Mobile applications in healthcare are taking off. What does ChipSoft do about app development? What can we expect, and what will the situation be, say, 5, 10, or 20 years from now? Heading towards a mobile future, we ask Mobile Development team leader Björn Sjunnesson to reflect on the past and peer into his crystal ball.
First a quick look in the rear-view mirror: can you tell us something about what it was like when ChipSoft first started developing apps?
We launched our first app in 2015, one designed for medical specialists. We wanted to prove to ourselves that we were capable of developing an app. And we succeeded. Initially, HiX Mobile Specialist was designed as an app to allow the user to access and view EHRs, but it currently offers many more features, such as ordering laboratory and radiology tests. The app is becoming increasingly popular. Many physicians on night or weekend duty prefer to look at the app on their phone when they receive a message or notification, rather than having to get up to dial in via their computer. In the meantime, we have also released apps designed for nurses, home care, and the sterile services department (CSSD).
Is the implementation process of apps a complicated one?
Implementing apps in a hospital is more challenging than is often thought. It's not as simple as downloading an app from the app store and you're ready to go. Ensuring that an app meets the safety requirements of a hospital, where the app connects to patient data, that takes time. Much time and effort goes into matters such as privacy and network security. It's nothing like downloading a weather forecast app onto your phone.
To many technical managers, this is uncharted territory. For years, they have been responsible for a specific type of server park and work stations, and now suddenly they have to work with something they have not been trained for. Together with our partner Microsoft, we are looking at ways in which we can lower the threshold for this implementation process, making it more accessible for those unfamiliar with this kind of process.
What are some of the major developments today, regarding the use of mobile devices in healthcare?
Most prominently, 'mobile' allows for new use cases. With an EHR at the point of care, healthcare providers also have access to important patient information outside the walls of the healthcare institution, at home, or en route.
In addition, we can see that, all around the world, healthcare is experiencing a shift. In order to make healthcare more affordable and more efficient, work process optimisation is always under consideration. This is now supplemented with additional options. This change is in line with the changes in our private lives regarding the use of mobile devices. Society, as a whole, is increasingly focused on mobility. Here too, issues as privacy, clear user interfaces, and fast delivery of software play a significant role. Much of what people see at home - with applications such as Facebook and WhatsApp - they also want to see in the healthcare processes. By using certain apps, for instance, people have become accustomed to communicating very briefly. Now, healthcare providers also want this for their work. Mobile solutions create new opportunities to think about simple and fast registration. It should be noted, however, that certain reports simply have to meet specific requirements.
In some circumstances, healthcare providers don't necessarily need a large screen with all features of the EHR. They may be able to manage perfectly well with a 'slimmed-down' piece of software, which would meet their requirements at that specific time and on that specific location. Such may be the case if they are on duty and have to dial in remotely.
Are we still able to support all of this with the current devices?
The size, shape, and design of a device, as well as the layout and position of the major components -the form factor- will play an increasingly important role. Currently, mobile phones, tablets, and smart watches are the main players on the field. There have been attempts to introduce other form factors, such as certain types of smart glasses, but none have quite hit the mark yet. New form factors are introduced and presented continuously. We monitor these closely and review their potential added value to the healthcare provider and the healthcare process.
Have you also considered working with voice commands?
I think we are heading more and more in that direction. It is clear that voice-controlled solutions such as Alexa and Siri are becoming increasingly intelligent, and rapidly so. However, one of the biggest challenges for healthcare is that voice solutions would absolutely need to be faultless, as people's lives are involved.
What progress has ChipSoft made with the development of these types of solutions?
We are continuously looking for and developing new possibilities. This includes speech recognition. We're also working on speech recognition in combination with mobile devices. The user would then be able to work hands-free and give a voice command to a new type of device, which then communicates with a mobile phone in the user's pocket. In turn, the phone gives feedback to the initial device, including a request for verbal confirmation that this is the correct command. Only upon spoken confirmation will the verbal command be used for registration in the EHR. This is an example of a concept that will need to be considered and developed much further, but it gives an idea of where healthcare could be headed.
Is this being developed jointly with doctors and nurses?
Yes, we always involve all stakeholders in the development of new functionalities and we have a 'panel' of consultants to advise us. We also visit our clients at their request to map out the mobile/ambulant processes together. Think of the work carried out by the nursing staff: they are continuously rushing to check a workstation or COW (Computer on Wheels) for their next task, then carrying out the task, and then having to go to yet another location to register the task. They cover many kilometres a day. If an app could replace the desktop or COW, which they currently depend on, it would save them a lot of time. What's more, record keeping would be safer because nurses could make entries directly at the point of care, rather than being forced to memorise everything until they find an available COW or computer.
So IT support changes along with the process?
Yes, process change and mobile development go hand in hand. Going mobile causes you to look at process automation in new ways, as we are restricted to time and place less than ever. This leads to new forms of IT support. Take the sterile services department: we started with reactive support via the app — tracking of used instrument sets — but we're moving more and more towards proactive, guiding support. This means the device would say: "I'm expecting this instrument set at this location. Is that correct?" By only having to confirm this with the barcode scanner, not only are you are able to work faster, it would also make the work accessible to less specialised staff. This gives you more flexibility in hiring employees. That's an additional advantage.
What other developments are you expecting to see in the near future?
I expect the shift to mobile working to become much more pronounced over the next five years. In addition, there is an increasing focus on personalisation and connection with specialty-specific activities. I expect that we won't be needing the COW for unplanned rounds, as pain scores and measurements can easily be recorded at the bedside through the app. For some planned rounds, however, the COW will still be required because you need the trolley at that point anyways to bring medication to the patients. But you can always take a tablet on the trolley instead of a desktop, of course. That provides a little more freedom of movement. Another great addition would be an in-app search function, allowing you to search for a specific colleague. Imagine you're doing your round as a nurse and you need the cardiologist on duty straight away. Wouldn't it be great if you could see per role who is currently on duty so you could then quickly get in touch with them? I don't know whether this is something all healthcare providers are waiting for— we still have to find out — but this is a potential next step in the development.
Does the emergence of the cloud create new possibilities?
Our goal is for healthcare institutions without a large IT department to be able to use our apps as well. We're already able to support that by providing the infrastructure and pre-configured content from the cloud. We're currently also looking at ways in which we can expand this, with options such as Mobile Application Management and conditional access. This would lower the threshold for such healthcare institutions. The "necessity" for a large IT department will decrease when elements are moved to the cloud. For example, healthcare facilities would not need to purchase hardware that has to be hosted and managed locally. The cloud also facilitates process elements, storage, and logic. If we capitalise on this development, small healthcare institutions will also be able to benefit from our integrated apps. In that sense, the cloud is an improvement. It's a new phenomenon that everyone in healthcare will have to get used to, but it certainly offers potential.
And what if you look beyond those five years?
In five years, I would put on my Star Trek glasses and be surrounded by a kind of AI consciousness. My IT environment will know exactly what I am doing and working on. In addition, the AI provides me with customised information. That may sound very sci-fi, but if you have enough screens around you that can "see" what you're doing, provide the data relevant to you at that moment, and automatically respond to what you want, then you have a virtual environment in which you can always work, without you even needing to use your hands. Wouldn't that be fantastic?! It's evident that an increasing number of technological innovations are put to use in the field of healthcare. These days, everyone has access to an excellent camera and microphone on their phone. You couldn't have imagined that ten years ago. Right now it's all about process change. We, ChipSoft, don't change the processes, but we do respond to them and we help wherever we can. Process change and mobile development go hand in hand; we help to facilitate the process change and the process change pulls us into that adventure. Isn't that great?
Has ChipSoft already started working on the scenarios you just outlined, with your Star Trek glasses on?
Yes, but it's still in its infancy. Among other things, we are conducting experiments in which the sensors and the device enable us to determine what someone is doing, where, and for what reason. If you combine these types of applications with a strong back-end that knows what you are doing and what you need in terms of information – whether you call that AI or machine learning – then you have a formidable solution. We're putting careful thought into that.
To conclude, let's turn back to the apps. Will ChipSoft be releasing any new apps soon?
Yes, we'll soon be launching our nutrition app, HiX Mobile Nutrition. This allows the dietician to record meals together with the patient. We'll also continue to develop our existing apps. What I personally have high expectations for is the integrated pain score and EWS registration in HiX Mobile Nursing, and the lab and radiology ordering via HiX Mobile Specialist. Ultimately our aim is to have relevant apps for each target group, which provide the user with the right options at exactly the right time.
Get a feel for HiX Mobile by watching the video abomut HiX Mobile for Specialists:
