Lack of mHealth Technologies Disrupts Workflows for Hospitalists

User-centered mHealth technology and applications could help reduce burden and increase the efficiency of workflows for hospitalists, according to a study published in JMIR Human Factors.

Hospitalists are physicians who work in hospitals and provide general medical care to patients during their stay. EHR systems play a big role in hospitalists’ workflows by aiding in documentation, information retrieval, and order creation, but their lack of mobility can lead to redundancy and inefficiencies for hospitalists.

“Healthcare systems across the country have invested heavily in health information technology [HIT], but when it comes to the mobile technology provided to hospitalists, HIT hasn’t incorporated many user-centered designs,” April Savoy, PhD, a researcher from the Regenstrief Institute and the Department of Veterans Affairs (VA), and a corresponding author of the study, said in a press release.

“Cell phones work well for ordering a ride from a car service or posting social media because their apps are designed for the consumers these companies wish to reach. But we found a lack of user-focused mobile technology apps designed to decrease difficulty and increase efficiency of hospitalists’ workflows and improve patient care.”

To understand what kinds of mobile technologies would best help hospitalists in their everyday tasks, Savoy and other researchers interviewed 12 physicians from an urban teaching hospital in Indiana operated by the VA.

According to participants, chart reviews, orders, and documentation were the most frequent, redundant, and difficult tasks that hospitalists performed as part of their workflows.

Fragmented information in the EHR and poor usability has led to hospitalists spending long amounts of time on these tasks or rewriting notes due to a lack of access to technology while in a patient’s room, they said.

For example, study participants noted that orders, including lab tests, consultations, and prescriptions, are entered electronically, but there are no bedside computers in patient rooms, which makes creating orders difficult and inefficient.

Hospitalists said that rounding was an inefficient part of their workflow as well. During their rounds, they see 10 to 18 patients and need to document patient history and physical notes in the EHR. They then copy the information onto a paper card so it will be readily available to them if they need it.

“During rounds, hospitalists don’t use mobile technology because it’s not user-focused,” Savoy said. “It lacks apps that are easy to use on small screens without keyboards because most healthcare systems haven’t figured out how to make mobile devices accessible when and where needed and haven’t solved such basic issues like battery life and device sanitation.”

Further, the absence of portable task-specific technology can increase cognitive burden in hospitalists, as it may require them to rely on their memory to relay certain information, the researchers said.

Some hospitalists noted that they had access to mobile technology, such as an iPad, but it wasn’t useful for the tasks they needed to complete.

When participants were asked about the mobile technologies that would be the most helpful for their workflows, they mentioned three key examples.

An iPad or tablet could help hospitalists enter orders at a patient’s bedside and aid in patient-provider communication, participants said.

Additionally, a note-taking application with a sharing feature that stored nurse contact information would be beneficial. Finally, a mobile application for electronic consent could help with hospitalist workflows.

“Since the completion of our study, the VA’s Office of Connected Care is working to achieve greater understanding of provider preferences for mobile technology and task-specific apps,” the study authors concluded.