BizTechReports, an independent research and reporting agency, found 74% of HIT decision makers feel that consumer-grade tablets present challenges for entering data into healthcare applications. Furthermore 58% of survey respondents agree that enterprise applications, like EHR management, are not designed for consumer-grade devices, like the iPad.

Results from the study have been published in the white paper “Diagnosis Danger: Governance & Security Issues Cause IT Concerns About iPad in Healthcare Setting*.” The report focuses on media tablets – specifically the iPad’s adoption in healthcare, and is based on a national survey of healthcare IT executives.

Healthcare IT reporter and blogger, Anne Zieger recently shared concerns about the iPad’s security vulnerabilities, in a recent post entitled, “Apple Security Issues Linger, Raising iPad, iPhone Concerns For Hospitals.” For example the mobile Safari browser used on most iPads, is infamous for security flaws. Zieger references a report from NSS Labs that found while Explorer 9 blocked 100% of malicious URLs, with Application-based filtering enabled, Safari 5 blocked just 13%.

According to the BizTechReports white paper, reliability and durability proved to be a major point of concern for HIT decision makers as well. 94% of participants feel that device durability and “ruggedness” are important requirements in hospital and clinical settings. After all, because of the highly mobile and occasionally chaotic nature of healthcare, the likelihood of a mobile device falling, being dropped or spilled upon is high. Consumer grade technologies are simply not designed to operate reliably in such a demanding setting.

The full white paper is now available for a free download on the Panasonic website.

Are you interested in using this new generation of tablets in healthcare? If so, let us know where you see the opportunities and obstacles.

* Diagnosis Danger: Governance & Security Issues Cause IT Concerns About iPad in Healthcare Setting was commissioned by Panasonic

Variety Care had previously been using commercial grade tablets that were not specifically designed for the demands of a healthcare environment; these tablets experienced breaks and failures which resulted in clinician downtime. Manager of Information Systems, Carl Flippin wanted to enhance the facility’s workflow with mobile devices that were durable, portable, lightweight, reliable and had wireless capabilities.

Flippin met with DataSource Mobility, a value added IT reseller with an expertise is mobile technology, to discuss the criteria for Variety Care’s next mobile computing solution. After research and evaluation, the Panasonic Toughbook T8 computers proved to be the ultimate solution.

Since deployment, Variety Care’s workflow has become more efficient. Doctors now have the flexibility to complete charting with a secure VPN when they leave the office.

“Because the Toughbook computers are durable and have great wireless connectivity, the doctors can seamlessly and efficiently move through patient charts, see patients quickly and transmit data immediately. It helps us better serve more patients and our community,” said Flippin.

Click here to download the full Variety Care Community Health Center story from the DataSource Mobility website.

To learn more about the value of Panasonic Toughbook mobile computers in healthcare, visit the Panasonic website.

In 2009, a new virulent form of influenza swept the world, reaching Japan in the spring, and prompting the rapid formulation of emergency measures by the government. At Tokai Municipal Hospital, a means of coping with the anticipated pandemic was set up by creating the super-flu Outpatients Clinic. The Toughbook H1 Health Mobile Clinical Assistant was introduced in the main hospital as part of integrated measures to fight a possible super-flu pandemic and prevent any outbreak of influenza from spreading. The H1 was selected, in part, because it was designed to be sanitized.

“Because it can be so easily disinfected, we chose the H1 as the best terminal for use when dealing with super-flu outpatients,” said Mr. Atsuhito Yamada, Radiological Technologist and Health Information Technologist Medical Professions Division, Head of IT Promotion Group Medical Information Section. “The body doesn’t have any projections or recesses; you can wipe it with alcohol.”

Beyond ease of sanitization, the Toughbook H1 offered benefits that made it an ideal fit for Tokai Municipal. The hospital found that the device’s durability, coupled with excellent connectivity and integrated features like a camera and barcode scanner, resulted in increased productivity for its clinical staff.

Click here for the full Tokai Municipal Hospital case study.  Additional information regarding Toughbook computers in healthcare can be found here.

HIPAA legislation has been in place for some time now, however, recent developments from the American Recovery and Reinvestment Act (ARRA) of 2009 are forcing many in the healthcare industry to re-evaluate their compliance to HIPAA regulations. Included in this legislation was the Health Information Technology for Economic and Clinical Health Act, or HITECH Act. Its major goal is to advance the use of health information technology (HIT).  A key provision of the HITECH is the move to digital health records – i.e. Electronic Health Records (EHR) and Electronic Medical Records (EMR). These changes require new ways of doing business and create new challenges for protecting the privacy and security of digital information.

Another element of HIPAA legislation is the applicability to both large and small providers. The Department of Health and Human Services (HHS) has stipulated that any loss of unprotected personal health information (PHI) must be reported. Plus if the number of lost records is above 500 individuals, then it must be publically reported. An annual study conducted by the Ponemon Institute found the average compromised record results in $144—$204 of indirect costs and $60 of direct costs. As a result, information systems being converted to digital format should review HIPAA regulations and determine four things:
1) Where will PHI be stored and accessed?
2) How will the information be protected when it is either stored or exchanged?
3) Who has authorized access to the information?
4) How will the paper records be handled (HIPAA has regulations concerning the disposal of PHI)?

The proliferation of mobile devices and storage options has tremendously compounded the problem of tracking the location of electronic personal health information (ePHI).  A recent study by the Health Information Trust Alliance (HITRUST) analyzed 108 reported breaches affecting over 4 million individuals and health records. The analysis found that 77%, or over 3 million records, were due to loss or theft of laptops or removable media. Add this to the diverse physical locations where information can be stored (e.g. teleworker) and data security becomes a significant challenge to any IT department.

The HITECH act set clear guidelines regarding the protection that must be afforded to stored data. HITECH specifies that if government recommendations for data encryption (NIST SP800-111) are met, then the ePHI has been “rendered unusable, unreadable, or indecipherable to unauthorized individuals”. As such, the risk to the individuals is low and a reportable breach has not occurred.

Failure to protect ePHI will result in fines and the requirement to notify and provide ID theft protection for all impacted individuals. As mentioned earlier, if the number of unprotected lost records exceeds 500, then public media must be notified of the breach. Not only does this incur a lot of expense, but requires a significantly amount of effort. The Ponemon study found that the average time the 65 surveyed organizations IT departments took to fully resolve a single security breach was 161 days.

With these types of challenges, what solutions are available to combat the threats? One of the simplest solutions is to stop the usage of certain devices, e.g USB Flash drives or other removable media. Software solutions exists, called Data Leakage Prevention (DLP), which prevent information from being transferred to removable storage. Locking the data to a single physical location can hamper a user’s workflow so much that the impact to productivity may not justify the approach. It can also lead to the creation of “special users” that are allowed to use removable mobile devices which ultimately defeats the intent.

A second approach is to remove the data from the endpoint device. This can be done by using a virtualized infrastructure approach. In this type of solution the application is executed on a central server and the endpoint simply provides a user interface. These solutions are ideal if the application can be run in a virtualized environment and the endpoint client does not leave any data remnants on the device. Unfortunately, in some cases only a small number of applications can be run in a virtualization mode, which is not the ideal solution for many healthcare facilities. A second challenge for this type of solution is the need for a network connection to the server, which may be difficult in some usage scenarios.

Finally there is endpoint encryption. As mentioned earlier, NIST SP800-111 specifies the configurations to be used. For example if the endpoint is a laptop that will be taken off premise, then full disk encryption with pre-boot authentication is recommended. This will ensure that all the data on the disk is protected. If this is coupled with a central policy and logging server, then a consistent security model can easily be established. Plus by having a centralized logging capability, a report can be generated on any lost or stolen device. The report will show the protection status on the device prior to its loss. This will meet the HITECH requirements for secured ePHI.

Once the data has been protected it must be integrated into an authentication solution. In many organizations this will translate into a centrally managed domain. Any protection solution, virtual or client will need to integrate into this existing infrastructure. Furthermore, in many cases the ePHI will need to be shared, one of the drivers behind digitization. When looking at any solution it is important to ensure that there is the capability to limit access to a preselected group. If not, this can lead to either sharing unprotected information or password sharing. Neither is an acceptable outcome.

One final point regarding implementation challenges. Although not overly covered in HITECH, HIPAA does have some clear mandates regarding the storage and disposal of paper records. So as information is converted from paper records to EHR/EMR, care must be taken regarding the disposal of the paper records.

Due to the ARRA legislation, Healthcare IT organizations are in a unique and difficult position. On one side there are considerable incentives to move to digital information systems. On the other, there are now considerable risks if the information is exposed. As healthcare organizations move forward to take advantage of the financial incentives that HITECH provides, these efforts must include a review of current information protection measures that are in place. The financial gains that are made from deploying an EHR/EMR system could easily be cancelled out by a single data breach.

How does Mobile Armor address these challenges?

Mobile Armor provides a wide range of data protection and encryption solutions for securing electronic and mobile data. The Mobile Armor Data Protection Suite™ protects information and enforces policies throughout an organization. With pre-boot authentication, the protection extends beyond the security environment and protects lost or stolen devices. The Mobile Armor solution is FIPS 140-2 Level 2 certified and, properly implemented, exceeds HHS guidelines. The Data Protection Suite simplifies the protection of healthcare data by providing:

• FIPS certified AES 256-bit full disk encryption and file-level encryption options.
• Data encryption for laptops, desktops, notebooks, toughbooks, netbooks, and all types of removable storage devices including external hard drives, CD/DVD and USB flash drives.
• Centralized policy administration and management to enforce the encryption of sensitive information to meet HITECH Act safe harbor requirements.
• Pre-boot authentication that enforces policy-driven access control that prevents unauthorized users from logging onto a device.
• Reporting and auditing to show and verify the current status of encryption deployment enterprise wide or by department, employee and/or serialized device.
• A “remote kill switch” that, should a device that contains health information be lost or stolen, permits the customer to remotely wipe the crypto keys, rendering the data on the device completely inaccessible.
• Multiple forms of authentication including fixed passwords, ColorCode, PIN, CAC, and Active Directory domain password.
• Individual, group and enterprise authentication for removable storage media.
• Robust port and device control that restricts various forms of removable media as well as restricts who uses what devices on the network.
• Tamper proof and security measures that detect and protect stolen devices.

The Mobile Armor Data Protection Suite has been designed for use by the most stringent/security conscious organizations such as the United States military for information protection due to its FIPS 140-2 Level 2/3 validation, ISO/IEC 15408 and other elite security certifications, providing even greater levels of mobile data information protection than required in the HITECH Act. And, because of the breadth of device protection (laptops, desktops, flash drives, CD/DVD), ease of use and deployment of the Data Protection Suite, an organization of any size is able to quickly benefit from the superior levels of data protection offered in the Mobile Armor solution.

For more information on Mobile Armor go to: http://www.mobilearmor.com/

Before implementing its mobile technology solution, Slidell Memorial Hospital tested a variety of units, including the Panasonic Toughbook T8. In the end, Slidell Memorial Hospital chose the Panasonic Toughbook T8 based on its screen, light weight, and of course, its ruggedness. In a rapidly-moving hospital climate, technology devices must survive unexpected spills, bumps, and drops on a regular basis.

“I didn’t understand how durable Toughbook computers were until I dropped one of our T8s about 20 feet,” said Mike Mickey, IT director for Slidell Memorial Hospital. “Much to my amazement, it booted right up.  It was unbelievable. We deployed the device and it works fine.”

Ultimately this returns to the argument of TCO vs. ROI. By implementing a truly durable solution, hospitals relieve themselves of the costs associated with computer failures. Take Sussex County Medical Associates, they deployed the Toughbook T-series notebooks in 2004. Six years later they are still using most of the notebooks originally employed.

“Our clinicians work in a highly mobile environment that is demanding for even a ruggedized computer.  That fact that we deployed our first Toughbook T series laptops in 2004 and still have most in service six years later means that Sussex County Medical Associates has received an exceptional return on its mobile technology investment,” said Jacque Konzelman, Practice Manager for Sussex County Medical Center.

The cost of computer failures isn’t just monetary; its time consuming to use unreliable technology. Exempla Healthcare, which manages doctors in a network of Colorado-based hospitals, has used a variety of Panasonic Toughbook devices, including the T7, T8, and the 52.

“Panasonic Toughbook computers can keep up with the high demands of our nurses,” said Jim Millard, IT director for Exempla Healthcare. “When something is spilled on it, it can be wiped off easily, or if it falls, it will start up again, keeping downtime low.”

The Electronic Medical Record market is expected to reach $2.6 billion in 2012, a 100 percent increase in only 4 years. As the use of EHRs swells, mobile computing solutions should rise to the occasion of reliability to survive in the demanding healthcare environment.

Ozarks Medical Center, a not-for-profit hospital serving South Central Missouri and North Central Arkansas, approached the reseller looking for a mobile solution to replace fixed computer stations and pen and paper reporting.

The relationship between the two sprang from a webinar series, produced by the reseller, on how mobile clinical assistants, like the Panasonic Toughbook H1 Health, can aid healthcare providers. Following this webinar, the reseller provided the medical center with a number of computer models, including the Toughbook H1 Health, Toughbook T8 and the Toughbook 19 under its “Proof of Concept” program, which allows testing of a variety of units to determine which model works best for a customer. After trying each out, the Ozark IT department wasn’t convinced that any of the devices were the right fit for the medical center.

Despite this initial rejection, DataSource Mobility knew better and pressed on, insisting Ozarks take another look at the Toughbook T8. In a unique sales move, the reseller sent Ozarks a link to its self-produced informational video about the device in an effort to show them what they may have overlooked. Through the video, the medical center realized that the T8, a touchscreen tablet alternative, had the exact features it was looking for – the reseller had been right all along.

The T8 video shows everything from how to remove the hard drive to how to take advantage of the device’s ergonomic design. DataSource Mobility’s series of online educational videos allow prospective customers to better understand the products, how they fit into their workflow and how they compare to other products on the market today. This creative approach allowed DataSource Mobility to outfit an additional customer with the perfect device to take the efficiency of its staff to the next level. You can see all of the reseller’s product overview videos here.

This kind of dedication to ensuring each Toughbook customer is equipped with the right device for its environment is a testament to the passion our resellers have for our products. Because of resellers like DataSource Mobility, our customers are outfitted with devices that perform reliably, even in the most demanding and mission critical situations.

Resellers, have you made any creative sales lately? Let us know in the comment section below.

Meeting specific criteria is daunting and for an EMR project to be truly effective and compliant with official regulations it will require a reliable mobile computing solution that offers security options like fingerprint scanners and smartcard readers. Durability is also a critical element in order to withstand inevitable bumps, drops and spills at the point of care.

I recently discussed critical points for EMR deployments in a blog post titled ‘It’s All About The System…’ The post is worth reading if you are in the process of rolling out an EMR and in search of tips for a successful IT system.

Check out Castle Rock’s story after the jump, and we also welcome any experiences you’d like to share with us.

How Castle Rock Fire and Rescue Uses the Toughbook 30 and High Plains ePCR software to streamline processes

The Castle Rock Fire and Rescue Department protects the lives and property of 51,000 Colorado residents. In 2002, Castle Rock decided to ease the burden on its EMTs and paramedics by upgrading their emergency call documentation system.

Prior to the technology upgrade, its paramedics relied on pen and paper notes that had to be transcribed on computers back at their station. This system presented significant challenges, such as incomplete information due to the difficulty of recalling every detail of a patient’s care.

A Winning Combination

Castle Rock began addressing these challenges by equipping their medic vehicles with fully-rugged Panasonic Toughbook® 30 mobile computers loaded with ePCR software from High Plains Information Systems.

The Toughbook 30 protects precious data with a magnesium alloy case and shock-mounted hard drive. The daylight-readable touchscreen and embedded mobile broadband capabilities also make it easy for EMTs and paramedics to file their reports from anywhere, at any time.

High Plains Information Systems provides a complete, fully-integrated fire records management system (RMS) that addresses nearly every aspect of a fire department’s operation, from incident and patient care reporting to scheduling and payroll.

Norris Croom, Division Chief of Operations at Castle Rock Fire and Rescue, has noticed a vast improvement in efficiency since implementing the solutions. “Prior to this procedure, it was taking 25-30 minutes after they returned to complete paperwork, and now it takes just a couple of minutes to wirelessly upload a report,” said Croom. “We are saving approximately 20 minutes per emergency call, and with more than 2,000 EMS calls per year, that time definitely adds up.”

Helping Every Touchpoint in the Healthcare System

The streamlined process has also increased efficiency at Sky Ridge Medical Center, the primary hospital receiving Castle Rock’s patients. Paramedics can easily create a detailed patient care report from their emergency vehicle while en route.

“From a legal perspective, if it wasn’t recorded, it didn’t happen,” said Dr. Steve Heinz, Physician Advisor for Castle Rock Fire and Rescue at Sky Ridge. “This system helps us streamline our process, eliminate errors and deliver the best possible overall care to patients.”

To read more about Castle Rock Fire and Rescue’s deployment, click here.

For the study, two members of the nursing staff were equipped with Toughbook H1 Health MCA devices.  The nurses were able to access the hospital’s information system as well as frequently consulted information.  The Toughbook H1 Health was used in day-to-day care for a group of hospitalized patients and workflow was observed and measured repeatedly over the course of the study.

Prior to the deployment of the Toughbook H1 Health MCAs, observations and measurements were made of the nursing staff conducting the same procedures with a group of patients in the same areas of the hospital. This was done using conventional methods which included taking notes at bedside using pen and paper and later inputting data into the appropriate hospital information system.

After comparing the results, the hospital saw a dramatic improvement in workflow efficiency when using the Toughbook H1 Health.  Perpetration time was eliminated; medication and note taking was cut approximately in half and water (or fluid) balancing time was cut by approximately one third.  In total, the hospital saw a 40 percent reduction in the time its nurses used to conduct their daily work.

The full study is available for download on the Panasonic Computer Products Europe web site at the following link

The topic of tablet computers in healthcare has received an enormous amount of attention since the introduction of Apple’s iPad and tablets using Windows 7. While demand for mobile devices in the healthcare market is growing, there is still no one perfect solution for healthcare users – and there never will be. Radiologists have different needs than surgeons and nurses have different needs than phlebotomists. If your goal is to improve patient safety and workflow, then you’ll need to find devices that work best for each user.

This sudden swell of interest in tablets merits a discussion of issues healthcare organizations should consider when looking for a tablet of any kind. Before deploying a tablet, you must consider a number of factors, including ergonomics, connectivity, durability, security, vendor experience, service and support, functionality and the ability to repeatedly sanitize the device.  These will all impact the success of the deployment.  The worst thing you can do is just look at price!

Ergonomics
Ergonomics is a critical consideration for a tablet.  If a clinician is going to carry a device all day, it needs to be lightweight and easy to hold for long periods of time.  Years of working with healthcare professionals resulted in Panasonic designing a “hand-free” ergonomic strap and dome hand support system that cradles the hand for comfortable long-term use.  You can see this technology in many of our devices.  When considering a tablet, I encourage you to look at the ergonomics of the design and to have clinicians consider this element as part of the testing process.

Connectivity
Tablets are designed to facilitate mobility, but the true benefits of mobility can only be achieved with connectivity.  Most healthcare facilities gain connectivity via Wi-Fi, but home health workers may require mobile broadband.  When looking at a tablet’s connectivity, consider its ability to capture a signal in fringe areas.  Most devices will have a clear signal near a router or cell tower, but how strong is the connection as you move them away from an access point?  Wireless testing is simple and often overlooked.  It’s common to blame the wireless network when you can’t get a signal, but often it’s the device.

Durability
In Panasonic’s experience, healthcare customers are some of the most demanding. This highly mobile and dynamic work environment often leads to dropped devices.  As a result, durability is a chief consideration for tablets. Fragility is not an option when your work is mission critical.

For those considering the new iPad, I’d point to a recent article from PC World.  The title – iPad Stress Tests: Buy a Case and Don’t Drop It – says it all.  At the end of the day, if you can’t rely on a computer to operate after an inevitable drop or spill, then your ability to transform your workflow is significantly reduced.  Be sure to ask about the drop rating (for both the device and hard drive) for the tablets you are considering.

It’s worth noting that the average annual total cost of ownership (TCO) of a ruggedized notebook is 40% lower than the average TCO of a non-rugged device, according to VDC Research. So purchasing a consumer-grade product and trying to make it work in a demanding enterprise environment is probably not the best solution.

Security
Security is crucial in a healthcare environment. Having options such as fingerprint scanners and smartcard readers, paired with bios-level security technology like Computrace, is critical. If mobile devices don’t offer these options, you need to consider if they’ll provide the appropriate level of HIPAA compliance.

Expertise
Since the announcement of the Recovery Act in February of 2009, we have seen a lot of interest in the healthcare market from technology companies.  When considering a tablet, make sure you are working with a vendor that has substantial healthcare market experience. Lack of domain expertise can significantly complicate your launch efforts.  You need a partner that can provide support from the evaluation process well into the deployment, not someone that will simply sell you a device.

Service & Support
Many new tablet products on the market are not replacements for current technology, rather an extra device for an IT department to manage.  Multiple devices running different operating systems can complicate IT management issues.  Also, since many new tablet devices will be widely available through consumer channels, it’s likely physicians will purchase their own, bring them into the hospital and ask for IT support.  We saw this very phenomenon in commercial markets with the iPhone.  This forced IT departments to debate the pros and cons associated with having an “our technology only” rule versus a more open policy.

You should also consider the availability of software written for the device.  In particular, how many full EMR applications are written for the platform?

Functionality
Although I stated earlier that there is no one-size-fits-all solution in the healthcare market, you definitely want to avoid devices that are one-dimensional. The ideal tablet (convertible or slate) allows clinicians to accomplish as much as possible with a single device.  A well designed, lightweight convertible tablet can serve as both a physician’s desktop computer and hand-held tablet for rounds and patient interactions.  Mobile Clinical Assistants (MCAs) have integrated features such as barcode scanners, RFID readers and cameras to improve point-of-care productivity.  Not all tablets can serve multiple roles or even allow for multi-tasking – something the demanding physicians we work with have come to expect as the price of entry.  A well designed tablet will allow your staff to maximize productivity while limiting the number of devices your IT department needs to support.

Sanitization
Since hospital equipment must be frequently sanitized, choosing a tablet that can be repeatedly cleaned is another key factor to evaluate during the purchase process.  If not properly designed, screen viewability could significantly degrade after repeated sanitization.  It’s good to ask what sort of testing has been done in this area, and if the device is IP (ingress protection) rated.

The move towards EMRs and the abundance of mobile computing solutions coming to market make it an exciting time to be in the healthcare IT business.  Pure tablets like the MCA (including our Toughbook H1 Health), along with new generations of convertible tablets running Windows 7, are generating a lot of interest.  Devices like the iPad will push the market forward and keep tablets at the forefront of the healthcare mobility discussion.  But before you make a decision, step back and thoroughly evaluate your options.  The wrong choice can have long-term ramifications for both the quality of patient care and bottom line performance.