Mobile communications in healthcare: An ever-changing landscape
Technology is accelerating at an exponential rate never seen before. During the 19th century, there was more technological change than in the previous nine centuries combined. In the first 20 years of the 20th century, we made more advancements than in the entire 19th century. Now, these shifts happen in just a few years’ time. Communications in healthcare is no exception. We conducted our first survey on mobile communications in healthcare in 2011. At that time, the state of smartphones in healthcare required organizations to develop and establish clear mobility strategies. Our survey largely focused on understanding those strategies—what they included, who was involved and the role bring your own device (BYOD) policies played.
As a reminder, in 2011:
- The U.S. Supreme Court agreed to hear arguments to determine if elements of the Affordable Care Act, signed into law in 2010, were unconstitutional.
- Many healthcare organizations were undergoing intense work on their electronic health record systems (EHRs) to meet the incentives of the American Recovery and Reinvestment Act.
- Only 38% of healthcare organizations had mobile technology policies.
- A short four years had passed since the introduction of the Apple iPhone in 2007, which launched the smartphone revolution.
- Just 35% of Americans owned smartphones (now, in 2019, that number is 81%).
- Mobile use among older generations was modest. In 2011, only 25% of Boomers owned smartphones. In 2019, 79% of U.S. adults ages 50–64 and 53% ages 65+ own smartphones.
As healthcare, technology and their intersection has drastically changed since 2011, so too have our survey questions and goals. In 2019, as mobile devices are more firmly rooted in healthcare organizations and strategies are well-developed and implemented, our focus has shifted to the “next phase” of mobile communications in healthcare—the biggest opportunities, ways to include patients and families, and understanding where mobile devices are invaluable. In our ninth annual survey, we seek to understand where mobile communications are in 2019, the plans healthcare professionals have for the future and how responses have changed over time.
Spok collected online responses in June 2019. In total, 460 healthcare professionals across the U.S. participated. The participants covered a wide range of roles—38% of respondents were physicians, nurses, or other clinicians; 21% were IT and telecommunications staff; 10% were executive leaders; and 7% were clinical application staff. The remaining 24% included business analysts, pharmacists, and roles related to patient services.
For the first time in the history of our survey on mobility, more than half (59%) of survey participants were either clinicians or IT and telecommunications staff.
Who uses mobile devices in healthcare in 2019?
It likely comes as no surprise—a large majority of healthcare organizations permit mobile device use for hospital staff. Physicians were selected as the staff most often permitted to use mobile devices at 90%, followed by administrators (84%), nurses (79%), and IT staff (76%).
The same is true of nonclinical staff who rely on a variety of devices to perform their work. Survey respondents reported nonclinical staff use pagers (53%), smartphones (17%), Wi-Fi phones (13%), voice badges (6%), and tablets (4%). Of the 7% who selected “other,” many were unsure what devices were used by nonclinical staff.
Which hospital staff members are permitted to use mobile devices for work purposes at your organization?
Nurses have the biggest change over time in smartphone use.
In 2011, 53% of nurses reported using smartphones. That number has jumped to 79% in 2019 (assuming nurses who are permitted to use mobile devices do use them).
What types of devices are supported?
Survey respondents report their organizations support a variety of mobile devices. In 2019, smartphones are supported by 75% of organizations, and 75% of organizations support at least one type of pager. Sixty-four percent support Wi-Fi phones, 55% tablets, 19% voice badges, and 10% smartwatches.
New devices introduced in our survey since 2011 include smartwatches, voice badges, and encrypted pagers. In 2017, encrypted pagers became a device option. Now, it’s a device supported by 27% of organizations.
Though still the least-supported device in 2019, smartwatches have seen steady increases since their introduction in 2015. In 2015, smartwatch usage was supported by a mere 4% of organizations, and has jumped to 10% in 2019.
The role of pagers
Though communication devices in healthcare have shifted since our first survey in 2011, pagers continue to show their relevancy year-over-year. 2019 was no different.
Nonclinical staff depend on pagers
At 53%, more than half of nonclinical staff—including housekeepers, transport technicians, dietary staff, etc.—use pagers as their primary communication device for work. The remaining 47% use a variety of devices as their primary communication device, including smartphones (17%), Wi-Fi phones (13%), voice badges (6%), and tablets (4%). Of the 7% who selected “other,” many were unsure what devices were used by nonclinical staff.
Pagers still have the best coverage
The survey participants selected the coverage area for paging networks as “excellent” or “good” more than any other option, at 65%. Wi-Fi networks followed at 62%, and cellular networks at 51%. Only 7% said paging had “fair” or “poor” coverage, compared to cellular networks at 15%.
Pagers are still widely supported
When asked which types of devices their organization supports, 75% of respondents selected at least one type of pager. The most common type of pagers supported is onsite pagers (57%), followed by wide-area pagers (40%) and encrypted pagers (27%).
In what activities are mobile communication devices essential?
As a new question in 2019, we asked respondents to identify the essential functions of mobile communication devices. Almost 80% identified communicating with care team members as essential, followed by delivering real-time clinical information (67%), receiving actionable information, such as nurse call alerts (67%), and sending and receiving protected health information (60%). Almost half also identified sharing information from the EHR as essential. The activity identified most often as not at all important was providing real-time web-based education for clinical staff (21%).
What mobile communication challenges do healthcare organizations face?
Hospitals are making progress in improving the challenges they face in mobile communication. Since 2016, respondents noted improvements across the board in areas such as infrastructure, data security, and compliance. However, the results indicate there is still room for improvement, with Wi-Fi coverage still a challenge for 47% of respondents. Some respondents reported having no challenges in mobile communications, at 11%.
In 2019, we added an option about consumer messaging apps (iMessage, WhatsApp, etc.) for use in patient care coordination. Almost a quarter of respondents indicated this is a challenge. This suggests that although hospital guidelines generally prohibit the use of consumer apps to protect patient health information, hospital staff are still using them.
What challenges are you experiencing with mobile device usage at your hospital?
In case of an emergency when cellular networks are down or overloaded, most (60%) respondents identified using overhead paging as a backup plan, followed by in-house paging (40%). Approximately 20% did not know what their backup plan was in case of emergency.
What backup plans for communication are in place for when cellular networks are down or overloaded?
Interestingly, though 60% of respondents identified overhead paging as a backup plan, it was also the option most frequently chosen to have poor reliability among communication channels for sharing clinical information, with 9% reporting “poor” reliability on a scale from poor to excellent.
Overall, a stable environment
Consistent with respondents reporting no challenges with mobile communications for the first time, the majority of respondents also feel the speed, ability to reach others, and information quality had either stayed the same or improved in the past year, which is another indicator of progress.
How does the future look?
When asked about the future in mobile communications, the survey told a story of varying priorities and strategies. The results of the survey did not show one consistent trend or clear vision for the future of mobile communication in healthcare.
The future: Secure texting?
Though most (56%) of the respondents have a secure messaging/texting solution, of the 44% who do not, 57% are evaluating one. If those who are evaluating a solution implement one in the near future, 81% of all respondents would have a secure texting solution at their organization.
The future: One of many opportunities?
The healthcare professionals who participated in the survey varied on their goals for mobile communication in the next 3–5 years. There is not one trend that stood out among the various options. Implementing secure text messaging, improving communication between devices and the EHR, and improving Wi-Fi coverage all received equal weight, with each option selected by 25% of healthcare professionals. Only 6% chose improving business continuity planning as the biggest opportunity.
The future: Mobile communications and patient engagement?
We asked when mobile solutions will be used to communicate information with patients and families, including patient chart access, appointment reminders, secure messaging, bill pay, and wayfinding. If respondents don’t currently offer these services, they often had no plans or were unsure about a timeline for implementation, suggesting extending mobile communications to patients and families is not a top priority at this time.
Timeline to extend mobile solutions to patients and families
When we started our survey on mobile communications in healthcare in 2011, it was impossible to anticipate how quickly healthcare organizations would use mobile communication technology to improve efficiency and outcomes. In 2019, healthcare professionals reported more use, fewer challenges, and varying strategies on what’s next for mobility in their organization.
Infrastructure as a challenge
As the priorities and emerging challenges in healthcare shift, no one can say for certain how mobile communications will evolve in 2020 and beyond. The results of the survey suggest continued room for improvement exists for Wi-Fi and cellular network infrastructure. Though organizations report fewer challenges with Wi-Fi and cellular coverage than in previous years, progress has been slow. Wi-Fi coverage is still a challenge for 47% of respondents (a decrease of 8% in three years). Similarly, 39% reported cellular coverage as a challenge (a decrease of 7% in the same period).
Do challenges impact patient communication?
These consistent challenges in coverage may influence the uncertainty around extending mobility solutions to patients and families. Most respondents had no plans or were unsure about implementing mobile solutions outside of their staff in areas of patient chart access, secure messaging, bill pay, and wayfinding. Only appointment reminders were selected as currently being implemented (37%) more often than having no plans or unsure of plans (34%).
Protecting patient health information
As we reflect on the history of mobile communications and work to understand the future, there remains one necessary commitment—to protect patient health information. No matter how patient care coordination may shift, it’s crucial these changes keep the protection of patient data at the forefront. With 23% of respondents reporting staff use of consumer messaging apps (iMessage, WhatsApp, etc.) for patient care, it’s imperative these organizations address the security risks of these apps.
Though mobile devices are now firmly rooted in hospitals, challenges still exist—particularly in infrastructure, expanding to patients and families, and protecting patient health information. We are certain healthcare professionals will continue to work tirelessly on these challenges to improve patient outcomes and make technology decisions that will escalate the quality of care.