Mayo Clinic Pioneers iPhone Use for More Intelligent Care

By David Raths, Healthcare and Information Technology Writer

In early November, Scott Silvers, M.D., was flying to Jacksonville, Florida when he noticed a passenger across the aisle was having a health problem.

Silvers, an emergency department physician at Mayo Clinic, saw that the 90-year-old man was pale, sweating, and nauseous. Neither the man nor his wife could remember what medications he was on. As the plane landed, paramedics were waiting to take him to a nearby hospital. But first, Dr. Silvers pulled out his iPhone and logged into a Mayo Clinic application through a virtual private network. “Because he had been a Mayo Clinic patient, I was able to access his allergy information and medication levels down to the dose, as well as some past medical information,” Silvers recalls. “The paramedics, the flight attendant, and the couple were all amazed I had access to that.”

As with other areas of intersection between healthcare and information technology, Mayo Clinic, headquartered in Rochester, Minnesota, is at the forefront of innovation in terms of mobile access to clinical data. Physicians and IT leaders at Mayo Clinic worked together over the last year to create a mobile version of their home-grown Synthesis application, which pulls pertinent data from several of the health systems’ clinical applications and displays it on one screen.

Although the Windows-based Synthesis application improved access to medical record information, a 2009 Mayo Clinic staff satisfaction survey indicated physicians wanted to reduce administrative tasks and sought greater mobile computing capabilities. In response, the Clinical Practice Committee sponsored a pilot project to develop a mobile version of the medical record viewer on the Apple iPhone, and in late summer of 2009 the SynthesisMobile project got under way.

Going Mobile

Mayo clinicians are not alone in seeking mobile access to hospital data. Physician smartphone adoption rates are expected to soar over the next few years. Sixty-four percent of U.S. physicians currently own smartphones, but that number is expected to increase to 81 percent in 2012, according to market research firm Manhattan Research.

By 2012, most physicians will walk around with a stethoscope and a smart mobile device, and there will be very few professional activities that physicians won’t be doing on their handhelds, predicts Manhattan’s report “Physicians in 2012: The Outlook for On-demand, Mobile, and Social Digital Media.” Physicians will be going online first for the majority of their professional needs and will be regularly pulling online resources into patient consultations, the report concludes. To prepare for this mobile revolution, hospital IT departments must determine how their architecture can best support these consumer-based mobile devices physicians are bringing into the workplace.

As with other innovations at Mayo Clinic, the catalyst for the mobile project was the physicians themselves, stresses Mark Henderson, IT division chair for infrastructure services. “We deploy an electronic medical record across the continuum of care. There’s very little paper involved anymore, so physicians need access to electronic information to do their work,” he explains. “Physicians had the idea of expanding that access no matter where they were, including off campus. Our care providers are very mobile. Many don’t even have an office. They log in and out of workstations all day as they move about the corridors of the campus. So speeding up that process of logging in and out was one impetus.”

The SynthesisMobile design team was multidisciplinary, including application developers Troy Neumann and Brian Wright, and a physician champion who helped flesh out the concept and develop use cases, says Mike Ryan, division chair for IT applications. Goals included providing rapid access to the electronic environment, reducing the need to access desktop computers, and improving navigation and efficiency for care providers. “We built a prototype that we tried with three or four physicians, and then conducted a pilot project with about 30 physicians in the hospital in January 2010,” Ryan says. “It took about four months from concept to pilot.”

Flip to iPhones

Those four months saw the team make several key decisions about what their new app would look like. First and foremost was whether to create a Web-based application a user could access from a Blackberry, iPhone, Android, and other device, or to standardize on one particular platform. “Historically we have had a lot of Blackberry users,” Henderson notes, “but after the rollout of the third generation of iPhone, we saw a flip to where the number of iPhones exceeded the number of Blackberries in the user base.” The team members decided they couldn’t develop a single application for all devices that would satisfy user expectations, so they decided to develop a native iPhone app.

Rather than try to replicate the user interface of the desktop Synthesis application, developers put the extra work into designing and optimizing it for the iPhone. Looking back, the IT leaders see that decision as critical to their success. “We didn’t just shove the desktop user interface onto a mobile device. We did a complete redesign of the user experience,” Ryan says. “The speed and responsiveness of a Web app are not the same as those of a native app.” He’s convinced they wouldn’t have received the positive response they did if they had watered it down to work on all platforms. (Mayo Clinic still supports other devices for e-mail and other functions, but not for access to the clinical applications.)

Making Security Personal

One goal was to increase efficiency while maintaining the highest levels of security. The iPhones have built-in data encryption. No patient medical record information is stored on the devices, and if they’re lost or if an incorrect password is entered a certain number of times, the devices can be wiped clean remotely. Access to clinical data is view-only, and that access is audited the same way it is on desktop PCs.

Logging in to a traditional workstation and navigating to a patient’s record could take up to 45 seconds. The mobile version requires entering a user ID and password, which only takes a few seconds. “The key to its value is that once you get through logging in, it’s a personal device,” Ryan explains. “It knows who your patients are for that day and what rounds you’re going to make. That information is all right there when you click on the application. You don’t have to navigate in the system to find that personalized data. It comes right up once you log in.”

A significant convenience is that users no longer have to search for an available workstation. “Although we have a large number of desktop computers dedicated to accessing the electronic medical record in hallways and exam rooms, we still heard the comment that there weren’t enough computers,” Henderson recalls. “The feedback we got was that if we had this mobile device with the application on it, it would reduce the amount of time to get to the information.”

Physicians wanted features unavailable in desktop Synthesis such as the dictation option. Without SynthesisMobile, a physician would log on to a computer to review the medical record, and then go to a phone to re-enter the patient and physician identifiers prior to dictating clinical notes.

Another new feature is the option to directly page, call, or text another provider or staff person. Other iPhone applications developed by Mayo Clinic include a staff directory and AskMayoExpert, which provides information about conditions and their treatment, and contact information for Mayo Clinic experts.

These applications reside in Mayo Clinic’s own internal “app store,” which handles software distribution in much the same way Apple’s own App Store does. “We had to figure out how to distribute the software across the Mayo Clinic enterprise to all those devices and make it easy for users without a lot of extra help desk support,” Henderson says. When there’s a software update, users get a pop-up message on their device and download it themselves. The interface is so intuitive that there has been no surge in calls to the help desk.

In February, the Clinical Practice Committee made the institutional decision to move forward on a Mayo Clinic-wide rollout. At that point, policies were established, and the Mayo Clinic campuses in Florida and Arizona were included. (They have different back-end systems, which required some additional integration work.)

After a few more months of development and policy work, SynthesisMobile was rolled out to all three Mayo Clinic campuses from August to November 2010. There are already 1,500 active users of the application. “We are pleasantly surprised by the uptake,” Ryan says. After seeing it had no adverse impact on network performance or on the number of help desk calls, the SynthesisMobile team expanded access to other clinical users including residents, physician assistants, and nurse practitioners. The next phase of the project includes adding access to images such as x-rays.

Change is Good

Looking back at the project, Ryan and Henderson suggest that their success should encourage other institutions. “The takeaway is that it is absolutely possible to do this,” Henderson says. They built a successful app for providers with a relatively small team. “The resources we have are few but very talented,” he adds.

The success was based on the decision to standardize on the Apple platform, Ryan and Henderson agree. Although they had hoped to support multiple devices, they now see it was a good decision to design it from the ground up just like other applications for the iPhone. “We kept our eye on the goal, which is to improve access to information for physicians and give them more time with their patients,” Ryan says.

Results of the January 2010 pilot involving 30 physicians

• 89% said they use SynthesisMobile frequently to a few times a week
• 90% said SynthesisMobile enhanced their clinical practice
• 90% said SynthesisMobile saved them time in their clinical practice: Most said it saved them 20-30 minutes per day; some said it saved them 5-7 minutes per patient
• 100% said using SynthesisMobile reduced the need to login to workstations for clinical applications