Health Records and Security

The third level of the technology is the ability to deliver patient information from the EHR.

Evans stressed that, currently, only a limited amount of patient data can be pulled up using the iDevice applications. The patient viewer app can provide clinicians with demographic information about the patient, as well as allergies, medications and lab results. It cannot yet deliver progress notes or imaging results.

“This application was put together over six months of development,” Evans said. “We only had so much time to do this.”

Even with its limitations, the ability to access patient information is the biggest game-changer for clinicians, especially on-call physicians.

Previously, clinicians who were away from home after hours had little to no access to patient information.

“If you’ve gone home and are now out at dinner and get a call from the lab about a panic abnormal lab result, you were stuck,” Evans said. “You either had to interview the lab tech over the phone and talk them into looking things up in the EHR and then call the patient, or you had to end dinner early and run home so you can log in through your home computer.”

Now, the physician can simply step away from the table, look the patient data up on their iDevice and save themselves, the technician and the patient time and trouble.

The biggest challenge in providing this third level of usability has been security. Security lapses in the past, in which patient data stored on laptops and flash drives has been lost or stolen, has put a spotlight on VA’s handling of patients’ private information.

Because iPads and iPhones do not originate with the level of security required, the designers of the applications had to create of work-arounds.

“Security was one of the critical parts of the 2011 pilot,” Evans said. “A lot of the work we did on the front end was simply working through the security issues.”

The default four-digit passcode system was replaced with a more complex passcode requirement. The copy-and-paste function on the devices has been disabled, meaning that no personal health information can simply be cut and pasted to another document.

Also, some devices are programmed to lock down within a minute if not used, requiring the passcode to be re-input. A mobile device management software (MDMS) program VA will roll out in the near future will allow VA to track the location of devices in case they are stolen and remotely wipe out all data on them.

Most importantly, as far as security of data is concerned, no patient data is ever stored on the devices. Clinicians access patient data online and see it on the screen, but no data is saved to the devices’ hard drives.

“There’s always a balance when it comes to security and usability,” Evans said.

“You can lock down a device so much that the advantages you get from a handheld tablet become less pronounced. It required a lot of discussion between the end user and IT community, but at this point in time, we’ve reached what everyone feels is a secure way to go about things,” he said.

Targeting Physician Needs

VA already has distributed 200 devices, with an additional 100 expected to be sent to providers shortly. This September, VA also plans to distribute 1,000 iDevices as loans to family caregivers of veterans who have been wounded since September 11, 2011.  

The devices will allow family caregivers to track a veteran’s health, medications and support being provided.

Much more is planned for the provider-specific applications. “VA providers are used to having an award-winning comprehensive EHR at their disposal at any moment they please that has all the data that they’re interested in,” Evans said. “This is why it will be important for us to deliver a similar experience on the mobile side.”

Now that the building blocks of the basic applications are in place, designers are beginning to look at developing applications targeting specific physician needs. For example, if a physician is seeing a patient in the clinic who speaks Spanish, and the physician is not fluent, an application can be created, providing the medically-specific vocabulary necessary to communicate with that patient.

Another example is an application that can help physicians during influenza immunization campaigns. “You have to look up a patients’ information, register them for their flu shot, record the lot number of the vaccine, provide them a patient education handout and then document that in the EHR,” Evans said. “We can easily build a nice, tightly-integrated app that does much of that automatically.”

During the pilot process, the designers have been asking physicians what kind of apps they would like to see created. Several of the apps in development came directly from physician responses.

The contract for this next provider suite of apps will be awarded in August, with the apps expected to be delivered by August 2013.

“Meanwhile, we have internal development going on, as well,” Evans said. “VA is also producing apps that we will be rolling out. These are being developed with direct input from the front line of care, making sure that we continue to be an aggressively patient-focused system.”

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