You may call it a quiet revolution. You may even call it a guerrilla insurrection. Whatever one may call it, nurses in large numbers are adopting the use of smartphones--often their own personal devices--at the point of care, whether their employer supports it or not.

This finding, among others, is a highlight of a new white paper from the Menlo Park, Calif.-based Spyglass Consulting Group. The report is what Spyglass Managing Director Gregg Malkary calls an outgrowth of a similar study performed in 2009. Malkary says the results demonstrate a definite change in attitude among nurses in the past five years.

"Without a doubt," he says. "Nurses are finally stepping up and saying, 'We are tired of being not counted. In fact, because you are not going to invest in us, we are going to take matters into our own hands and use our own personal devices.' That's the real shocker here. We only talk about doctors and BYOD. What about nurses?"

In fact, Malkary says, most hospitals have rejected a BYOD approach for staff nurses out of hand; one factor, he says, is the potential for administrators and nurses' unions to get tripped up over simple affordability of smartphones. But more than half the hospitals in the report, 51 percent, responded that they plan to either evaluate or invest in enterprise-class smartphone solutions over the next 18 months.

In the meantime, though, it appears nurses, dissatisfied with landlines and overhead paging, will increasingly use their personal devices--67 percent of hospitals reported their nurses used them--and 91 percent of hospitals said they were aware of this usage but did not have the time, tools, or resources to monitor such usage.

"I suspected nurses were using their devices," Malkary says. "I just didn't realize how widespread it was. And it's not just nurses, it's doctors as well. Nobody wants to use a secure text messaging app. They don't want to have to use two apps, they want one, and the prevailing attitude is that unsecured SMS is just fine. They know it's a violation, but it's more fluid, they know everyone else's smartphone number, and they can coordinate care. They're leveraging consumer grade tools to facilitate closed loop communication, and to support multidisciplinary care. Unfortunately, it's outside the firewall."

The "look the other way" approach does not have long to live, though, Malkary thinks. The HIPAA Omnibus ruling of 2013, he says, provides a strong incentive, such as million-dollar-plus fines per incident, to get mobile governance policies in order sooner rather than later. The good news, he says, is that both hardware and application vendors are stepping up to provide durable devices--he mentions the Motorola MC40 and Spectralink Pivot as examples--and secure software from vendors such as Voalte and Extension Healthcare.

"What do you need?" Malkary says about the basics hospital IT execs need to consider when evaluating smartphone needs. "You need integration with the PBX. You need secondary alarm and alert management, and by the way, it has to have FDA Class II 510(k) approval, and that is not a trivial fact. You also need to have secure text messaging and access to reference-based materials. And you potentially need to do be able to do BCMA, so you need an integrated bar code reader."

One positive trend the report notes is that wireless network infrastructure is nearly ubiquitous: 97 percent of responding hospitals reported the reliability and quality of their WLAN as good to excellent, up from 29 percent in 2009.

But, Malkary says, the hard work for healthcare CIOs is just beginning. They will have to meld the innovative concepts of the consumer mobile revolution with the stringent safety and security requirements of healthcare, and find how to satisfy the vastly different communications needs of vastly different constituencies, including doctors, nurses, and patients.

"It's a very complex problem, and the requirements will drive what technology you implement," he says. "At least, evaluate it today and then decide, because what we have today doesn't work."

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