Developing Documentation Guidelines for Mobile Apps

Stephanie Luthi-Terry, MA, RHIA, CHPS, FAHIMAAllina Health, Minneapolis MN

Objectives

• HIM leading the work• Discuss Mobile App environment• Mobile Apps and Patient Generated Health Information• Identify Use Case(s) – apps developed by your organization

and apps that are retail• Development of work-stream decision making• Determination of PGHI as a part of the legal (disclosable)

medical record

What is a Mobile App?

What is a mobile app?

From Wikipedia: A mobile app is a computer program designed to run on a

mobile device such as a phone/tablet or watch. Mobile apps were originally offered for general productivity and

information retrieval, including email, calendar, contacts, the stock market and weather information. However, public demand and the availability of developer tools drove rapid expansion into other categories, such as those handled by desktop application software packages

Do people really use a mobile app?

• Gartner’s prediction is 268 billion downloads in 2017 will generate an income of $77 billion in 2017

• 2016 - $58 billion• 2015 - $45 billion• 2014 – 35 billion

Source: Business2Community.com

Mobile Apps in Healthcare

Considerations for Mobile Apps• Mobile apps may be downloaded for free

• Anyone can create an app; not all developers are trustworthy.• Mainstream app stores – Apple, Google Play, Amazon, etc. – are the safest sources

for apps but aren’t perfect. • Studying app components can help you gauge risks before downloading

• Mobile apps may have a retail expense• Is there a one time fee for download? Annual update?• How are upgrades handled?• Be wary of “free” versions of paid apps, especially if by different developers

• Mobile apps may be developed by an organization• Does your organizational IT team develop mobile apps to push out via patient

portals?• Mobile apps may be developed by an endorsed organizational vendor

• Does your EMR vendor develop mobile apps for you?

What Do We Do with This Data?

The Road to Documentation Standards

A “Use Case” snapshot

Mobile App Considerations • What is the use case?• Who owns the technology?• Guidelines for intake?• Consents – do we need one?• Rules of the Road – do we need these? What are these?• Workflow options (organization portal vs external portal;

integration with EMR)• Provider/service line input and standardization?• Who are the decision makers for mobile app use?• What types of assessments needed for a retail mobile app?

Committee SME Considerations• Needs to be composed of applications and operational SME’s

• Identification of organizational authority to appoint workgroup• Physicians who are EMR leaders/decision makers• Portal experts• HIM/documentation SME’s• Privacy/legal/compliance • Site relationship manager• Ad hoc members

• Use case submitter• Digital strategy leaders• Workflow analyst

Technology vs Documentation• Team needs to be focused on documentation

• Does your designated record set recognize Patient Generated Health Information?

• How will you use and disclose this information?• What is workflow for ingestion of mobile app information to EMR

• Is it via an EMR patient portal or via an external portal accessed by a provider/delegate?

• What is technology review requirement• Do you require a privacy/risk assessment• Do you require an IS security risk assessment• Do you require a storage assessment (e.g. cloud vs server)• Do you require some 3rd party endorsement (e.g. FDA)

Collaboration

Developing Standards

What is a Standard?

“An idea or thing used as a measure, norm or model in comparative evaluations”

Source: Oxford dictionary

What is the intent of Standards

• Are your standards intended to:• Describe the who, what, where, when, how of mobile app data resides

in your EMR?• Intend to describe the technology?• Provide aligned guidelines related to documentation workflow?• Describe a procedure?• Establish a governance model?

Mobile App Standards – Patient Initiated

These standards apply to those applications that the organization has evaluated and approved (e.g. security risk assessment, privacy assessment and business approval) for use by patients

that include the potential for the organization to ingest the data from the application

Building a Governance model• Creates a repeatable process • Documentation standards respect technology innovation• Aligns with organizational documentation content requirements• Integrates with designated record set• Patient engagement• Respects the information technology governance functions• Supports the principles of Information Governance:

● Accountability ● Transparency ● Integrity ● Protection ● Compliance ● Availability ● Retention ● Disposition

Approval and Communication

• Decision making/authority to approve approach and standards

• Identify the communication plan • Consider using project management tools for

communication plan• Include training team for onboarding new staff• Socializing the standards as an “FYI”, not approval bodies• Use organizational intranet, internal medical staff

bulletins, staff and management communication avenues.• Consider inclusion of PGHI as part of DRS (if not done

already)

Celebrate your hard work and team efforts!!

Thank You!

Questions?

Contact Information

Stephanie.Luthi-Terry@Allina.com

Allina HealthMinneapolis, MN

612-863-7982