This document summarizes a presentation on mobile electronic health record (EHR) trends. The presentation covers: 1. Phasing EHR functionality to mobile platforms and formulating a development strategy. 2. Building the right team with considerations for user experience and security challenges. 3. Representative case studies of mobilizing EHRs and mobile chronic disease management solutions. 4. A question and answer section.

2. Agenda
Mobile EHR Trends
1
Phasing EHR Functionality to Mobile Platforms
Formulating a Development Strategy
2 Building the Right Team
UX Considerations
Security Challenges/Best Practices
3 Representative Case Studies
4 Q&A

3. Trends – Mobile EHRs
1
Phasing EHR Functionality to Mobile Platforms
Formulating a Development Strategy
2 Building the Right Team
UX Considerations
Security Challenges/Best Practices
3 Representative Case Studies
4 Q&A

4. Trends - Mobile EHRs
Several leading EHR vendors have developed mobile solutions for their products:
Vendor iPhone iPad Android Other Notes
Epic – Haiku, Canto Partnered with Apple
Allscripts Remote
NextGen Mobile
Greenway - PrimeMOBILE Third Party Partner
Practice Fusion
GE Healthcare CAMobile
Cerner - MPages Web-based access
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5. Trends - Mobile EHRs
Various technical/OS approaches are being used by vendors/developers:
Type Examples
1. Native Mobile EMRs Apps – Mobile applications developed using native Greenway PrimeMobile
SDK and utilize devices specific features, touch UI, etc. Native apps may Dr. Chrono
use web services also. PracticeFusion
Allscripts Wand
2. Web-based Mobile EMRs – These systems utilize a web brower. Webchart
3. Hybrid Mobile App – app that utilizes some native and some web-based (many)
functions
4. Remote Access EMRs – Most client/server, on-premise EMRs can be Citrix
accessed from a remote system through thin-client utilities like Citrix. Users
can use their laptops or iPads to access systems. Similar to web-based
apps the UX may not be as rich as a native app
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6. Trends - Mobile EHRs
Allscripts Mobile Solution has a variety of functions:
Patient Summary Medication Favorites Patient Timeline
Images
Appointments Results
Patient Review
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7. Trends - Mobile EHRs
The Practice Fusion Mobile solution has a broad range of functions:
Scheduling e- prescribing
Patient Records
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8. Trends - Mobile EHRs
Epic’s Haiku mobile application:
Patient List Activities Results – Visual Display
Voice Dictation
Schedule Problem List
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9. Trends - Mobile EHRs
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10. Trends - Mobile EHRs
Several key trends are noteworthy:
 Continued Growth in Use of iPad within Health Care Enterprises – the Apple iPad continues to have
appeal with physician community
 Native Apps Development by Large Vendors Continues– Large EHR vendors continue to develop
native apps e.g., recent release of Allscripts Wand
 Embedded Speech Recognition and NLP Software– Vendors are embedding speech recognition
and NLP software into their solutions
 Patients Accessing EHR Using Mobile Device – Large providers (IDNs) are providing patients with
mobile access to EHR (e.g., Kaiser Android App)
 Integration of Specialized Patient Facing Apps – several specialized mobile apps (e.g., Airstrip,
WellDoc) have been integrated into mobile EHR platforms – patient data collection into EHR
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11. Trends - Mobile EHRs
Several key trends are noteworthy (cont’d):
 Open APIs – Some vendors (e.g., PracticeFusion) are opening their system to developers to connect
patient data collection solutions
 Non Traditional Vendors Building Smart Mobile Layer – solutions that act as ‘mobile smart layer’
are being developed by vendors from outside tranditional EHR space (e.g., SAP Electronic Medical
Record Mobile App)
 Mobile for Stage 2 Meaningful Use – mobile technologies are being used as way to achieve
Meaningful Use goals (e.g., point of care data capture, coordination of care, etc.)
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12. Mobile EHR Trends
1
Phasing EHR Functionality to Mobile Platforms
Formulating a Development Strategy
2 Building the Right Team
UX Considerations
Security Challenges/Best Practices
3 Representative Case Studies
4 Q&A

13. Phasing of EHR Functionality to Mobile
Common functions established on mobile EHRs, phasing of functions/roadmap varies:
Functions Basic Advanced Future
Patient Lists/Search – Ability to see list of patients, appointments
Results – Ability to view lab results, etc.
Work Lists – view, process, add, assign tasks
ePrescribing – ability to place electronic prescription orders
Images and Scanned Documents– access to images, documents
Dictation – use of speech recognition and embedded NLP software
Visual Display – Results, Timelines
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14. Mobile EHR Trends
1
Phasing EHR Functionality to Mobile Platforms
Formulating a Development Strategy
2 Building the Right Team
UX Considerations
Security Challenges/Best Practices
3 Representative Case Studies
4 Q&A

15. Formulating Development Strategy
1. Development Approach 2. Technology Plan 3. Functional Approach
 Phases- organize build in  Platform agnostic, Multi
platform/ Single platform?  Core functions first - bells and
phases (by function, platform, whistles later
etc)  Tablet/ Smartphones?
 Must Haves vs. Nice to Have
 Connected/ Offline Support?
 Iterative Approach - Build  Early stakeholder validation
working prototypes; clarify use  Frameworks vs. Custom
patterns Development  Regulatory Requirements
 Build foundations first –
 Life Cycle - Define a forward Security framework, Patient
looking product life cycle that list, Access control, Storage,
supports ongoing improvement etc.
of app
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16. Mobile EHR Trends
1
Phasing EHR Functionality to Mobile Platforms
Formulating a Development Strategy
2 Building the Right Team
UX Considerations
Security Challenges, Best Practices
3 Representative Case Studies
4 Q&A

17. Building the Right Team
The following teams play a vital role on the project:
Product Development Engineering/Technical Development /Testing Implementation/Deployment
• Define Direction, • Core Architecture • Build the Product • Customize for specific
Roadmap, Clinical Use need of a paying
• Define Workflows, • Maintain Quality customer
• Vision, Strategy Making Features
• Ensure acceptance and • Involved in Deployment,
• Pricing, Business • Enhance the vision adherence to core vision Implementation
Outlook given by Core Team
• Technical and quality • Support & Maintenance
• Long term goal setting • Technical, Clinical, representation in majority
Quality Systems and • Pure Developers and
• Representation from all operational • 10-50 members Support staff
Org. functional units representation is must
• 5-10 members per
• 6-10 members • 5-20 members support contract
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18. Building the Right Team
Team Composition
Clinical Staff Technical Staff Regulatory Experts Operations Staff
• Providers • Architects, Leads • Healthcare IT • Support (Tier 1-3)
Specialists
• Nurses • UX Consultants • Administrative
• QMS Representatives
• Consultants • Platform Engineers • IT and ITES staff
• QC Engineers • Project Management
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19. Building the Right Team
The following skill sets are involved:
Skill Sets
 Management Professionals - Project Managers, Business Analysts, Technical Writers)
 Solution Architects - Java, .Net, Database, UX, Mobile Technologies
 Mobile Platforms/Device Management - MEAP and/ or MDM Developers
 UX Consultants - UX Designers, UX Developers
 Senior Mobile Developers - iOS, Android, BB, etc.
 Programmers -C++, Java, Dot Net, Objective C, PL/SQL
 Quality Control Professionals, Leads and Engineers – Automation, Manual Testing Experts
 Build and Configuration Engineers
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20. Mobile EHR Trends
1
Phasing EHR Functionality to Mobile Platforms
Formulating a Development Strategy
2 Building the Right Team
UX Considerations
Security Challenges/Best Practices
3 Representative Case Studies
4 Q&A

21. UX Considerations
Understand & Analyze Design Stage Usability Test
 Understand the objective  Physicans/Clinical interviews  Clinical test of visual ergonomics
 Branding  Live user scenario & records  Easy to find (learnability test)
 Solution priority/Product Mgt  Movement capture  Record lock & feedback loop
 Focus group study
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22. UX Lessons Learned
Some lessons learned:
 Mobile Context is Key – It is not possible to transfer all EHR functions to mobile platform. Focus on
key ‘out of office’ functions that are regularly used by physicians
 No Silver Bullet – it Is unlikely that a single device (e.g., iPad) will support all documentation needs.
Recognize that smart phones and tablets complement a broader set of “situational tools” – e.g.,
during rounds tablet may be used; on road a smart phone; in the office a laptop, and so on.
 Be Aware of Ergonimic Constraints – ergonomic factors such as the absence of a physical keyboard,
the need to carry the device need to be considered during the design process.
 Mobilization is not Miniturization – recognize that moving an EMR to a mobile platform is not a
“minituratization exercise; a replication of the desktop system for a mobile device. Instead it requires
unique design considerations.
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23. UX Opportunities
Despite challenges, several
opportunities for innovation exist for
Mobile EMRs:
 Speech Recognition and NLP
 Unified Communicaton
 Camera/Image Capture
 Gesture-Based Computing
 Visual Display
 Video
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24. Mobile EHR Trends
1
Phasing EHR Functionality to Mobile Platforms
Formulating a Development Strategy
2 Building the Right Team
UX Considerations
Security Challenges/Best Practices
3 Representative Case Studies
4 Q&A

25. Security Challenges/Best Practices
 Security means
- Maintain privacy, integrity and high availability of the solution, data contained within
- Restrict unintended, unauthorized access to any or all parts of the solution by all means
 Three Levels of Security
- 1) Device 2)Network 3)Application
 Enterprise Grade
- EHR apps need enterprise grade security - robust enterprise and organizational policies to be implemented. No
exceptions allowed!
 Demographic Challenges
- Local Government Laws for Electronic Data Security
- Health Information Exchange between heterogeneous systems. e.g. Labs, Pharmacies, patient facing Applications,
Operations and Scheduling, Accounting Systems
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26. Security Challenges/Best Practices
Securing and Provisioning Medical Devices
• The proliferation of devices on the network presents unique challenges. E.g. BYOD Strategy
• Ensure that only known and authorized devices access
• Effective Guest Access Management (Visiting providers, clinicians)
Secure Access to Patient Information
• See exactly what you need to see. Nothing less, nothing more!
• Access control list, Exercise Roles and Access rights strictly.
• Building Extensive Audit Log and keeping the performance top notch
Regulatory Standards Compliance
• Follow Government and Industry standards for securing Electronic Information
• Health Insurance Portability and Accounting Act (HIPAA), Payment Card Industry data Security Standards (PCI DSS), CITI,
CIA, HITECH
• Validate the system security architecture from regulatory compliance point of view
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27. Security Challenges/Best Practices
Device Level
 Policy Enforcement, Extend the organization IT policies to Mobile devices with little or no waivers!
 Use standard MDMs and MEAP Solutions or build custom hooks to manage the devices.
 Secure Device Configuration – Authorize, De-Authorize, Wipe, Disable
 Device Restrictions – bring all devices under one umbrella. BYOD devices may need some waiver, but they must pay the price by having
limited access that accompanies the waiver!
Service Level
 Health Information Exchange (HIE)
 VPN, SSL/ TLS, WPA/ WPAs
 Stick to the Industry Standard transmission methodologies such as Local only networks, Private networks.
Solution Level
 Crypto Architecture (Encrypt/ Decrypt)
 Runtime Frameworks, Integrity
 De-identify data (Protect Privacy), Enforce that authorized personnel to handle the data must be CITI certified (Or equivalent certifications)
 Secure Authentication Framework
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28. Security Challenges/Best Practices
 Security is everywhere!
 Stick to Device Capabilities
 Use Industry standard
solutions instead of re-
inventing new
 Educate technical staff to
acquire HIPAA, CITI certificates
 Build robust access and audit
mechanism in the solution
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29. Mobile EHR Trends
1
Phasing EHR Functionality to Mobile Platforms
Formulating a Development Strategy
2 Building the Right Team
UX Considerations
Security Challenges/Best Practices
3 Representative Case Studies
4 Q&A

30. Mobilizing Electronic Healthcare Records
Requirements Solution
 Access to vital patient  Patient Summary
information away from the  Messaging System
office  e-Prescribing
 Communication between  Schedule
care teams  Managing Rooms
 Mobile ePrescribing  Charge Capture
 Reliable Documentation at
point of care/out of office
 Enable productivity – task
lists, lab results
 Charge Capture
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31. Mobile Chronic Disease Management Solution
Requirements Solution
• Develop a “patient coach” that WellDoc Diabetes Manager
guides patient with care • Patient Coach/Mobile App
• Develop unique • Expert System
messages/prompts based on • Decision Support
health status • Integrated with EMR
• Support data entry with
educatonal content
• Deliver feedback to patient,
physician, utilization managers
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32. Mobile EHR Trends
1
Phasing EHR Functionality to Mobile Platforms
Formulating a Development Strategy
2 Building the Right Team
UX Considerations
Security Challenges/Best Practices
3 Representative Case Studies
4 Q&A

33. Questions ?
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34. Thank you!
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