Clinicians have long been disappointed at the quality of healthcare software, writes Justin Yeung, dual-qualified plastic surgeon and clinical implementation director at Canadian startup, ShareSmart, and Drea Burbank, a consultant for disruptive technology in medicine and medical technology and adviser at ShareSmart. What are the dangers of unsecured communications technologies and how can dedicated tools boost staff efficiency and enhance processes?
In a 2016 survey by Deloitte, 70 per cent of physicians thought their electronic health record (EHR) reduced productivity, 75 per cent thought it was a net financial loss, and satisfaction is shown to be decreasing over time. To quote a 2014 article:
"No other industry, to our knowledge, has been under a universal mandate to adopt a new technology before its effects are fully understood and before the technology has reached a level of usability that is acceptable to its core user."
But the truth is that hospital systems are commissioned and built at the enterprise level, with little-to-no incentive to create good software. Enterprise clinical systems benefit from reduced interoperability allowing them to retain market share. Enterprise clinical systems are commissioned by hospital administrators and often fail to perform usability testing with clinicians and are built to constantly out-of-date legal requirements, which means they often fall behind the standards of more competitive markets. As a 2015 National Health Service (NHS) panel concluded, the "digital revolution has largely bypassed the NHS."
However, physicians also use consumer-technology such as smartphones, gaming interfaces, and cloud-based platforms. As these systems evolve, physicians are beginning to quietly rebel.
The UK panel reported:
"Many records are insecure, paper-based systems which are unwieldy and difficult to use. Seeing the difference that technology makes in their own lives, clinicians are already manufacturing their own technical fixes.
"They may use Snapchat to send scans from one clinician to another or camera apps to record particular details of patient information in a convenient format.
"It is difficult to criticise these individuals, given that this makes their job possible. However, this is clearly an insecure, risky, and non-auditable way of operating, and cannot continue."
As most clinicians know, working groups frequently text patient details and clinical photos to each other to facilitate care interactions. In the U.S., a 2012 online survey conducted at the well-respected UC Davis medical centre privately recorded that 88 per cent of residents and 71 per cent of attending surgeons texted residents for patient-related care. In the UK, the aforementioned 2015 NHS survey reported 63 per cent of doctors admitted texting patient information, and 46 per cent sent photos or X-rays to colleagues.
Physicians still give lip-service to privacy regulations, 55 per cent of physicians say they are worried about cyberattacks, and 87 per cent of physicians claim their practice is HIPAA-compliant. However, only 60 per cent of physicians are confident they know what HIPAA-compliance requires.
As one of the most common security breaches in healthcare is stolen mobile phones, and 83 per cent of physicians use mobile phones, texting patient info is a non-trivial issue in clinical data security.
Given that this behaviour is not likely to cease we need to facilitate it in more functional ways. As Harvard scientists proposed in 2011, the most efficient way to improve medical software is to enable cloud-based clinical apps to run over existing legacy databases. This allows competitive app development cycles (i.e. iterative “agile development” vs. top-down “waterfall development”) while retaining legacy security infrastructure which most app developers are little inclined to replicate.
In Canada, we have taken the time to obtain clinical approval and legacy buy-in from hospital administrators for ShareSmart, a secure messaging app. This enables clinicians to have the utility of smartphone messaging and cloud-based photo sharing, without the potential security leaks. With this approach, it is now the gold standard for smartphone communication in Canada.
Clinicians report increasing multidisciplinary collaboration and efficiency of care and hospital administrators have reported cost savings from avoiding data breach fines.
This app is easily adapted to the UK where doctors using WhatsApp can continue to use the functions of their smartphones, but protect themselves and their patients, while keeping dual personal and work communication streams on their mobile phones.
We believe in empowering clinicians to advocate for better software. If clinical texting is a positive evolution, increases physician satisfaction and physician productivity, then forward-thinking administrators will seek to enable it with secure applications and EMR integration rather than attempting to suppress it.