A wise man once said, “Adversity does not build character; it reveals it.”

This adage has proven true of healthcare professionals collectively during the COVID-19 pandemic. Millions have done yeoman’s work caring for the sick and (sadly, and too frequently) the dying. Their skill, empathy, and dedication has been on display for all to see, and has been praised widely.

You could also say adversity reveals the “character” of organizations, in the form of their inherent strengths and weaknesses. That certainly has proven true of hospitals during COVID-19. Acute care facilities, especially those in the most hard-hit communities, rapidly adjusted their services, staffing and infrastructure to address the COVID-19 patient surge as best they could. From repurposing clinical and non-clinical spaces, to expanding care to tents in the parking lot, all made changes to their operations.

Five months into the pandemic, COVID-19 is proving to be an accelerator of digital transformation in healthcare. The digitization of healthcare, broadly defined, is not a new trend; it has been ongoing for decades, and received a significant financial jolt in 2009 with the passage of the HITECH Act. But in the first half of 2020 – as telehealth has become the norm for much outpatient care, population health issues are in the national news daily, and public health officials are the new rock stars – it is clear that health systems must hit the gas on certain mission-critical IT initiatives.

From a hospital IT perspective, perhaps the most glaring functional gap revealed by the pandemic relates to care team members’ inability to access patient records and each other at a moment’s notice, anytime, anywhere.

To that end, nothing could be more practical or timely amidst the COVID-19 surge than enabling patient data access and care team collaboration capabilities on mobile devices. Smartphones and tablets are the information access and communication tools of choice for most clinicians, wherever they may be – within the hospital, in a triage tent, quarantined at home, or anywhere in between. (Surely using secure mobile devices makes more sense than installing a dozen hard-wired terminals in a temporary facility in the hospital parking lot!)

But for hospitals under the gun in the midst of this pandemic, is implementing such mobile functionality really feasible?

In fact it’s a fairly light lift, especially when compared to the move from paper to electronic patient records – think of those systems as “EHR 1.0” – that many hospitals undertook 10 years ago. That transition required a massive cultural shift for physicians; and yet in some ways it accomplished fairly little.


I’ve been a practicing hospitalist for over 20 years. When I trained back in the days of paper records, if I was writing a progress note and wanted to see the patient’s labs I would grab the little tab, turn the page to see my labs, then flip right back and keep writing my note. Now most EHRs force me to navigate through multiple screens to accomplish the same thing. Imagine if, in the paper days, I had to sit at my desk and click my pen 25 times before I could write down the labs data in my note; it would have driven me crazy. But that's effectively what EHRs have done to physicians.

Today we live in a mobile-centric world, in which the use of apps, with their intuitive swipe-and-tap interfaces, is second nature to most people. That surely was not the case when medical records first migrated from paper to EHR systems; nor would anyone have called the typical EHR 1.0 interface “intuitive”. Rather, most EHRs simply replicated the paper-based workflow and page design on a computer screen. EHRs recreated the paper chart digitally right down to the fish bones that physicians used as a form of shorthand to document certain lab results.

Still, the move to mobile represents an adjustment for EHR 1.0 users, if only because change brings at least some measure of the unfamiliar. But this change promises to solve at least one major problem: We’ll finally put the computer to its best use, as a tool that makes physicians better and more efficient clinicians, rather than treating it as an electronic piece of paper.

For example, we can now envision intelligent systems that effectively put patients with a known disease and treatment plan on a care “glide path” that helps the provider track the patient’s progress to discharge. Orthopedics already does this very well. A provider knows that following surgery on post-operative day one PT is going to initiate a standard process designed to effectively move the patient to discharge by post-op day three. We’re not far from adapting such a computerized “glide path” model for patients with congestive heart failure or diabetes.

Forcing physicians to wait their turn for one of too-few hospital workstations is not making them better. The inexplicable persistence of UIs that fail to effectively parse information in a manner consistent with a physician’s workflow or thought process isn’t helping. Obtrusive, non-emergent automated queries that foster alarm fatigue aren’t helping. System design predicated on a one-size-fits-all user experience strategy hinders delivery of care. These are some of the shortcomings of “EHR 1.0” systems that must be remedied going forward.


Advancing system interoperability will be a key to the emergence of next-generation (“EHR 2.0”) systems in all their potential richness and functionality, not only from a mobility perspective. Whatever “system of engagement” (device or interface) a clinician uses to interact with the hospital’s system of record (EHR) and other departmental systems, all relevant clinical data must be available in one place, formatted and presented consistently, in order for clinical care to be delivered in a manner that makes sense to each individual provider. As HIEs grow, and more healthcare apps (both for patients and providers) are built using SMART on FHIR and other advanced development technologies, practical interoperability will move from the realm of aspiration to reality.

The value of “mobilizing” the hospital EHR goes far beyond effectively caring for patients under crisis conditions. It has become essential for provider collaboration on patient care generally, as physicians today are as “siloed” as patient records once were. We are not all in the same hospital at the same time. Remote access to records and the ability to easily communicate with each other within the context of a patient chart are key to the kind of collaboration that fosters better care.

Mobility also is a prerequisite for telemedicine. Without a mobile foundation, telemedicine would be relegated to a FaceTime conversation between doctor and patient. If it wasn’t for the initial work in simplifying the EHR on a mobile platform, the rapid scale-up of telemedicine during the COVID-19 crisis might not have been possible. In addition, mobility affords providers an opportunity to limit unnecessary personal exposure beyond patient encounters by removing them from common spaces and shared equipment. Following a patient encounter, a provider may review records and document the visit away from the nurse’s station, on their own tablet or phone.

The future is mobile. It's definitely where healthcare is headed. Well-designed mobile apps, which afford ready and actionable access to relevant patient data, can accelerate care. And if such apps are (a) an extension of the existing EHR, and (b) as intuitive to use as any consumer app on your phone today, then training and adoption shouldn’t be a problem.

We need to continue to develop mobile clinical workflow capabilities that allow clinicians to transcend the brick and mortar confines of the legacy EHR – in the interest of safety, efficiency, and improving the quality of patient care – during COVID-19 and beyond.


About the author: Dr. Christopher Maiona is the chief medical officer for PatientKeeper, Inc.