Joseph R. Grajo, M.D.

1. Joseph R. Grajo, M.D. Chief Resident University of South Florida

2. Education

3. The “Millennial Learner” • The term “millennial learner,” is an umbrella term referring to students who turned 18 in or after the year 2000. • Many of these students may be more familiar with learning via electronic media than with printed media. • Consequently, more educators are adapting to fit the unique needs of these learners.

4. E-Books and Journals • Mobile computing offers cutting-edge educational opportunities for resident physicians as well as practicing radiologists. • Unlike printed media, these e-materials contain high quality digital images, are often updated with current information, and are readily accessible.

5. E-Books and Journals • Tablet computers offer more than just portability and accessibility of traditional content; they offer the significant advantage of dynamic images. • A journal article of the future might not contain just static ultrasound images through the liver, but rather a stack of Doppler images showing blood flow in the portal vein.

6. Continuing Medical Education • Educational tools accessible using a mobile platform would be a useful adjunct to tools available on desktop computers. • Educational modules with CME quizzes on mobile devices could be accessed during commutes on mass transit or other travel, allowing for productive use of travel time and minimizing time spent on CME while at home.

7. Resident Assessment • Faculty could immediately document resident assessment in required ACGME Core Competencies and Radiology Milestones. • Resident peers, patients, and nurses or technologists could also contribute to “360 degree evaluation.”

8. Online Teaching Conferences • Faculty and residents are often scattered at numerous institutions, limiting active conference participation. • Applications such as GoToMeeting allow for active participation in educational activities and help foster collaboration. • Mobile platforms could allow for dynamic datasets in lieu of standard static images.

9. Procedural Training • New software has been developed to utilize accelerometer of cell phones to help train US-guided needle skills. • Similar products used to improve spatial and anatomic awareness in ultrasound. • Hands-on training using mobile devices may allow for more rapid acquisition of physical skills needed for patient care.

10. Social Networking

11. History • Social networking has evolved from college student “guilty pleasure” to mainstream media sensation. • Utilized in presidential campaigns and institutional promotion (AUR, RSNA, ACR) • Readily accessible via “apps” on smart phones and tablets

12. Social Networks • General ubiquitous forums • Facebook, Twitter • Professional platforms • LinkedIn • Radiology-specific sites • radRounds, Radiolopolis

13. “Mobile Consultant” • A concept that has transformed from theory to reality across specialties as the need for instant access to subspecialists has grown • Could be utilized on several levels • Resident to Attending • General Radiologist to Subspecialist • Community Radiologist to World Expert

14. Potential Applications • Research Meetings (Skype, FaceTime) • Education (Podcasts) • Teaching Files • Real time language translation • Translation of foreign documents/reports

15. Limitations • Fear of litigation • Potential loss of confidentiality • Possibility of decreased productivity

16. Patients

17. Increase in Mobile Technology Use by Non-Physicians • As EMRs are implemented, there is a push for integrating the patient into the healthcare network. • Patient care information systems (PCISs) are broadly defined as applications that support the health care process by allowing health care professionals or patients direct access to scheduling, order entry systems, and medical records including imaging reports.

18. Increase in Mobile Technology Use by Non-Physicians • 2011 Nielsen survey • More than half of 18-34 year olds owned a smart phone • More than 5.6 billion people worldwide were using cell phones and smart phone purchases had outpaced computers

19. Increase in Mobile Technology Use by Non-Physicians • A 2011 Manhattan Research survey • 81% of surveyed physicians used at least one smart phone • 75% had downloaded at least one application • 30% were using an iPad to access electronic health records, view images, and communicate with patients • Research suggests that the market for mobile computing devices in the healthcare market is set to go from $100 million in 2011 to $1.7 billion in the year 2014.

20. Clinic Logistics • Online patient scheduling is now being offered at an increasing number of healthcare facilities in an effort to increase efficiency and improve patient satisfaction. • Digitally-literate patients are expected to find this experience similar to online reservations for airline tickets, hotels, and restaurants. • For example, a patient requiring a CT scan could schedule using a mobile device as they leave the physician office. This could initiate precertification and send a screening questionnaire regarding contrast allergy or pregnancy.

21. Clinic Logistics • Appointment confirmation automated via email and received by a smart phone or other mobile device could save money. • Using a digital model, patients can notify the clinic of their intentions to keep the appointment by confirming or cancelling with just one click via an email hyperlink or via a dedicated healthcare portal.

22. Clinic Logistics • A patient could even be called from the waiting room on a tablet or their personal mobile device. • Satisfaction surveys could also be entered on these same mobile devices at check-out or electronically sent to the patient.

23. Imaging Results Communication • Patient portals for accessing imaging results may be integrated with the organizational EHR, which facilitates medical record documentation of communications. • Once the patient has a diagnosis, he or she could read a lay description of the disease and possible treatments.

24. Imaging Results Communication • For example, if a patient receiving an abdominal CT is found to have a hiatal hernia, this result and even the images could be published instantly. • Furthermore, the patient could be provided a link to educational information about reflux and hiatal hernias. • The Mayo Clinic has already developed such a database of disease information intended for patients.

25. Potential Pitfalls • Comments such as “limited by body habitus” may have to be removed entirely due to the potentially inflammatory response. • Care should be exercised when informing patients about potentially devastating results such as a new cancer diagnosis. • Age and socioeconomic disparity regarding desire for and access to electronic reports

26. Patient Education and Compliance • Empowering patients with mobile technology could increase patient adherence as well as improve overall health outcomes. • For health care practitioners, the use of mobile IT can bring additional resources to the point of care and can change the location of that point of care.

27. Portable Electronic Medical Record

28. Mobile Alerts • Physicians can use mobile technology to counsel patients via mobile alerts. • For example, Aetna and Columbia University dentists worked together to develop a smoking cessation program built for the iPad.

29. Mobile Alerts • Radiologists could offer the same type of education and empowerment by encouraging patients to learn about their disease process and management. • For example, if a patient with a small lung nodule is recommended to return in 6 months for a follow-up CT, the patient would have already seen their images, report, and recommendations for follow-up.

30. Home Physiologic Monitoring • Small handheld devices that monitor patient vitals and other health information usinga smart phone as a reader are likely to become mainstream within a few years. • Potential Radiology Applications • Pulse (cardiac CTA) • Blood glucose (PET) • Blood pressure (pre-procedure)

31. Barriers to Acceptance

32. Barriers to Acceptance • As with all new technologies, there will be many technological and social challenges that need to be addressed. • Barriers to early adoption for patients and physicians include availability of necessary hardware and software, a lack of familiarity with the technology, fears about information security, and standardization across healthcare networks.

33. Availability of Needed Technology • Among the first barriers to overcome • Coordination with the hospital’s informatics department is crucial as new technology must be validated and training and support provided. • In addition, there will be an upfront cost to purchase any new equipment or commercial software.

34. Familiarity with Mobile Technology • A lack of familiarity with an online health portal could hinder utilization by patients. • However, Kaiser Permanente has reported that 63% of its eligible membership have used their online health portal to review lab results, order prescription refills, and even email their provider. • US Census Bureau found that the one of the most common reasons to access the internet in all households was to search for information about healthcare.

35. Standardization of EMR Information • Medical imaging has been a pioneer in the standardization of medical records with DICOM -the accepted format standard for nearly 30 years. • Since images are transmitted in this universal format, standardization should not be a problem. • However, each healthcare system may have a different EMR or RIS, which will present barriers to reporting findings or accessing a patient’s history. • This will likely limit the application of mobile computing in radiology to those providers within a single healthcare system.

36. Strategies For Success • Healthcare organizations must provide effective methods such as strong access controls both at the device and network levels to secure identification and authentication, and allow systematic auditing. • The safest strategy is to allow applications to view data locally on the mobile computing device but not permit the storage of sensitive data without strong encryption.

37. Strategies For Success • Due to the complexity of regulatory compliance, it may be convenient to contract implementation and support to a company with experience in deploying and maintaining medical networks. • Ideally, this contractor would also be able to provide a contract that clearly delineates the negotiated costs and details of responsibility sharing for cost overruns or project delays.

38. Strategies For Success • Business plan will have to show quantifiable benefits so that opportunity costs can be evaluated • Compelling metrics should demonstrate improved equipment utilization, decreased cost, and improved quality • Decreased turn-around time • Increased availability of subspecialty reads • Perception of accessibility to ordering physicians

39. Mobile Computing For Facilitating Radiology Communication