InterSystems Corporation announced that Partners HealthCare Systems is now providing clinicians throughout its integrated delivery network (IDN) with mobile access to its electronic health record (EHR). The InterSystems CACHÉ high-performance object database is the foundation platform for Partners HealthCare’s EHR and for hundreds of clinical applications used by thousands of clinicians throughout the IDN.
Boston-based Partners HealthCare is an IDN that includes major teaching and community hospitals with more than 5,000 practicing physicians attending to four million outpatient visits and 160,000 admissions annually. InterSystems is a global provider of advanced integration, database, and business intelligence technologies for breakthrough applications.
“Partners’ longstanding relationship with InterSystems and extensive use of CACHÉ and of the InterSystems Ensemble
rapid integration and development platform means that we have a rich library of services built on CACHÉ-based repositories with Ensemble providing smooth integration of those services,” says Steve Flammini, Partners CTO. “As a result, we were able to leverage the performance and scalability delivered by CACHÉ and Ensemble’s advanced integration capabilities for this mobile project.”
Innovation in 90 Days
A high adoption rate of smartphones in the physician community at large was one driver behind the decision to develop a mobile EHR (mEHR). A May 2010 survey of more than 2,000 physicians nationwide by the Manhattan Research Institute, for example, revealed that an estimated 81% of physicians are using smartphones. And, a study entitled “Point of Care Communications for Physicians” published by Spyglass Consulting Group in July 2010 found that 94% of physician respondents are using smartphones to communicate, manage personal and business workflows, and access medical information.
This high mobile technology adoption rate combined with a focus on improving clinician mobility and workflow put the mEHR initiative on a fast development track, according to Flammini. “The maturity of a related cluster of technologies including high-speed mobile processors, browsers, operating systems, battery, display technology, Wi-Fi, 3G and 4G wireless, and service-oriented architecture (SOA) also made the timing right for an mEHR,” he says.
Pilot project planning and development were coordinated by the Partners SOA team. Re-use of existing data, services, and infrastructure was a strong focus from the start of the project, according to John Pappas, associate director of clinical systems integration. “For example, we used what we call a Continuity of Care Document (CCD) factory, a compound service that integrates many other CACHÉ-based services via InterSystems Ensemble.”
The CCD specification is an XML
-based markup standard intended to specify the encoding, structure, and semantics of a patient summary clinical document for exchange. It has been selected as a standard by the U.S. Healthcare Information Technology Standards Panel
. Leveraging services, the SOA development team was able to bring up the initial pilot in just over 90 days—an impressive illustration of rapid application development at work.
The major challenge was to optimize for the smartphone by taking a dashboard that displays a large amount of patient data and transforming the presentation and navigation for a miniature screen. “We initially developed the presentation layer for the iPhone. The fact that they’re encrypted devices and were being used by many physicians made them a logical choice for the initial rollout,” Pappas says. “We also built out the application on the BlackBerry and iPad platforms.”
Mobile…and Loving It
Clinicians are rapidly adopting the mEHR, which went live on a production basis early this year, with an estimated 2,000 individuals already using the new app. One physician says, “As a medical resident, the mEHR has been extremely useful, pushing the wealth of information on the LMR [Partners HealthCare’s longitudinal medical record]. I use the mEHR on my iPhone to inform clinical decision-making without interrupting rounds, update patients without leaving their room, and check results, notes, and clinic schedules from home. It generates enthusiasm from every clinician I have shown it to, all of whom are seeking ways to access critical information irrespective of time or place.”
“There has been a lot of feedback…and 98% has been positive,” says Pappas.
“The mEHR enhances the daily life of physicians by enabling them to be mobile. Instead of finding a workstation, logging in, accessing the patient record and then going to see a patient, they can just pull the iPhone from a pocket and review results at the bedside while they’re talking to the patient. And, they can check on the latest information—test results, for example—at any time from any location…it’s having a major positive impact on workflow,” Pappas noted.
Support of personally owned and managed devices brings some challenges, including less control over the platform operating environment. However, it seems clear that mobile apps that are fast, simple, and intuitive are now expected and will be adopted by Partners users organization-wide. “There is definitely a growing demand for new mobile apps as well as additions to the mEHR. We’re getting requests from business units and clinical groups throughout the organization,” Pappas said. Building on success, plans are to begin making radiology images accessible on the iPad and to add support for Android devices once the necessary level of security is ensured.
“Partners’ success at developing and deploying the mEHR so rapidly is an example of why they’re viewed as an innovation leader in the use of healthcare technology,” says Paul Grabscheid, InterSystems vice president of strategic planning. “Mobility is becoming a watchword in the healthcare sector. The Partners mEHR provides clinicians with the ultimate in mobility by delivering the information they want, when and where they want it, in the presentation form that they want and expect. We welcome the opportunity to provide the CACHÉ and Ensemble platforms that underlie this breakthrough Partners app.”