Bring-Your-Own-Device is not the cure; it’s the disease

The reversing fortunes of Research-in-Motion and Apple over the last few years would seem to mirror a trend in enterprise: People are rejecting their employer-provided gadgets in favor of using their own Apple or Android smartphones. It makes a certain amount of sense that people would want to use devices at work with which they are already comfortable using in their private lives. And while IT departments have to scramble to meet security requirements, Apple at least has shown a new enthusiasm for enterprise support.

But there are several reasons this trend may not work for hospitals.

First and foremost, while businesses rely mostly on secure e-mail and calendar functions, hospitals use a dizzying array of applications with incredible complexity. There are both technical and philosophical reasons why these applications cannot be easily ported to mobile devices. Technically, this requires vendors to release software in an operating system with which they have no experience. Philosophically, it requires large organizations to completely re-imagine how users interact with data. The first problem can be overcome with a huge supply of man-hours, while the second cannot easily be overcome by any large organization.

The iPad is an exciting new form factor, and there has been unprecedented enthusiasm among doctors to bring the devices to work. They see how easy and elegant it is to check e-mail, flick through photos and do so many other tasks that they naturally assume it was the iPad that led to these workflow enhancements. In reality, it was never the hardware, but Apple’s software navigation paradigm that led to the new efficiencies. Doctors have been trying to use hardware to solve a software problem. They have been demanding to connect their iPads, and since most of the big vendors have not released any native iPad software, IT departments are virtualizing the desktop applications on iPads –which leads to the dreaded pinch-and-zoom. This creates a truly terrible user experience. Again, it’s not the hardware at fault, but a lack of imagination in how doctors must interact with data in the post-PC era.

This leads to the second major problem with BYOD in healthcare. To provide a good user experience, an HIS vendor would need to develop a native application for each of the major operating systems. Given that many of these vendors have only recently begun to consider physician workflow, it seems unlikely they will provide this functionality soon. They would first need to understand how to build applications that meet the needs of clinicians, and then figure out how to meet those needs in the constraints of mobile devices.

And then there's the security issue. How can health IT departments keep track of all these devices and keep them secure? Can IT departments, already stretched to the brink with meaningful use, really troubleshoot all these different devices and different operating systems? Everywhere I’ve worked, the help desk seemed quite busy enough.

The disease is that both the hardware (stationary PCs or COWs) and the software (point-and-click) are disrupting the physician’s thought processes and eroding the patient-doctor relationship. Doctors have seen incredible potential in mobile devices and are bringing them to work, hoping to get them to work in clinical settings. But that’s a symptom of the disease, not the cure. The cure is for hospitals and vendors to bite the bullet and deliver both the best hardware and best software for the job. Right now, the best hardware is Apple’s iPad, but no major vendor has stepped forward with a commitment to designing native software for it. So the cure is not yet widely available. That doesn’t mean we should settle for just treating the symptoms.

Brian Phelps is an emergency doctor and cofounder and president of Montrue Technologies, whose flagship product Sparrow EDIS is an iPad-based emergency department information system.