Mobile devices in NZ's health sector - benefits and barriers

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eHealthNews.nz editor Rebecca McBeth  

Mobile devices are easy and convenient and have become an intrinsic part of how people acquire and communicate information in both their personal and working lives.

In the health sector, health professionals are using mobile devices every day for clinical tasks such as managing teams and workload, inputting patient observations and information, requesting advice and sending medical images.

An Official Information Act request shows that, as of February 2018, more than 26,000 mobile devices are used by staff in New Zealand’s 20 DHBs. See Table 1 at end of story for details.

Numbers of DHB-distributed devices range from 100–300 at the country's smallest boards; Tairāwhiti; Wairarapa; West Coast; and South Canterbury, to nearly 4000 at the largest, Auckland and Canterbury DHBs. Many health professionals are also using their personal devices at work.

A British Medical Journey study, The ownership and clinical use of smartphones by doctors and nurses in the UK, found that nearly 100 per cent of doctors and nurses owned a smartphone and 93 per cent of doctors and 53 per cent of nurses found them to be ‘very useful’ or ‘useful’ in helping them to perform their clinical duties.

The numbers are likely to be similar in New Zealand, where device ownership and connectivity rates are also high.

A paper published in the Patient Experience Journal in 2017 reported on a study of the impact of mobile devices on community allied health clinicians and patient experience at Waitemata DHB and

found that mobile devices had a positive impact on clinician and patient experiences and workflow.

“In addition to improved patient engagement, clinicians reported emotional and physical benefits of mobile device use. Clinicians talked about feeling less stressed as a result of improved workflow,” the paper says.

However, with the benefit of mobility and easy seamless communication also comes a level of risk that health providers need to manage. Keeping patient information secure and confidential is key to retaining trust in the healthcare system.

Benefit vs risk

Chief executive of secure messaging app Celo, Steve Vlok, says the needs of clinicians, who want to use their mobile device to ensure timely communication and ultimately improve patient care, are often at odds with the need of the management and policy makers who need to protect the organisation.

Vlok argues that simply telling doctors to not use text or WhatsApp groups to communicate fails to accept the reality that were this communication to stop, patient care and safety would be affected if no suitable secure alternative was offered.

He says the benefits of using smartphones in healthcare outweigh the risks and have been shown to save money, reduce length of stays and reduce the risk of complications such as medication errors.

“At the end of the day, health professionals are trying to save time, and sometimes that time-saving benefit or instant advice in a critical moment can outweigh the risk of sending something using a non-approved platform,” says Vlok.

However, there are risks in using personal phones and consumer messaging apps to send patient information, such as information stored locally on the phone, sending to wrong phone numbers and the possibility to mix up patient information and therefore administer the wrong treatment.

NZ Telehealth Forum chair Ruth Large agrees that where policies or platforms are not in place, clinicians will find workarounds, such as the Resident Medical Officer workforce managing their tasks using WhatsApp or other online groups.

She explains that while mobility is a growing part of health innovation, this has been mainly organic growth, as opposed to something explicitly led by organisations.

“There’s nothing wrong with that, but giving thought to mobile device management programmes, patient and staff security, those things haven’t necessarily been at the forefront in people’s minds,” she says.

As smartphone cameras have improved, clinicians are also increasingly using them to take medical images.

“It’s become relatively common practice to share images between clinicians, consenting the patients and then deleting them. There’s a lot of room for risk in there and that’s certainly driven a lot of careful consideration,” says Large.

The NZ Medical Association released guidance, Getting smart with smartphones, in August 2016 in response to the proliferation of electronic devices used by doctors, especially for taking pictures.

Association chair Kate Braddock tells eHealthNews.nz the guidance had a significant impact in the general practice space.

In her own practice, they instituted a policy whereby each surgery has a camera with a SIM card for taking medical images and uploading them into patient notes, and many others implemented similar policies.

She says taking an image on a personal device then deleting it can be problematic as many devices now sync to the cloud and once deleted, it is no longer part of the patient’s record.

Braddock argues that if taking and sending images is part of a doctor’s role and they do not have or want to use their own device, they should have one made available to them by their organisation.

“And that’s something institutions as a whole need to come to grips with,” she says.

Private vs personal

Large explains that many devices issued by DHBs are for personal and private use, with staff sometimes choosing to contribute to the cost of the phone plan if they want to use it personally as well.

Devices can be locked down but are often not, and the system relies on a level of trust.

“We need to be building these apps to make sure people have really secure passwords, and there’s mobile device management policies so they can be wiped remotely and ensure people are treating them like they would any information they may hold for a patient,” says Large.

But mobile device security, storage of things like medical images and integration with an electronic medical record all comes at a cost, at a time when hospitals are faced with rising demand and pressure on resources.

“Keeping your computers and mobile devices up to date comes at a huge cost, and it’s interesting as to how do you measure the benefit? Because we all know mobile devices contribute to people’s distractibility and productivity and there’s a huge amount of stuff here we just don’t know about how it’s going to affect our workforce,” Large says.

In Vlok’s experience, clinicians in a hospital setting mostly use their own devices to coordinate their teams and discuss patients.

“Although a managed or corporate device is appropriate in some circumstances, you will always get a scenario where someone is using their phone simply because it improves how they can check on the rest of their team,” he says.

A range of mobile device management platforms are available and in use across health organisations and most give control to the organisation to remotely wipe the device.

Vlok argues that this is problematic for personal devices as they will contain private photos and messages and believes Bring Your Own Device strategies are the way forward, with work applications treated separately from personal information. 

According to their OIA responses, seven DHBs have a BYOD policy and at least four are developing one.

The Ministry of Health does not have an official policy on BYOD, but group manager digital strategy and investment Darren Douglass says “compliance with broader privacy and security standards such as HIPC, HISF, and NZISM is expected”.

From MDM to UEM

In the Northern Region, 7000 staff every day connect to the corporate network using personal devices via secured connections, and anyone interacting with clinical systems via mobile devices must enrol their phone so it can be securely managed and remotely wiped if it is lost or stolen.

Richard Raj, head of digital and mobility at healthAlliance, which provides mobile device management services to the four Northern DHBs, says any mobile device policy needs careful consideration in an ecosystem with more than 26,000 users and multiple devices.

He says organisations traditionally think of a mobile device as a ‘thing’ and then put a strategy around that, but healthAlliance is trying to think several steps ahead to design a strategy based around the userand unique DHB persona types, such as nurses, doctors or allied health staff.

He says the rapid maturity of cloud offerings and mobile devices means there are strategic opportunities that were not even thought of one or two years ago to provide a completely seamless experience to users.

“User experience needs to be improved further: it’s not seamless having to log in to lots of different devices all the time, but if you look at unified endpoint management, you consider whatever your endpoint device to receive the service is – either desktop, mobile, hybrid device or IoT – and then create a unified experience across all of it,” Raj says.

The Northern Region Information Services Strategic Plan, which is not yet published externally, takes a user-centric approach and involves creating about a dozen personas for various DHB roles. This would mean that a charge nurse working anywhere across the region’s four DHBs would have the same experience on a device no matter what systems they were using.

“The ISSP team is developing these persona groups and the UEM solution will help to manage all the devices that the personas interact with,” explains Raj.

“When you develop solutions with key persona groups, the apps that people use can then be developed with that ‘use-case’ in mind. By using APIs, the ability to share information while keeping it secure, as well as device performance, will improve.

“UEM is not in the distant future; our Workspace programme – which has UEM in its scope – has already started. While the region has security policies for individual devices, collectively UEM will provide wider device management capabilities across the region and this is where we are heading to at a rapid pace.”

Table 1. Mobile devices used by district health board employees

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