Dr. Shrestha is Vice President, Medical Information
Technology, University of Pittsburgh Medical Center, Pittsburgh, PA; and
Medical Director, Interoperability & Imaging Informatics,
Pittsburgh, PA. Disclosures: Dr. Shrestha is a Founding Member Executive
Advisory Program at GE Healthcare, is on the Medical Advisory Board of
Nuance, Inc., and Vital Images, Inc., as well as on the Editorial Board
of Applied Radiology, and the Advisory Board of KLAS Research.
face it, most radiologists like their technology toys. We are mostly
geeks at heart. Being surrounded by monitors, radiology workstations,
and imaging modalities all day long is just not enough. We have to have
our eReaders to read our journal articles, our smartphones to stay in
touch with friends, family and colleagues, and our tablet computers to
at least appear to stay productive and connected ‘on the go.’
But what about real
work? Are we actually reading studies on our iPads, yet? Is that even
right? Ever since the FDA cleared the first diagnostic imaging
application on a mobile device,1 new diagnostic imaging apps
for smartphones and tablets have flooded the wireless airwaves. The
imaging vendors are on a warpath to develop ways to embrace the mobility
fever and feed the consumer-driven frenzy.
Some may have
expected the mobility frenzy to die down, especially in radiology, where
clearly, most of our actual work really does need a full set of
applications and technologies (eg, picture archiving and communication
systems (PACS), radiology information systems (RIS), computer-aided
detection (CAD), and voice recognition) that can only be provided by our
diagnostic workstations in the reading room. However, the mobile
maelstrom shows no signs of calming. According to Gartner, mobile
computing in 2013 poses more challenges than ever for CIOs who will
struggle with hundreds of new smartphones and tablets, face business
demands for ever-more-sophisticated apps, and fight to secure corporate
information on employee-owned devices. In fact, physicians are 250% more
likely to own a tablet than are other consumers, with 80% of doctors
found to be using smartphones and medical apps.2 Indeed,
mHealth is poised to explode even further. There are about 320 million
mobile phones in the United States, and an estimated 1.7 million
hospital beds—that’s about 185 phones for every bed.2
So, onwards and upwards we go!
Quick, choose two out of the following: Cost, quality, access
is an often-quoted fallacy that from the trifecta of cost, quality and
access, we can at best, just achieve 2 out of the 3. Most health care
executives would never ignore costs, and most clinicians would never
disregard quality. So in this presumed ‘battle,’ access loses out. The
reality of course is that all 3 are critical. Mobility enables wider
access to clinical content, such as information from the electronic
medical records (EMR) and images from the PACS. Indeed, as we push ahead
with the paradigm of coordinated care, access becomes increasingly
important not just for the radiologist, but also for the ordering
physicians, the ancillary clinical staff (eg, radiology technologists,
PACS administrators, nurses) and even for the patients themselves. Especially for the patients.
after all, is a trend that is clearly consumer-driven. And as health
care organizations grapple with enterprise mobility strategies, it is
critical to ensure that patients are not left as an afterthought.
Engaging patients in their own care is critical to ensuring compliance,
and the correct path forward is really in empowering patients with
access to their images and reports, including all priors, as well as
related educational materials around their procedures, medical
conditions, and other support-related, curated medical content.
Embrace mobility with purpose-driven use cases
is futile to “do” mobility just for the sake of checking a box and
moving on. Some imaging vendors choose to do the bare minimum so they
too, can tout that they have access to their content via mobile devices.
While there is tremendous value to simplicity in designing imaging apps
for mobile devices, vendors should place much more emphasis on function
and clinical workflow enhancement. This is true for information
technology (IT) departments and hospitals trying to address the mobility
needs of their groups. As opposed to tolerating radiologists’ demands
to support mobile devices, IT departments should take the opportunity to
look at the solutions as part of a larger enterprise mobility strategy,
not just a departmental one. This is especially true for hospitals and
medium- to large-sized health care organizations.
entire trail of the imaging workflow reveals specific opportunities to
add value in a number of areas—and these include study ordering,
scheduling, study capture, storage, image distribution, interpretation,
report distribution, clinical image viewing, patient education, charge
capture, image sharing, and many more.3 There are also
perfect-fit opportunities for mobility in ancillary support around the
radiology department, such as for technologies, quality control tasks
for PACS administrators, and for scheduling and protocoling. So clearly,
the opportunity is so much bigger than just creating one more app that
no one will really use more than once.
Embracing the mobile form
factor opens up additional purpose-driven use-cases, such as for
reviewing images and related clinical data for stroke management, and
enabling care coordination leveraging voice, video, and more.
Telehealth, too, offers ideal scenarios for mobility, especially in
being able to offer quick consults and wet reads, as well as leverage
the camera or cameras available in mobile devices for engaging patients
and end users in conversation or to snap photographs of external lesions
to further corroborate clinical indications and findings.
care organizations can also leverage mobility to rope in the patients
and ensure that they are able to not just allow for easy access to their
images and reports, but also allow for convenient access to patient
portals and enterprise scheduling tied to the global positioning system
(GPS) on mobile devices. Dispersing relevant patient education materials
and follow-up instructions via mobile devices will also go a long way
to engage the patients in their health.
Mobile devices also offer
a tremendous opportunity to extend workflow beyond clinical desktops
and workstations, allowing for fluidity in workplace collaboration. It
is predicted that by 2016, most collaboration applications will be
readily and equally available across tablets, desktops, smartphones, and
browsers, reinventing the way employees work.4 Done right,
mobile devices could truly leverage unified communication (UC) and
location awareness, enabling collaboration across care teams and
specific to targeted clinical workflows.
is apparently never a dull moment in the market dynamics of the key
mobile device and operating system (OS) vendors. Medical and health care
apps are the third-fastest growing category for iPhones and Android
phones.5 The worldwide mobile phone market is forecasted to
rebound from recent growth standstill, increasing by 7.3% year over year
in 20135 and possibly resulting in more than 1 billion
smartphone unit shipments for the first time in a single year. Google’s
Android operating system remains the dominant smartphone operating
system, with 75.3% of the market, much ahead of Apple’s iOS with a 16.9%
market share. Apple clearly intends to change this paradigm with its
recent announcement of a cheaper phone range and a refresh to their OS
and flagship product. It is predicted that Microsoft Windows will gain
traction and move from a 3.9% market share in 2013 to a 10.2% share in
2017, in part taking some users from the Blackberry OS, which moves from
2.7% to 1.7% market share.
Device manufacturers continue to
innovate, and this can only be good for consumers. Apple will attempt to
revamp their lineup of devices and refresh the now somewhat stale OS
visually and functionally. Microsoft, with the acquisition of Nokia,
seems to be serious about pushing ahead with innovation in the tablet
and smartphone sectors, giving app developers a third ecosystem to
consider building apps.
consumer-driven push to adopt mobile devices brings up interesting
challenges for the health care enterprise. Most organizations are
starting to adopt or develop strategies around mobile device management
and what is referred to as “bring your own device” (BYOD). A sound
policy around device management has to be simple, yet clear. The ease of
slipping in an Internet-enabled device that could potentially tap into
PHI (protected health information) must not be taken lightly. Health
care institutions need to start dictating expectations and standards to
vendor partners as opposed to the free-for-all, first-come-first-served,
let-see-how-it-goes mobility deployment frenzy we are seeing today.
need to ensure mobile data security embedded into the core
architecture, along with clear mobile policies that balance user demand
and workflow needs with security requirements and enterprise control
capabilities. BYOD controls allow the IT department to segment personal
and corporate data. This means that in the event of a lost device, the
device can either be wiped in full, or can just have the corporate data
Device manufacturers are trying to play to the
needs of the enterprise, but Android, iOS, and Windows still have their
own sets of challenges, and the more open nature of the Android platform
often brings along additional concerns. Multiuser support,
verification, device encryption, and malware-prevention improvements
have to be made more robust inherently at the OS level. There is a
growing role for enterprise mobility management vendors with managed
mobile services (MMS) in providing health care enterprise users with
mobile device provisioning, life cycle management, real-time mobile
analytics, and helpdesk support.
Zero-footprint client viewers, and more
the past decade, radiology has seen a gradual series of transitions
happening across various image viewing technologies, such as ActiveX,
Java applets, client-server, and thin-client or server-side rendering
applications. The rapid adoption of mobility in health care calls for a
more consistent interface to the applications, especially in viewing of
images across a broad spectrum of devices and form-factors (eg, laptops,
tablets, hybrids, and smartphones, etc.). A zero-footprint viewer
addresses this need while providing a platform for rapid iteration and
better enterprise security using client-server visualization
architecture and standard browsers, plug-ins, and even perhaps built-in
hardware virtualization. Zero-footprint viewers do not need a
client-side install or download and allow users to view images and
reports within their native web browser. The viewer typically utilizes
dynamically with the server and loads document objects, such as images
and reports, in real-time in a format understood by the user’s
environment and browser, thereby eliminating the need for any additional
software or plug-ins.
We are seeing a spectrum of image viewers
emerge in the market, with some PACS and 3-dimensional imaging vendors
choosing to opt for a client-side install or download in order to
provide added functionality. These unified viewers are getting better
through rapid iterations and provide the promise of a more useful
viewing experience for images on mobile platforms, whether via the
native PACS or for imaging content stored in vendor neutral archives
The trend is for the continued
push towards cloud-enabled, mobile-empowered workflows in the imaging
department and beyond. Image exchange and remote image viewing workflows
are enhanced as a result of these developments on the mobility front,
and we are seeing the adoption of some of these in practice today.
Across the enterprise, we need to not just simply tolerate the demands of the mobility movement, but embrace
mobility with purpose-driven use cases. The goal should be to truly
enhance the workflow around imaging and engage radiologists, ordering
physicians, and ancillary radiology and clinical staff in a
collaborative workflow that extends naturally beyond just the confines
of our diagnostic workstations and enhances the overall value of
- Brandon G. Radiology mobile app Mobile MIM’s long, strange FDA trip.
Medcity News. [Online] February 9, 2011.
Updated February 9, 2011. Accessed: September 9, 2013.
- Is mHealth poised to explode? Float Learning. http://floatlearning.com/mhealth/. Accessed September 9, 2013.
- Shrestha RB. Mobility in healthcare and imaging: Challenges and opportunities. Appl Radiol. 2012;42(9).
- Arlotta CJ. Gartner: Workplace collaboration moving to multiple
Updated September 5, 2013. Accessed September 9, 2013.
- Arlotta CJ. IDC: Mobile phone shipments to grow in 2013; Android
Updated September 5, 2013. Accessed September 9, 2013.