The outlook for mobile apps in healthcare looks bright
mobihealthnews: "The market opportunity for mobile apps in the healthcare enterprise is currently $100 million, according to a recent report from Chilmark Research. Because of the rapid evolution of mobile devices, physician demand, and the healthcare enterprise’s need to improve quality and efficiencies, the market will climb to $1.7 billion in three years time, Chilmark Research predicts." - In case you missed it, that's billion, with a "b".
The article goes on to talk briefly about the lack of tie-in between clinical reference applications and enterprise information systems in healthcare. "The core focus of Chilmark’s latest report is on enterprise mHealth Apps that link into a healthcare enterprise’s HIS including EHR, CPOE, eRx, CDS and Charge Capture. Chilmark predicts that these types of apps will be “competitive differentiators” for healthcare enterprises who seek to not only meet meaningful use requirements and structure themselves for payment reform, but also to improve internal workflow for higher efficiency." I'm not sure what Chilmark has in mind as clinical reference material has long been available outside the enterprise without any problem. I'm not sure I see any dire need to integrate drug information references into healthcare information system. It's a different story however if we begin talking about clinical decision support (CDS), which is frequently limited to pharmacy information systems. Even with the increased interest in CDS, we still have a long way to go in developing these systems.
Some applications may not belong as part of an integrated solution in healthcare. Many pharmacy systems I've used during my career have had some form of drug information available within the application, but I've always preferred to go to external resources like Lexi-Comp or UpToDate. The information is often more complete or offers tidbits not found elsewhere.
With that said, the picture becomes somewhat blurry as we move away from legacy style desktop applications and begin using more cloud-based or web-based applications. As we move toward the web and away from the desktop, applications will become more component based. I don't think we'll see as much "integration" as we will "interoperability", in which case clinical information components within a healthcare information system would make sense.
I agree that the mobile space is the place to be. I'm just not sure that all mobile applications have to be integrated into enterprise systems.
Comments
Need to integrate DI in EHR
Jerry: I do see a dire need to integrate drug information in HIS and EHR. 80% of medication errors are due to lack of information. CDS can only do so much. Hyperlinks to drug information at the point of care can do a lot to inform providers. There is a standard for this called "InfoButton" that some have implemented. More need to. I have been wanting to do a podcast on InfoButton for a while. Have had it scheduled but day job issues have got in the way.
Imagine that every mention of a drug, diagnosis, lab value, genomic sequence in a EHR was hyper linked to information on those items in the context of the patients. For example in a 84yo kidney cancer patient the dose of the drug was linked to the dosing schema for that condition. This might eliminate a lot of decision support if the information was a click away.
DI in EHR not so much
Interesting point John. I'd like to know where you got the 80% stat for med errors though. Just because the drug information is only a click away won't ensure that anyone uses it. Have you ever been in an acute care pharmacy that doesn't have a truck load of drug information at the fingertips of every pharmacist? I haven't. And to take it one step further, many physicians have easy access to drug information, but chose not to use it. I've seen this over and over again. Now if you were to force the clinician to acknowledge the dosing for the 84yo renal cancer patient in your example, then I can see the value. If you're just relying on the end user to click on the information, then not so much.
In my opinion integration of drug information gives better access, but giving humans access to better information doesn't guarantee anything. In the scheme of things it just seems fairly insignificant. Of course it's just my opinion.
Gaps in Knowledge account for the 80%
I could conjure up a reference, but gaps in knowledge account for a great deal of errors. You have an excellent point of bringing a horse to water. They may not drink. Some will and some will not. We should at least give them the option. There are some decent articles by Jim Cimino (Columbia, now NLM) and Savario Malvigla (Partners) on InfoButton that show some of the utility of the concept. Check it out.