Mobile Devices Make EHR Functionality More Portable for VA Clinicians

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By Stephen Spotswood

WASHINGTON — The past few years have seen a revolution in personal technology. Smartphones and tablet computers have made all the functions of the personal computer and the Internet completely portable and far more convenient.

With a new program that began at the Washington DC VA Medical Center (DCVAMC) and is rolling out across the VA system, VA hopes to adapt this technology to bring that same convenience and portability to the interactions between care providers and veterans. The VA Mobile Health Clinician pilot program, begun in January 2011 and funded as part of VA’s Innovation Initiative (VAi2), was created as a way to deliver information from VA’s electronic health record (EHR) to mobile devices in a way that would meet government security specifications.

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“We’d put out the competition, because we knew there was high penetration of tablets and smartphones in the physician population. We know this is the future,” said Neil Evans, MD, associate chief of staff for informatics and co-chief for primary care at DCVAMC.

The contract was awarded to Agliex, a Chantilly , VA-based company known for providing technology solutions to federal agencies. Working with VA clinicians beginning in January 2011, Agliex created applications for the phone and iPad that could deliver data from the EHR to the device.

The application was completed by July 2011, and 15 iPhones and iPads were deployed at DCVAMC to physicians and nurses working across the full spectrum of care. Some had considerable experience with such technology, while some had none. Either way, the impact of the technology on their day-to-day jobs was dramatic.

“Some of it was very simple,” said Evans, who was the lead clinician providing input on the project. “They were connected to their internal VA mail in a secure way. That, in and of itself, caused all kinds of excitement. That was possible before on a Blackberry, but, for most front-line clinicians, they typically have not been folks who are approved for a Blackberry.”

That email capability and the ability to take notes on the device were what Evans referred to as “first-level” applications. The second level involved medical-specific applications. These included a clinical calculator, with which physicians could plug in patient data to help calculate measures such as body mass index. Another was an application called VisualDX, which provides clinicians a library of medical images for consultation.

For example, if a patient presents with a rash, clinicians can open up the application on their iPad and, with the patient, go through pictures of rashes caused by various conditions.

“This can help develop a differential diagnosis, and the clinician can better refer a patient to dermatology,” Evans explained.

During the pilot, Evans and his colleagues also found the devices to be very useful in patient education. Using the iPad, they can call up detailed images of anatomy and walk patients through disease processes or explain what they will be doing in an upcoming surgery.

“We found it easier during inpatient rounds to walk into a patient’s room with an iPad in our hands and show them a very visual representation of what is happening to them healthwise, as opposed to wheeling in a laptop strapped to a cart,” Evans said.

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