Not Just Another App: Managing Mobility at UPMC

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Rasu Shrestha, MD, MBAThe thought of health IT leaders managing the mobility trend conjures up images of Heracles attempting to slay the multiheaded Hydra. Every time he cut off one head, two more grew in its place: Think iOS®, Android®, Symbian®, BlackBerry®, Windows®, and bada®, with Mango and other mobile platforms in the wings.

Accommodating network users’ mobile devices of choice while protecting personally identifiable information is a challenge, according to Rasu Shrestha, MD, MBA. In addition to his role as medical director of digital imaging informatics across the University of Pittsburgh Medical Center (UPMC) enterprise of 20 hospitals and 30 imaging centers, the board-certified radiologist also is responsible for interoperability and emerging technologies, as enterprise vice president for medical information technologies.

“On the mobility side, our strategy toward embracing what’s out there on the mobile platforms is an evolving one,” he acknowledges. “I’d be wrong if I said that it’s solid and complete, and we’re at the finish line. We are very much at the start, but we’ve made some good strides.”

As he embarks on the mobility journey at UPMC, Shrestha is taking a stepwise approach to rolling out new applications with zero footprints and thin clients, working closely with vendors, and focusing on leveraging the form factor to improve patient care (while staying one step ahead of enterprise users).

Multiple Experiments Underway

Shrestha is both optimistic about the potential of mobile devices to improve patient care and cognizant of the potential threat to security. Currently, a limited subset of users can access a zero-client advanced visualization tool on an iPad® or another mobile device. Another set of imaging users can access UPMC’s electronic record systems through the health system’s Citrix® (Fort Lauderdale, Florida) environment.

Yet another experiment underway involves the use of a remote-access receiver through Citrix; it addresses some of the security issues inherent in accessing the UPMC network through a non-UPMC network, whether from home or a mobile device.

“This receiver also addresses some of the concerns around how to access what you need from any platform, not just a Windows-based platform,” Shrestha notes. “Up to now, most of what has happened in health care has been very much Windows focused. This allows for much wider access through Mac platforms, iOS, Android, and others.”

Several other mobile tools are already in use at UPMC: a tool for emergency-department discrepancy communications, preliminary report distribution through various Web-based means, and a contextual paging application (developed within the UPMC Technology Development Center) that taps into the institution’s longitudinal care record.

In the radiology environment, if there is a critical finding, such as pneumothorax, an urgent communication can be sent directly to a smartphone. “The user will get not just information about the key finding in the radiology environment, but also a snapshot of the image and relevant clinical contextual information about the patient and his or her disease process,” Shrestha explains.

A Life of Its Own

Shrestha is well aware that if he does not move quickly enough to accommodate the mobility needs of his system users, they will find their own work-arounds. Demand for mobility in the health-care environment is very much consumer driven. “Part of the reason we see so much penetration, with a device like the iPad, is there was so much pent-up demand,” he notes. “We’ve been talking about a tablet—and the use of a device that has a bigger screen, that’s a little bit smarter, and that’s more connected, so that it is usable on the go—for such a long time that when the iPad finally came out, the pent-up demand suddenly exploded.”

Coupled with the familiarity of physicians with the tablet form factor, that pent-up demand resulted in widespread adoption of a device that initially was used to access email because there were few health-care applications. “Residents, fellows, and other physicians were coming in and saying, ‘Hey, I already use my mobile device for all these things outside of health care; why can’t I use it for this?’” Shrestha says. “There is this huge push coming in from outside our imaging world.”

What has been a boon for Apple (Cupertino, California), however, has been a major headache for those individuals responsible for security in a health-care enterprise. “The biggest success that