Palomar's self-developed EHR app set for March debut, July rollout

It was kind of a crazy idea at the time: In early 2011 San Diego-based Palomar Pomerado Health set about building its own smartphone app to allow physicians access to its electronic health record.

With dozens of vendors working on their own mobile-enabled EHRs, it seemed like reinventing the wheel. And with a tiny team of three heading the project--only one of which is a programmer--it seemed destined for the dustbin.

But as the health system closes in on a planned pilot test of its Android app--Medical Information Anytime Anywhere (MIAA)--in March, the idea is actually inspiring other hospitals to do the same.

In fact, after hearing Palomar CMIO Ben Kanter describe the project at the Toronto Mobile Healthcare Summit last week, a host of CIOs all of a sudden seemed bitten by the app development bug.

"I leaned over to my IS director next to me and said 'Why can't we do that?' ... We've got smart people up here to do it," Dan Coghlan, finance vice president and CIO of Providence Care Centre in Ontario tells IT World Canada.

The app is basically Palomar's reaction to the Citrix process many hospitals use to gain mobile access. Kanter's team wanted a natively developed app for smartphones, with tools set up for touchscreens. The idea was to just not pull up clunky Citrix views of the EHR, but to display the patient records graphically, and even provide live feeds of patient vital signs, X-rays and other images.

Even more ambitious: The app needed to interface easily with a variety of EHRs, to allow for affiliated physician offices that don't use the hospital's primary Cerner EHR system. The health system already has an agreement with Cerner to allow the app to pull data from its EHR, but will need similar arrangements with other vendors before the app truly can do its job.

The team has informally tested interfaces with NextGen and the Veterans Health Administration's VistA systems, Kanter tells FierceMobileHealthcare. And he's committed to a "system-agnostic" app that physicians can use with virtually any EHR.

One of the big surprises for the development was the level of revision needed to core functionality, Kanter admits. His team did a good deal of thinking about exactly what functions the apps' true audience needed--rather than simply enabling the entire medical record for the smartphone.

The target audience in this case is the physician outside the hospital walls, he says. So, for example, the team reconfigured functions like CPOE for more limited use. Rather than being able to craft a full medication regimen, the mobile-enabled CPOE is set up for tasks the physician is likely to do on the fly--adjust medications or add an antibiotic based on a lab test--Kanter says.

"On a phone, the physician's intent isn't to sit down and do wholesale order entry. And that would be inappropriate" in a non-clinical environment anyway, he says.

Right now the app remains in a test environment, as a prototype. Its first big rollout starts March 1, with a pilot test with 12 in-house medical staff, Kanter notes. It's an accelerated pilot of only six to eight weeks, though, and by July he hopes to have the app ready for prime time, and in use by physicians enterprise-wide.

There's a plan to port the platform to iOS, too, for use on iPhones and possibly iPads, although interestingly, Kanter is rather fiercely anti-tablet when it comes to healthcare. His take: Tablets are too big for true mobility (outside the clinical environment), but not big enough to provide PC or laptop-sized images, screens, and functionality.

"We're really focused on the doctor on the go," he says. And doctors "don't go to a baseball game with an iPad in their pocket."
Down the line, the product may well have commercial potential, he says. The hospital created a subsidiary of its charitable arm as a for-profit entity, Palomar Health Technologies, to allow for commercialization in the months or years ahead. He envisions possible licensing arrangements with health IT vendors, although no potential customers, such as individual hospitals or health systems, are off the table just yet. - Sara