Imaging Mobility and the IT Department: Advantages and Challenges

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Freddie AdornoThe clinical advantages of mobile access to images and reports are just one side of the story, according to Freddie Adorno, enterprise imaging informatics manager at Nyack Hospital, Nyack, New York. Adorno has managed the hospital’s beta testing of a new mobile viewer for its enterprise imaging platform that is device- and browser-agnostic, making it accessible on tablets and smart phones as well as traditional desktops. “The benefits it offers are significant for me as an administrator and for the IT team here at Nyack,” Adorno says. The primary advantage of a mobile, web-based viewer, from the IT perspective, is flexibility, Adorno explains. “We now have the ability to roll things out much more efficiently,” he notes. “In the past, we had to visit each of the workstations and physically update the software, or do it remotely, which took some time and effort on our part.” With a web-based viewer, on the other hand, the department can take advantage of its centralized server updates: “We push out the software changes to the web servers, and once the user’s device connects, the changes are applied immediately and automatically.” Device Ownership While being able to update users’ viewing software in such an unobtrusive manner is a big advantage, it highlights one of the most critical, emerging questions when it comes to clinicians and mobility: What is the best approach to device ownership? “The bring-your-own-device movement has quite a bit of momentum right now,” Adorno says, adding that at Nyack, the mobile devices in use are a mix of hospital- and physician-owned. “It raises a lot of questions about whose responsibility it is to manage these devices.” For instance, he says, when devices are physician-owned, they are potentially vulnerable to third-party applications; hospital-owned devices, on the other hand, can be managed by the IT department to ensure that no inappropriate or potentially vulnerable applications are downloaded, and that applications are compatible with one another. “From a management perspective, it’s really important to be able to control what applications are on the devices,” Adorno notes. “When devices are hospital-owned, they can control the applications’ content and accessibility, which gives them better control over the management and health of the devices.” In addition, when devices are hospital-managed, they can be encrypted, tracked, monitored, and remotely disabled from accessing resources—all functions that are helpful in preventing security breaches. Even with a web-based viewer that makes no information resident on a device, a thief could potentially steal a device before the viewer session timed out, Adorno notes. “You want these safeguards in place so that no patient data are compromised in the event of theft, or if the device is misplaced,” he says. At Nyack, the IT team is in the process of incorporating a mobile device management solution into its suite of applications to address this concern. Wireless and Touch-screen Access While mobile access is convenient, it also raises the question of how much bandwidth is needed for an application to run efficiently, without sacrificing the end user experience. This holds true for mobile access to a data-intensive application like a PACS viewer, Adorno notes. “With a mobile viewer, you really need optimal performance from you wireless provider,” he says. “Current 3G or even 4G connectivity won’t really give you optimal performance.” To address resource utilization issues both within and outside of the hospital, Adorno and team have added redundancy to their infrastructure. “When you have a significant number of users trying to access the same resources, you will see a decrease in performance due to the high demand,” he explains. “In addition to redundancy, you have to have IT measures in place that will load-balance your throughput and usage, so that if one resource is being heavily taxed, the system can efficiently divert users to another resource.” Adorno adds that applications may play differently within different mobile interfaces. “Planning and preparation for any contingency is key, and the best way to approach that is to think about what the right device is for the task,” he says. For instance, a legacy application that was programmed for a keyboard and mouse may be awkward to use on a touch-screen device. “Some hospitals use a virtual desktop infrastructure to access their EMRs,” he says by way of example. “The challenge is that when you are using a virtual application to access your EMR, you may need to adapt your workflow.” For that reason, Adorno advises, “Make sure to set aside enough time to evaluate the major devices—you may be surprised which one fits the needs of your organization best.” Even with those caveats, however, Adorno is enthused about the future of clinical applications on mobile devices. “Our physicians are now empowered with the patient’s health record, images and reports literally at their fingertips,” he says. “By giving physicians access to data on mobile devices, we are able to improve the delivery of care dramatically and also allow the patient to be an active participant in the care process. The possibilities created by mobility in health care are quite remarkable. These innovations, along with many others, make it a very exciting time to be a part of the health care IT community.” Cat Vasko is editor of HealthIT Executive Forum.