Physician adoption of smartphones and tablets is higher than it's ever been, but poor communication between IT departments and doctors keeps those devices from being effectively used, according to a new report from Spyglass Consulting. The report estimates that 96 percent of doctors have smartphones, but only 10 percent are actually willing to use their mobile devices to access electronic health records.

"There are inadequate mobile EMR tools," Gregg Malkary, the founder and managing director of Spyglass told MobiHealthNews. "When lot of organizations think about BYOD, they go 'We’re just going to use desktop virtualization tools from organizations like Citrix, leverage our Citrix licenses and there you go, we’ve now provided you the ability to access your clinical systems.' The irony there is that Citrix provides a poor user experience that’s difficult to use, it’s difficult to navigate, and it crashes, therefore physicians don’t want to use it. ... So docs are not enamored with the tools being provided by hospital IT. And when you ask a lot of organizations we spoke to about what their future plans for mobility are, many aren’t planning extensive investments moving forward, because they’re not part of meaningful use."

Spyglass spoke to 100 tech-savvy doctors for the report. Malkary said only one third of the hospitals these doctors worked at provided help desk support for doctors trying to use their mobile device to access the EMR. They found that 83 percent of physicians expressed frustration with using the EHR for clinical communications, and 70 percent "believe that hospital IT organizations of affiliated hospitals are making inadequate investments to address physician mobile computing and communication requirements at point of care due to limited planned investments, poor mobile EHR tools, and inadequate mobile user support." 

"I think we have a conflict of agenda," Malkary said. "If you look at hospital IT, they think they’re doing a pretty good job. They’ve given you desktop virtualization tools, they’ve now recognized that SMS is in widespread use, so they’ve implemented secure messaging, but no one wants to use it. And they’ve implemented mobile device management, so they have an increasing list of checklists they’ve done, but all they’ve done is they’ve alienated the clinical staff."

Malkary said that secure messaging software and mobile device management are both problematic ways for hospital IT to deal with the consequences of BYOD. Doctors continue to use consumer text messaging rather than secure messaging apps because it's easier (it doesn't require a login to use) and because of the network effect: a critical mass of doctors and other care team members needs to be on a secure messaging platform before it's useful.

Meanwhile, when it comes to mobile device management, IT secures physicians' devices at the cost of their privacy and efficiency, at least according to the physicians.

"Hospital IT and the clinical staff don’t like each other," Malkary said. "If you didn’t like someone, would you give them control of your device, where they have the ability to delete all of your personal data, including contacts, emails, photos, music? It also slows the device down. So the docs are saying 'I’m not letting Big Brother take over my device'. So they’re in a stalemate."

A lot of things need to change before mobile tools really work for doctors, Malkary said. Solutions need to be implemented on an enterprise-wide level, with proper support, and payment methods need to change so doctors are compensated for time spent working and coordinating with a care team. But most of all, hospitals need to take a holistic, physician-user-experience-based approach to designing mobile infrastructure.

"If they really cared about what physicians were doing they’d come up with an overall strategy," Malkary said. "The overall strategy would dictate policies and procedures. They’d have to redo the overall infrastructure to support mobility as a core modality for accessing information. They’d figure out how do we utilize mobility, and really integrate it into the entire infrastructure."