116 3rd St SE
Cedar Rapids, Iowa 52401
Frustrated with a teenage transplant patient who wouldn't take his medication, University of Iowa Hospitals and Clinics physician Patrick Brophy came home one evening and vented to his son.
“What's wrong with you guys?” Brophy asked his 15-year-old, explaining his irritation with the adolescent patient whose failure to medicate caused his body to reject a kidney.
Mike Brophy smiled at his dad and suggested he create some kind of medication application.
“You should put it on Facebook,” the teen said. And so that's what they did.
Working with his son, Patrick Brophy developed a web and Facebook application called Iowa MedMinder that is customized to each patient. The application, which is secure and approved by the state's Institution Review Board, creates a box listing all a person's medications that pops up on Facebook and asks the user to check off those that he or she has taken.
The information is relayed back to the physician via the application, which also can send emails and text messages and can be viewed on any platform - mobile phones, tablets, laptops and desktops.
“The goal is to incorporate it into your normal life,” said Brophy, director of the UIHC's Division of Pediatric Nephrology, Dialysis and Transplantation. “That's the point of all mobile health care. It has to be part of your health. Not your health care.”
Brophy's application is just one example of how mobile technology is changing the nature of health care in Eastern Iowa. Physicians now can access patient medical records anywhere via smartphone. Patients can check test results and upcoming appointments on their mobile devices.
Doctors can show patients their charts on tablets. And medical professionals are starting to communicate and make assessments using video chat programs on mobile technology.
Brophy said mobility marks the future of health care from his view.
“People want locality and convenience, and they want to be in control of their own health,” he said. “I want the ability to sit in my office and text my provider or Skype or Facetime them and have a brief conversation and get things done in a hurry.”
A lot of the medical issues these days involve chronic diseases rather than acute care, Brophy said, meaning patients need to receive treatment in their everyday life.
“Chronic disease belongs in the community, and we have to deal with it there,” he said. “We have to make sure we have a convenient way that patients are enticed to do it and reminded to do it as part of their daily living.”
Most of the major hospitals in the Cedar Rapids-Iowa City area have been allowing doctors to access patient records electronically on mobile devices for years. But, as technology advances and more devices emerge, facilities are rolling out new mobile tools and more physicians are getting on board.
Mercy Medical Center in Cedar Rapids, for example, is in the process of going live with a new electronic medical records provider - Epic Systems - that will allow doctors and patients to access health information remotely in a variety of ways.
A new Epic application, among other things, will enable doctors to make a note in a patient's record or electronically prescribe medicine from anywhere. Mercy's clinics went live with the new system Friday, as did patient access to electronic records using the new system.
Mercy's downtown-based hospital will go live June 1 and, even though some doctors have been accessing records remotely using the old system, many more are expected to get on board now, said Jeff Cash, senior vice president and chief information officer at Mercy.
“I think the number is going to grow dramatically with Epic,” Cash said.
Some of the mobile systems being used by hospitals allow records to be stored on the device. Others have made sure no patient information can be kept on a physician's cellphone or tablet. National studies have shown patient concerns when it comes to the privacy of their records being accessed by physicians on personal devices.
But, locally, no hospitals have reported patient concerns or complaints. And Cash said Mercy is willing to store patient information on physician devices because of the security involved.
The data is stored in an encrypted container that requires two passwords to access. If a physician loses the device, the container can be accessed from another computer and deleted off the mobile technology, Cash said.
The UIHC, which uses a system that keeps data stored within a mobile application on physician devices, is planning an upgrade that will allow doctors to view and make changes to medical records from anywhere, said Douglas Van Daele, chief medical information officer for the UIHC. Currently, physicians are working with a view-only system, but that should change come April.
“Looking at something is great, but you want to do something about it,” Van Daele said. “We will be doing an upgrade soon that will come with better capabilities so they can e-prescribe and do things like dictate a note.”
Mercy Iowa City also currently allows doctors to view medical records online via a web-based application without making changes to medical records.
“But we are moving in that direction,” said Paul Foelsch, vice president of information systems and chief information officer with Mercy Iowa City. “Once a clinician gets access, and they start to see some of the information, they want to see more.”
Area hospitals are interested in technology being developed that would allow doctors to view pictures like radiology images - not just lab reports - on mobile devices. But Foelsch said the technology isn't quite ready.
“The images, which are large picture files, are problematic on a small screen,” he said.
Still, the technology that is available to physicians these days is vastly improving the convenience and speed of patient care, said Dustin Arnold, St. Luke's chief medical information officer.
“I've been able to direct patient care from out of state,” Arnold said. “It's a real luxury.”
The ways mobile technology is changing health care is not limited to remote access of records for physicians and patients. It's improving communication and record-keeping within hospitals as well.
Consider Joanna Layrock and her 2-year-old son, Sawyer. Layrock brought her toddler to Mercy in Cedar Rapids on Wednesday because he was struggling to breathe. A chest X-ray showed pneumonia, and Sawyer was admitted.
Physicians who visited the child throughout the day checked his records on tablets they carried. Nurses and doctors shared medical records with his mom using mobile screens on wheels - referred to as Workstations on Wheels.
The mobile workstation that visited Sawyer on Wednesday was dressed up like a cheetah.
“Do you like the ears?” a nurse asked the boy, who nodded and mumbled something under his pacifier.
Layrock said she loves the new, easy-to-view devices, and appreciates the fast access that both she and physicians have and will continue to have more of in the future.
“I think it's awesome,” she said, adding that she's excited to start accessing medical records for both her sons remotely. “I have two who are hospitalized regularly, so it will be great to be able to keep them straight.”
Cash, the hospital's CIO, said patients like to see their charts on the easy-to-read screens.
“They feel more comfortable when they can see it,” he said.
That's why Mercy bought more than 300 of the mobile stations to be rolled out in the next few weeks. The hospital also is launching several new pilot programs that employ mobile technology, including one in which hospital psychiatric counselors analyze emergency room patients from home.
Right now, when a person needs to be evaluated, ER officials page psychiatric counsel to come to the hospital. That means waiting for patients, Cash said. The new system, set to debut at the end of March, will employ tablets and video-chat programs so counselors can stay off site to evaluate patients.
“This will replace the need for that face-to-face, and in many cases give them faster treatment,” Cash said. “We are really excited about it.”
Some ambulance services also are now taking electrocardiogram readings and transmitting them using mobile technology to emergency rooms while en route, Cash said.
Scott Whitson, program manager of physician information technology services at St. Luke's, said the hospital is trying to move everything remote as long as it makes sense. This includes a secure messaging system for physicians within the hospital and remote conferencing.
The goal, eventually, is to make it possible to review things like heart readings, X-rays and fetal monitoring remotely, Whitson said.
Van Daele, with the UIHC, said the Iowa City-based hospital is rolling out a new use for mobile devices that will replace pagers. The devices don't have cellular capabilities but instead employ the Internet to allow doctors to communicate with nurses, receive alerts and monitor patients.
“They carry these as separate devices from their cellphones,” he said. “It's been tremendously beneficial in the hospital.”
Right now, the devices can only be used within the hospital's walls, but the vendor is working on getting the technology onto physician cellphones, Van Daele said.
“These smartphones become more and more powerful as computer devices,” he said. “And as this happens, they will become more and more commonplace.”