  

''Improved Clinical Workflow:''  One of the key functionalities of utilizing MT in the clinical setting is that it can serve as a mobile extension of the EHR by providing access to real time patient information.(7)  For example, critical lab values such as life threatening hyperkalemia can be immediately addressed with instantaneous secure text messages. This real time synchronous communication allows the care team to initiate the appropriate treatment and simultaneously confirm that interventions have been initiated.  One study found that the use of MT can decrease the time from when a critical laboratory value has resulted to the time a physician communicated appropriate treatment by 40.8%.(3)



'''Concerns about the use of Mobile Technology in Healthcare'''

''Security and HIPPA Compliance:''  The ability to enforce HIPPA compliance is a major and legitimate concern of HealthIT departments.(8) The use of smartphones to communicate patient information by unsecured short message service (SMS) texting is not HIPPA compliant. Spyglass Consulting Group in 2014 found as many as 96% of a group of surveyed physicians reported using SMS for coordinating patient care. In order to ensure HIPPA compliance for text messaging in healthcare, HIPPA compliant applications must be installed on the mobile devices.(6) This requires IT departments to invest time and limited dollars into developing and implementing a mobile device management policy for the majority of clinical staff whom use their personal devices for hospital communications. 

''Disrupted Clinical Workflow:''  Increased interruptions in the clinical workflow of physicians has also been cited as a drawback as physicians are easier to contact via mobile devices compared with pagers.  Some physicians found that MT caused more interruptions due to the ease of contacting them and were less satisfied using MT.(2) 



'''Future Research Required'''
While using MT as a tool for hospital staff communications can provide more efficient patient care and potentially improve patient outcomes, no research studies exist that actually demonstrates that MT has a positive impact on improving patient outcomes.(9) The current literature is lacking evidence-based studies in which clinical situations (critical vs non-critical) and for which end users (physicians, patients, nurses), and which type of mobile technology will actually improve the delivery of healthcare and patient outcomes.(7)
	


'''References'''
#Uy RCY, Kury FSP, Fontelo P. Wireless networks, physician handhelds use, and medical devices in U.S. hospitals. In: New York, New York, USA: ACM Press; 2015:1-6. doi:10.1145/2811780.2811956.
#Nguyen C, McElroy LM, Abecassis MM, Holl JL, Ladner DP. The use of technology for urgent clinician to clinician communications: A systematic review of the literature. International Journal of Medical Informatics. 2015;84(2):101-110. doi:10.1016/j.ijmedinf.2014.11.003.
#Khairat S, Gong Y. Understanding effective clinical communication in medical errors. Stud Health Technol Inform. 2010;160(Pt 1):704-708.
#	Agarwal R, Sands DZ, Schneider JD. Quantifying the economic impact of communication inefficiencies in U.S. hospitals. J Healthc Manag. 2010;55(4):265–81–discussion281–2.
#	Soto RG, Chu LF, Goldman JM, Rampil IJ, Ruskin KJ. Communication in Critical Care Environments: Mobile Telephones Improve Patient Care. Anesthesia & Analgesia. 2006;102(2):535-541. doi:10.1213/01.ane.0000194506.79408.79.
#	Przybylo, J et al. Smarter Hospital Communication: Secure Smartphone Text Messaging Improves Provider Satisfaction and Perception of Efficacy, Workflow. 2014:1-6.
#	Prgomet M, Georgiou A, Westbrook JI. The Impact of Mobile Handheld Technology on Hospital Physicians' Work Practices and Patient Care: A Systematic Review. Journal of the American Medical Informatics Association. 2009;16(6):792-801. doi:10.1197/jamia.M3215.
# McAlearney AS. Organizational and Physician Perspectives about Facilitating Handheld Computer Use in Clinical Practice: Results of a Cross-Site Qualitative Study. Journal of the American Medical Informatics Association. 2005;12(5):568-575. doi:10.1197/jamia.M1816.
# Comstock, Jonah. MobiHealthNews. Web Access: http://mobihealthnews.com/45623/almost-one-third-of-physicians-use-smartphones-to-manage-patient-care
# Acohido, Byron. USA Today. Web Access: http://www.usatoday.com/story/cybertruth/2013/05/07/healthcare-technology-cybersecurity-privacy-patient-care/2142739/



Submitted by: Matthew Barrett, MD

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