Embed Size (px)
Citation preview
Perfect Storm of Mobile Devices and Application in Hospitals
BYOD Nightmare
Neha Patel, MD MSDirector of Mobile Strategy and ApplicationsDirector of Quality, Section of Hospital MedicineUniversity of Pennsylvania Health System
2
Agenda
• Case for mobile strategy in health care
• Considerations for BYOD in health care
• Mechanics of UPHS BYOD policy
3
4
Driving factors
Mobile devices and apps are ubiquitous Rising demand from patients, providers, and partnersfor mobile medicine
Vendors accept that mobile is inevitable App creation culture expanding at Penn
5
Role for mobile health in hospitals “Workaround Culture” in healthcare organizations
• Focus on current, immediate patient care needs rather than on improving system for future patients
• Fragmented methods of communication and workflow• Vicious cycle: bad process workarounds bad process
Tethered to
desktop
Keyhole views
Pagers
Paper handoff
Secured
Paperless handoff
Real‐time dataClosed loop
Mobile
6
Adoption not a problem …
Medview mobile
Cureatr
Rolodoc (organic)
Carelign
iAntibiogram
7
Cureatr: secure messaging
Mobile, real-time communication for providers HIPAA-secure, Inter- & intra-organization text messaging
iOS Android
Web App
Mobile Chart Review & Handoff Tool
9
PERFECT STORM
10
Penn Medicine current state (July 2015)
• The Good○ 4507 Corporate provided Smartphones○Mobile Device Management (MDM)– Device Encryption– Passcode Required– Remote Clean/Wipe when Stolen/Lost
• The Not so Bad○ 6843 MDM licenses for Smartphones○ 1387 MDM licenses for Tablets
• The Ugly○ Frontline staff are using personal Smartphones (fellows,
residents, nurses) in clinical setting
11
Use cases of personal smartphones by clinicians
Texting/Pictures
Medical reference
Cellular
“Tactically speaking, bring your own device (BYOD) is an unstoppable
user‐driven force. “
12
Healthcare institutions are addressing mobility…
Items included in a Mobile Technology Policy PercentMeans of securing devices (i.e. storing information on device) 85%Use of personal devices for clinical/work use 7%Management of lost/stolen devices 86%Ability to access data from remote locations 72%Types of applications approved for use 49%Brand/version of device 36%
190 organizations (56% AMC) surveyed in 2015238 respondents57% indicated that their organization has a mobile technology policy in place
Source: 2015 HIMSS Mobile Technology Survey.
86% including in future work
13
Penn Medicine mobile device strategyWhile we work through the development of a mobile device strategy,
there is an immediate need to manage users across the organization who currently use personal devices to access Penn Med business and clinical
applications.
Manage mobile risk• Locate lost/stolen devices
•Device encryption•Control Penn Medicine data moved to mobile environment
Configuration standards
Develop policy
Enable mobile
productivity
14
Considerations of a “Bring Your Own Device” policy
• Privacy and security
• Financial considerations– Stipends– Reimbursement
• User categories
• Devices and level of support
15
Less Privacy Expectations
More Privacy Expectations
Close the gap between perception and reality when it comes to privacy and information protection on mobile devices
Balance information protection and privacy interests in your mobility programs
Corporate Provided
Joint Ownership
Personal Phone
16
17
Containerization…
• Enables separation of business and personal applications and data so that a single device
• Helps an enterprise manage the risk of sensitive data exposure through authentication, encryption, selective wipe and data use controls
• Provides a common user experience across multiple devices
• Potential to reduce enterprise support costs for mobility
• Can provide a single sign‐on capability across multiple applications
• User experience is not the same as native applications on the device
• UI still has a poor reputation
• Users do not like the process of switching between the container and the main user screen
• Do not support the complete separation of phone and texting functions on mobile devices
StrengthsStrengths WeaknessesWeaknesses
18
Privacy and security addressed in Penn Medicine’s BYOD policy
We bear the burden of establishing our employees’ privacy expectations when it comes to mobile devices and so offer two options for BYOD users:
1. Current Mobile Device Manager (Default)
2. MDM Containerization (Opt‐in)– Workspace on the device that is defined and managed by IS
Device(Personal Apps and Data)
Container(Business Apps and Data)
App
App
App
App
App
App
App
DataData
19
Beware: personal information IS sacred
• Data that is monitored• Who• What
• Data that can be wiped• Selective wipe
20
Trojan horse strategy for shifting costs to employees?
Corporate‐issued BYODHow much will be spent on each device
Cost of a partially subsidized data plan
Cost of a fully subsidized data plan
Eliminates cost of the device purchase
Cost of recycling devices every few years
Cost of mobile device management
Warranty plansIT time and labor in managing the program
21
Models to finance BYOD…
Employee pays
Company pays service plan
Company reimburses employee
Employee reimburses company
Employees are responsible for all costs related to operating the device they own.
Company pays all operational costs associated with the employee owned device.
Allows the enterprise to aggregate voice minutes and data usage, which often allows the enterprise to negotiate lower overall rates
Requires regular payments to an employee that are designed to offset the cost of service plans and other operational investments
May be considered taxable revenue
Company makes the payments for the service plan and other costs and deducts them from an employees pay
22
Financing BYOD from the employer side…
Fixed Payment (Stipend or Allowance) Reimbursement
Advantage
• Low process overhead (just add to paycheck)
• No action is required on the user’s part to initiate the payment
• Provides the user a chance to substantiate the expense
• Avoid taxes on reimbursement
Disadvantage
• Payroll tax implications for the organization
• Tax implications for the users (potential for income, social security, Medicare, and state taxes)
• Increased process overhead for organization
• Administrated work for user (required to submit a bill)
• Stipend: a fixed sum paid periodically (usually monthly) to defray a specific expenses; it is usually added on to an employee’s regular pay as a gross‐up on their paycheck
• Reimbursement: a payment to the employee for a business expenses, typically after the expenses has been incurred and in response to the employee filing an expense report.
• Allowance: a fixed amount of money allocated on a periodic basis (often per year) for an employee to spend on specified goods or services related to his or her job.
23
Pay up: Is the free ride over for Corporate BYOD?
24
25
User categories for UPHS BYOD policy
The BYOD program is intended to be voluntary for exempt employees. • Incentive to enroll will be access to apps that add value to workflow
Eligibility for participation in the BYOD Program will be assessed by the user’s department manager. • There is a justifiable business requirement for having mobile access to Penn Medicine information
• The user has elected to use his/her own device
Human Resources approval is required before a nonexempt employee may participate in the BYOD Program
26
BYOD InitiativesTake on a variety of different approaches
INFORMALUsers can access
apps and data from their personal
device
FORMALBYOD policy, stipend, self-
service web site and support
We are here
27
13%
20%
22%
24%
27%
29%
32%
32%
32%
36%
51%
Doesn't Fit in Workflow
Clinician Resistance to Technology
Lack of Executive Support
Challenges Regarding Wireless Capabilities
Lack of Staff Expertise
Inadequate Privacy/Security
Lack of IT Staff
Lack of Standards/Interoperability
Immaturity of Vendors
Limited Incentives for Use
Lack of Funding
Barriers to use of mobile technology
N = 231
Source: 2015 HIMSS Mobile Technology Survey
28
Penn Medicine mHealth Governance focus
• Smartphones >> Tablets• Corporate-BYOD
• Policy setting (security, eligibility)
• Infrastructure & Support• Financial implications
Mobile Devices
• Functionalities• Secured messaging• Directory/schedules• Workflow • Resources
• Software Architecture• Native vs Web App
Mobile Applications
Apps will change care deliveryCourtesy of Glenn Steele, CEO of Geisinger
EHR World Today
Data dispersed, not easily found, Useless
Copy and Paste
Workflows not efficient or user‐
friendly
Minimum analytically supported clinical decision support
Difficult to implement changes
The Future
Data extracted, re‐organized and
presented in a user‐friendly way
Workflow facilitated via clinical logic; results of analyses integrated
into workflow
Decision support based on analysis of data outside and inside of
EHR
Easy to program changes
Benefits
Saves clinician time
Improves quality of care
Easier and less expensive to employ
Increase coding scores and documentation
requirements
30
Considerations of leveraging mobility in healthcare
Design for today but need to anticipate tomorrow• Develop and invest in existing talent (PI specialists, clinicians,
designers)• Incremental build‐start with an idea/prototype and get it into
hands of frontline providers• Build vs buy decisions
Lack of scientific evidence to measure the efficacy of mobile apps• Measure what we can, but not what counts…• Develop evaluation criteria focused on business cases and
patient care benefits
EMR integration• To do or not to do…• Accept timeline of vendors?• Partnership between Clinicians and IS
