Step into most healthcare facilities and you will notice that while community physicians are openly using their smartphones, employed clinicians are carrying voice-only phones, multiple pagers, or wearable voice-activated two-way communication devices provided by their employers. Hospitals report that 67% of nurses use their personal smartphones for clinical communications, while 89% of hospitals say they do not allow nurses to use them during their work shift (Spyglass Consulting Group, 2014). Although potentially in violation of their organizations’ policy, nurses and other employed clinicians use their personal devices to support their patient care activities in part because the communication equipment their hospital provides lacks the functionality, applications, and workflow support of a smartphone.
Updating an organization’s “bring your own device” or BYOD policy to include nurses and other employed clinical staff may seem like a natural solution for this situation, but it actually might expose the organization to increased operational costs, Health Information Portability and Accountability Act (HIPAA) violations, and patient safety risks. Allowing or requiring employed clinicians to use personal devices as part of their daily responsibilities also raises many security, privacy, and procedural challenges that must be considered.
However, healthcare organizations also cannot disregard the benefits of smartphones for clinical workflow, interprofessional communications, and patient safety. The capabilities and flexibility the technology offers are already preferred and used by clinicians in their personal lives because they facilitate effective communication. That unfortunately is missing in the work environment, where telephone tag is still a common occurrence between clinicians. Clinical communication strategies exist today that are an alternative to changing BYOD policy. These strategies can help organizations rethink clinical communications in light of today’s technology with the goal of deploying a single device strategy that leverages modern smartphone capabilities but eliminates the risk of employee ownership and usage.
BYOD Policies Pose Challenges
Smartphone use on the job is popular among non-employed clinicians, especially physicians. An estimated 80% of physicians are reportedly using their own device (Wolters Kluwer Health, 2013). Since most of those physicians are credentialed and have privileges at multiple hospitals, the use of a single, personal smartphone device is more efficient for their duties.
BYOD policies may vary for physicians and other non-employed clinicians because organizations have the greatest control over devices they own and distribute. Employed clinicians are usually restricted from using their personal smartphones at work. Regardless, clinicians still use their smartphones to text other care team members, access reference materials, even take and share photographs. Often, using their personal communications device is faster and more efficient than using devices provided to them by their employer.
Hospital CEOs, CNOs, and CIOs may not be aware, however, that expanding, updating, or adding a BYOD policy to include nurses and other employed clinicians may create more challenges and inefficiencies than it solves. Executive leaders need to consider the following questions before allowing clinicians to use their own smartphones for clinical communications:
- A recent survey of healthcare workers found that 39% did not password protect their smartphones (Cisco, 2013), so how will those devices be secured to protect the organization, such as with a numerical password or fingerprint reading capabilities?
- How will compliance be monitored and validated every time an employee buys a new phone?
- The same survey (Cisco, 2013) also found that 52% of workers used their devices on unsecured networks. So, how will the phone be protected from malware, viruses etc. once the employee leaves work so that the organization’s network remains safe?
- What happens when a device is lost or stolen? If the smartphone is wiped remotely of all its data, or “bricked,” then potentially both the employer’s and employee’s data will be lost. How will the employee feel about losing all their personal photos, phone numbers, and music?
- How and when will device surfaces be disinfected at work and at home?
- If the employee-owned phone is damaged at work, will the organization be responsible for replacing it?
- If employees use their personal phones, will they expect reimbursement of cost?
- What if an employee chooses not to purchase a smartphone? Could requiring staff to obtain a smartphone become a union issue?
- Could inequity in communication options among employees cause morale issues, discrimination concerns, or physician and patient satisfaction issues?
By creating a BYOD policy for employed clinicians, the hospital in effect may become the default technical support center for all the different devices of varying ages, capabilities, and potentially conflicting apps and operating system platforms such as Android, iOS, BlackBerry, and even pre-smartphone devices that can send text messages and shoot photos. They may also become responsible for all the clinicians’ personal data on these devices, potentially making them liable for personal data loss or privacy breach.
Smartphone Technology Offers Advantages
Faced with the IT challenge of supporting multiple devices, hospitals may be inclined to simply disregard the idea of smartphone technology for their employed staff. This strategy, however, may not be in the best interest of the organization because many hospitals are desperately in need of modernizing clinical communication.
For example, consider the types of clinical communication equipment and methods their employed clinicians use currently: pagers, Voice Over Internet Protocol (VoIP) phones, and overhead intercom systems. In fact, some facilities still use two-way radios as the primary method of communication.
Electronic health record (EHR) systems, while helpful in managing clinical data, are not convenient tools for alerting clinicians about new, discontinued, or changed orders, overdue tasks, or any other cognitive workload support notifications. Clinicians do not spend their days in front of a computer, so reminders or alerts tied to the computer go unobserved until the next time the clinician logs on to that patient or views a status board, if one is available.
EHRs and all of these legacy communication devices—each with its own demands on clinicians’ time and attention—contribute to clinicians’ cognitive workload, which is already overburdened (Ebright, 2010). And workload is not alleviated by many current health IT tools. In fact, a report published by the Agency for Healthcare Research and Quality (2010) concluded that “the impact of health IT on quality and safety shows mixed results,” primarily due to “a lack of integration of health IT into clinical workflow in a way that supports the cognitive work of the clinician and the workflows among organizations.” Too many devices simply create more distractions, increasing patient safety risks and decreasing the time and attention devoted to patients, impacting their experience.
Moreover, these legacy communication devices are often highly limited in functionality and incapable of taking advantage of the workflow efficiency opportunities presented by smartphone technology.
Updated Clinical Communications Technology
Rather than trying to manage hundreds of personal devices, hospital leaders could instead consider implementing a smartphone device that the organization owns and controls. More importantly, these devices can operate with software and integrated point-of-care tools designed to fit the clinician’s workflow. A single, properly equipped smartphone device can, for example, be used for:
- Phone calls and voice messages through a VoIP platform
- Secure text messaging to any device, including physician smartphones, that supports organizational HIPAA compliance policies
- Intelligent alerts and notifications that are muted when the nurse should not be interrupted
- Provisioning policy and procedures manuals, drug reference, and other applications that can assist clinicians, including medical calculators and translation software to better communicate with patients and families
Taking it one step further, today’s smartphones, with the right applications can enable:
- Vital signs, I&O, medications, pain scores, and other flow sheet documentation
- Barcoded medication administration and specimen collection
Furthermore, these devices can operate over the hospital’s secure Wi-Fi network where all data is stored only on the organization’s servers, so if the device were stolen or misplaced, it would be useless outside the facility and would contain no protected health information.
Asynchronous texting is more workflow friendly than traditional telephone tag. It is critical to provide secure, encrypted texting to support the clinician’s workflow. Software exists for smartphones that provides relevant patient and clinical information via secure text messages, which is not feasible with many current communications devices in use today. Adding automatic patient tagging and clinical context takes basic texting to the next level of patient safety by decreasing the risk of wrong patient communication.
Smartphones have recently been found to be carriers of numerous harmful bacteria (Porter, 2012). Smartphone devices, however, can be disinfected with UV light systems or, if medical grade, common hospital cleaners without worry of structural damage, which is a concern with personal devices.
Intuitive smartphone design and familiar communications features that clinicians recognize from their personal devices minimize training time and further encourage employee adoption. Eliminating the need to carry multiple devices is also appealing to staff.
Consolidating clinical communications to a single mobile device that is easily accessible reduces the clinician’s cognitive workload by eliminating competing devices and providing immediate notification of updates in the EHR.
More than a Policy Update
While updating a BYOD policy to include employed clinicians seems simple, the ramifications of expanded permission are labor-intensive and expensive. Supporting the personal-device technical needs for hundreds, if not thousands, of employees could be a significant challenge given the wide variability of smartphone devices and user-added personal software.
Hospitals are already spending thousands of dollars per year maintaining and replacing multiple legacy devices that deliver basic communication functions but are incapable of improving the clinical workflow. Over the long term, updating clinical communications technology with a single device and smartphone strategy for employed staff will likely deliver greater ROI than allowing them to use personal devices and trying to manage all the associated challenges and risks.
Above all, a smartphone-based clinical communications device supports improved patient care by allowing clinicians to remain mobile. Not only would the organization improve workflow efficiency and information exchange between clinicians, it would also allow them to devote more attention to patients, who should be at the heart of every communication exchange.
References:Agency for Healthcare Research and Quality. (2010 October). Incorporating health information technology into workflow redesign. Summary report. AHRQ Publication No. 10-0098-EF. Cisco partner firms. (2013 March). BYOD insights 2013: A Cisco partner network study. Ebright, P., (2010, January 31). The complex work of RNs: Implications for healthy work environments. OJIN: The Online Journal of Issues in Nursing, 15(1), Manuscript 4. Porter, C. (2012, October 12). Calling all germs. The Wall Street Journal. Spyglass Consulting Group. (2014 March). Healthcare without bounds: Point of care communications for nursing 2014. Wolters Kluwer Health. (n.d.). Wolters Kluwer Health 2013 physician outlook survey.