The current state of the art in terms of hospitals offering physicians what they need in mobile technology is more like stick figures than da Vinci, according to veteran healthcare IT analyst Gregg Malkary.

"On a scale of 1-10, I'd say we're at a 2 or 3," says Malkary, founder and managing director of Spyglass Consulting Group, about the findings of the firm's latest report on the state of hospital communications, Point of Care Communications for Physicians 2014.

Malkary does not mince words – or maybe feelings, for that matter – when he says hospital IT is paying "lip service" to supporting physicians' mobility requirements. In a little more detail, he says, there is a profound disconnect between what IT execs, burdened by other issues such as federal security regulations, EHR implementation, and the discovery that many of their highest-cost patients need care coordination outside their organizational walls, and physicians, who find what they've been offered in mobility support sorely lacking.

Nobody's accusing hospital IT staffs of standing still, Malkary says; 81 percent of the physicians surveyed said their organizations had implemented BYOD policies. But, with enterprises paying so much attention to the never-ending morass of EHR implementation, the rapid growth of mobile platforms as essential components of coordinated care is not receiving the attention it needs. As an example, he cites the statistic that, while large numbers of hospitals have invested in an integration platform such as Citrix or EHR-native applications such as Epic's Haiku and Canto, these offer dissatisfying user experiences.

"Ten percent of doctors are using their device with Citrix. They say it's such a god awful experience, 'Find me a desktop computer.'" Likewise, he cites Haiku and Canto's limited functionality as a "dislike" factor among physicians.

Nor does the way organizations approach data security on mobile devices garner much agreement between IT executives and physicians: while 41 percent of the physicians surveyed in the report said their organization had implemented a mobile device management solution, the idea that IT could wipe their device clean of their personal data struck a very unpopular chord.

"Hospital IT and the clinical staff absolutely hate each other," he says Perhaps hate is too strong a word, but the report certainly paints a picture of many incompatibilities and discouraging feedback loops: for example, while tight and intuitive EHR-device integration is essential, very few EHR vendors are working seriously on it.

Where to From Here?

There are a couple examples of a way forward, Malkary says. The first is to tackle the issue of nurses' devices. "If we can solve the problem with nursing, which is a more defined and contained problem, we have the same exact platform that can extend itself to the physician community as well," he says.

Another possible avenue of innovation in mobility strategy might be taking place in a sort of reverse way from the traditional provider-out way of thinking. The recent rise of platforms that combine coordinated care and engagement freely promotes the use of the patient's mobile device as a vital node, while care team members can remain hooked up via desktops, laptops, tablets. Many of these platforms, such as the recently announced remote diabetes care management partnership between Cerner and remote care startup Livongo, focus on a specific condition. Such specialization, Malkary says, will make mobility support across the relationship easier.

"The way we're going to address mobility is by addressing very specific workflows," he says. "This really bubbles up to the bigger issue of population health and care coordination. For example, diabetes clinics have very well defined workflow processes. Look at cardiac rehab, same thing. It's going to happen in specific workflows where we can address specific requirements. Things start to fall apart when you try to normalize across all care. Let's crawl before we walk.

"What I'm hearing from leading edge organizations is, they are trying to answer how to find a way to leverage the spirit of consumer-oriented tools, and put an enterprise wrapper around it. That's where we need to be."

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