• Preparing for Mobile Clinical Decision Support

    Oct 31, 2012

    Midway through an iPad pilot project, Timothy C. Birdsall, ND, chief medical information officer for Cancer Treatment Centers of America (CTCA), is not sure how the popular tablets are going to be incorporated into the organization's health IT arsenal. But he is convinced that they will be-and soon.timothy-birdsall

    "I fully expect that we will have iPads implemented broadly within the next 12 months," he says. "We're concerned about font size and the ability to read, so we are working through those and other issues."

    CTCA provides cancer care through five hospitals, each providing both inpatient and outpatient services, around the country. Since 2008, computerized provider order entry and full clinical documentation via the EHR have been a way of life. Plus, more than 1,000 order sets are embedded into the EHR. For example, one order set prompts clinicians to evaluate each patient at admission for risk of developing a blood clot and requires them to take steps to prevent a blood clot or document why those steps are inappropriate for a specific patient.

    Like all clinical decision support-savvy executives, Birdsall wants CTCA clinicians to have decision-making tools as close to the patient as possible-whether that is at the bedside or in the exam room. But the perfect solution has not yet emerged.

    While some CTCA physicians use a computer on a cart in a patient's room or carry a laptop to the bedside, most prefer to interact with the patient's EHR at the nurse's station because the technology seems bulky and disruptive to the patient visit, Birdsall says.

    Lightweight tablets are more patient-friendly, which is why CTCA is experimenting with them. Its EHR vendor offers an iPad application but its functionality is currently limited to read-only access.

    "We depend so heavily on order sets and currently the iPad application does not allow the use of order sets," Birdsall says. "The other challenge has to do with documentation, as the application does not allow for the use of structured documents. I'm a little concerned about giving clinicians essentially a read-only tool that allows them to do part of their job, but does not allow them to complete their job with the necessary documentation unless they access a second computer after the patient visit is over."

    Other issues still to be worked out include how to keep mobile devices clean to avoid transmission of disease and whether to allow physicians to use their own mobile devices as they interact with patients. Because it may be difficult to provide Internet connectivity and high-level technical support for a wide array of devices that clinicians might choose, CTCA has purchased iPads for physicians. However, Birdsall expects the security issues in the bring-your-own-device debate to come to his office eventually.

    "We are in the process of developing a policy around what we do if a physician says, 'I want to bring my own iPad or my Android tablet,'" Birdsall says.

    Access related article: Building Effective Clinical Support  

    Interviewed for this article: Timothy C. Birdsall, ND, FABNO, is chief medical information officer, Cancer Treatment Centers of America, Schaumburg, Ill. (tim.birdsall@ctca-hope.com).