Tuesday, July 28, 2015

Deploying the mobile radiology service

Dr. Marc Kohli
Dr. Marc Kohli is Assistant Professor of Radiology and Imaging Sciences and Director of Informatics at Indiana University in Indianapolis. The radiology department has 106 faculty radiologists providing services at five sites along with evening teleradiology services. In addition, the program supports 15 residency slots per year with four residency classes and a number of fellows. Dr. Kohli specializes in abdominal imaging, informatics, research and education support. As part of his education function he manages the mobile-device program for the residents. He recently spoke at SIIM 2015 about implementing the mobile device program at IU. In November he will begin a new position as Director of Clinical Informatics in Radiology at the University of California San Francisco.

Q. How are you using mobile devices?
A. We use them for a couple different things. The biggest one is the distribution of literature, and book material. Our university library gives us access to about 16 GB of books that we can easily distribute without requiring each user to manually find and add each book individually. And the other thing I use quite a bit is the PACS application on my iPad. I do biopsy procedures and a lot of times patients that come to me haven't seen any of their imaging, so I take that opportunity to go through their imaging.
Being the imaging expert, I have found that to be very rewarding, and the patient feedback has been fantastic.

Q. Do the residents also use the iPads for patients or is it primarily for the literature resources?
They do, in fact there is a resident who is talking about starting a new consult rotation in the Emergency Department where they would use one of the department supplied iPads to show and explain imaging studies to ED patients during their visits.  We believe that this could also be useful when radiology residents are integrated into clinical rotations.

Q. Is it tied into the PACS system, or is it just a log-in?
The iPad app is provided by our PACS vendor via a specific mobile server that retrieves the data from PACS and displays it on the iPad. One of the benefits of that setup is that there is no residual protected health information that resides on the mobile device. From a security perspective that is really attractive. 

Q. Is that one of the things you were looking for when evaluating the system?
A. Yes, definitely that is one of the things we found to be really useful. We were lucky that our PACS vendor supplied such an easy-to-use mobile solution. There are other third party companies that have similar features, but our vendor already had it in place before we had the tablet program.

Q. What prompted you to implement a mobile device management system?
A. The opportunity to hand a trainee a resource that has all the materials that they'll need throughout their training that is already set up and ready to go is something we thought would be really valuable. All of us have tons of resources available to us, but the issue is trying to synthesize them together into a manageable tool. We saw an ability with a mobile device to do that once and give that benefit to all of our trainees.
Additionally, while we have a strong reputation as a residency program, Indiana is a difficult place to attract top candidates.  We wanted to have our tablet project as an enticement to get the best and brightest residents to come to Indiana. We made the investment in tablets to compete for higher-level applicants.

Q. What was the mobile device management (MDM) tool you chose and why?
A. Our first decision was a mobile platform: Apple vs. Android.  If you look at the numbers, more physicians use Apple than Android devices and there are more high-quality applications for Apple than Android so we decided on Apple iPads. The MDM technology allows us to do things like set policy, preconfigure email addresses, deliver applications and content. I can buy applications at the institution level and deploy those out to individual devices without having to try to give a resident a gift card to allow them to download a new piece of software.

We use mobile device management product VMware Air Watch because it’s provided by our University IT team. It was a benefit to us to go with that product because it was free to our department to use internally. We use it to manage the security policies on the devices, make sure they have passcodes, make sure they are adequately encrypted so that we can mitigate any risk from loss or theft. 

Q. Is this coordinated through the PACS or is it something you administer yourself?
A. No this is something that myself, and one of the other physicians here, named Aaron Kamer, put together. The overhead to do this is fairly low. The PACS application existed before we had the department-supplied iPads, so it is really a matter of installing an app. We do leverage all the system-wide services, there is no special login for the PACS client, it is the same as the residents use for their work everyday.

Q. Are there any other features that were particularly attractive or useful?
A. The one stop shop is the biggest selling point, the ability to hand a resident a tablet and say every book that you'll need is on here is huge. The other major benefit with our mobile device management is that it allows for business use and personal use in a side-by-side fashion. So each user can use their App Store with their personal ID and buy and install personal apps. At the same time we can also install institutional applications and they kind of live in harmony on the same device, which has been a major benefit.

Q. Were there any other challenging obstacles that came up during deploying these?
A. If you are thinking of doing this you need to have a user agreement in place that spells out the user’s rights and responsibilities. That was helpful because one of our residents left his iPad on an airplane and had to replace it. These are department-owned devices that they are allowed to use while they are trainees but they are responsible for them.

Q. Do you have the tracking deployed so that if someone does lose it you can find it?
We do, but the limitation with that is that our iPads are harder to track than iPhones because they don't have a built-in data connection, so they have to be connected to a known WiFi network in order for the location tracking to work. If you have a passcode on it, and everyone has to have a passcode, unless it connects to a network that it knows, you are not going to find it. 

Q. Have there been any interesting or unexpected outcomes?

A. I see a lot of them around the department, and in conferences so I know people use them. One side benefit has been that it makes it easier for us to use audience response systems, like diagnosis live or poll everywhere. It’s really been a great improvement to our mission.

No comments:

Post a Comment