Mobile Access to Electronic Health records

Partners HealthCare Systems is providing clinicians throughout its integrated delivery network with mobile access to its electronic health record – a rollout the system achieved in 90 days.

Boston-based Partners HealthCare is an integrated delivery network (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.

The Partners SOA team coordinated pilot project planning and development. 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,” Pappas said.

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 is a U.S. Healthcare Information Technology Standards Panel standard. 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, Pappas said.

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,” said Pappas. “The fact that they’re encrypted devices and were being used by many physicians made them a logical choice for the initial rollout. We also built out the application on the Blackberry and iPad platforms.”

About 2,000 clinicians are using the new mobile EHR, Pappas estimated.

“The mEHR enhances the daily life of physicians by enabling them to be mobile,” he said. “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.”

Partners’ technology experts say the InterSystems platform, which serves a foundation for the Partners Healthcare EHR and for hundreds of clinical applications used by thousands of clinicians throughout the network, made the quick turnaround possible on a project of this scope.

“Partners’ longstanding relationship with InterSystems and extensive use of Caché and of the InterSystems Ensemble’s 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,” said 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.”

The maturity of a related cluster of technologies including high-speed mobile processors, browsers, operating systems, battery, display technology, WiFi, 3G and 4G wireless and service-oriented architecture (SOA) also made the timing right for an mEHR, he said.

“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,” said Paul Grabscheid, InterSystems vice president of strategic planning.