As I contemplated writing this piece over the past few months, I had generally assumed that I would be reporting on the overall goals of the Patient-Centered Care and Portability working group, but this month a topic came up in the weekly call that seems so important that I decided to focus on it. The subject is one that I had heard nothing about, has not been covered in the non-medical media at all, and has had minimal exposure in the medical journals – the high probability that mobile physical technology devices, laptops, cell phones, tablets, may become reservoirs of infectious agents (fomites) and actually spread disease while being used in healthcare settings.
This came up during a discussion of why there appears to be a backlash against the use of EHRs in some places, so much so that it has its own Twitter hashtag, #EHRBacklash. As the group was talking about how the objections of some patients to their physicians’ interaction with a computer during office visits, a few people provided anecdotes about how care has changed, including the fact that doctors no longer wear ties when doing exams, after it was proven that they were liable to spread infection. Our addictive and ubiquitous smart phones have the potential to be even more dangerous. They go with us everywhere, we touch them frequently and put them down and pick them up in all kinds of places, and don’t think twice about it. In fact, a 2011 study by Jackson & Coker, a healthcare staffing firm, found that four out of five physicians regularly use mobile devices for medical purposes. (Jackson & Coker Research Associates. Special Report: Apps, Doctors, and Digital Devices. Jackson & Coker Industry Report; Volume 4, Number 7. September 2011. http://industryreport.jacksoncoker.com//physician-career-resources/newsletters/monthlymain/des/Apps.aspx.) One can only surmise that the ratio is likely to be higher now.
This led into a discussion of how many healthcare organizations are struggling with the desire of providers to BYOD (bring your own device) into the workplace and connect wirelessly to the network. If you google the terms ‘mobile device’ and ‘disease,’ you get a whole list of links having to do with tracking the spread of infectious diseases, but not much having to do with actually spreading the diseases. The combination of ‘BYOD’ and ‘health’ results in a slew of articles about network security, concerns about lost or stolen devices, and data breaches, but nothing (on the first several pages of results, anyway) about health impacts. This a problem and the conversation in the HIT vendor and user communities needs to include the use of prophylactic measures to ensure that our mobile devices don’t become the undoing of all the positive aspects of electronic records.
I recently had an appointment with my primary care provider and was given a survey prior to being seen in which I was asked to observe whether or not my doctor and the staff washed and/or used hand sanitizer immediately before and after examining me. My doctor did use sanitizer right before the exam, but went back to the laptop to make her notes without using it again. If I had had an active infection, the probability of transferring an infectious agent to the keyboard would have been high. I don’t know whether the keys are regularly disinfected, but I would guess they aren’t.
So, what do we do with hundreds of devices in a hospital that are carried in pockets, set down on counters, tables, and trays, and checked multiple times a day for schedules, messages, or consulting patient charts, and then, potentially taken back to the user’s home environment? Laptops are bad, with numerous places where contaminants can lodge and accumulate, including inside the case. But how about smart phones and tablets that might be handed to a toddler to keep him amused in a restaurant or car seat? At a minimum, providers should be trained to use disinfectant wipes on their devices at least as often as they wash or sanitize their hands. Frequently used chlorhexidine wipes are a possible solution, except that they can cause unpleasant reactions in people with sensitivities. Better yet would be ‘gloves’ for the devices – sterile sleeves to slip on and change frequently. In a hospital setting, protocols, such as a UV light ‘bath’ like a TSA screening station, to ensure that all personal devices – even those not being used for medical purposes – are clean coming into and leaving the workplace, should be in place. Those of us invested in using technology to improve healthcare outcomes and empower patients are as responsible as care providers to anticipate and ameliorate the risks that come with that use of technology, and it’s not just in cyberspace that viruses lurk. Let’s make sure that our clients look at the outside of the box as well as the contents as we implement systems and train users.