Tuesday, December 28, 2010

Distinguishing Remote Access From Mobile Access

We frequently encounter folks who ask us about remote access via mobile devices. There's an important distinction to be made here. The usage intentions, patterns, and requirements for remote access and mobile access are very different. [1]

The purpose of remote access is to work in your computing environment when you are not on location. An example of remote access would be accessing hospital information systems and applications via a PC or laptop from your office or home. Often, remote solutions involve a VPN connection, a Windows desktop and/or web browser, and perhaps a remote license to allow the user to interact with the applications they are accessing. Mobile access is a different animal. Mobile users want to do specific tasks - check a lab value, view a waveform, see a medication list, check allergy status - while on the go. Providers want the data transformed into accessible, meaningful chunks, they don't want to have to navigate the entire medical record from their Droid in order to make a time sensitive decision. See table 1.

Some organizations have considered using Citrix to provide interpreted or emulated application access or a pdf view of EHR data and clinical information systems via a mobile device. That's like reading the New York Times on your smartphone using the internet browser. You can do it, but it doesn’t really work. Use the native application provided by the publisher. Native applications are built to run on a specific device and operating system.

We also do not recommend accessing any patient monitoring data via a non-native solution, because visual distortion is almost certain when things like medical aspect ratios cannot be controlled. Further, be advised that the FDA is mandated to regulate medical devices, including mHealth applications on cell phones and associated products. [2], [3]

We know that the reasons for and usage of remote and mobile access differ. We have learned that patient safety and provider efficiency are paramount in mobile application delivery. To optimize your provider access strategy, both approaches must be accommodated.


[1] Madden, B. 2010. Remote desktop access vs. mobile access: What’s the Difference? http://searchvirtualdesktop.techtarget.com/feature/Remote-desktop-access-vs-mobile-access-Whats-the-difference.

[2] Thompson, B., Kendall, L. 2009. How to Get FDA to Clear a Mobile Health App. http://www.ebglaw.com/showarticle.aspx?Show=12184

[3] Kumar, R. 2010. The FDA’s Regulation of Mobile Technology as Medical Devices. http://www.law.uh.edu/healthlaw/perspectives/2010/kumar-fdamobile.pdf.

Tuesday, December 7, 2010

Meaningful Mobility for Cardiology Care

A 12-lead ECG is a snapshot in time of 3 spatial views of the heart's electrical activity from 12 angles. It is generated by placing 10 electrodes on various parts of the body including the arms, legs, and chest. With a 12-lead, we are simply taking a multi-dimensional picture of heart conduction from right to left, top to bottom, and front to back.

Once the electrodes are placed, the ECG recorder is run. The recorder digitally captures the multi-dimensional picture. Although the machine will virtually record all 10 seconds of data per lead, all traditional ECG print outs and the current pdfs currently used in most mobility solutions only provide 3 seconds of data for each lead, and those three seconds are printed, static, flat, and non-interactive.

The output of an ECG recorder is a tracing on a graph. Time is represented on the x-axis, and voltage, or amplitude is represented on the y-axis. Look at the following picture describing the time and voltage for a traditional ECG tracing. Notice, for example, how one small 1 mm x 1 mm block represents 40 milliseconds in time and 0.1 millivolts in amplitude? (See Figure 1).

Now let’s look at how mobility providers can add serious value to the ECG equation. One way is to mobilize a pdf version of the ECG tracing. (See Figure 2). Helpful - but where is our data transformation in this equation? Consider it’s time to move to the next generation mobile solution. (Figure 3).

Figure 1

Figure 2

Figure 3

AirStrip Cardiology ™ provides the ability to scroll through a full 10-second ECG for all 12 leads and set any of the leads as the rhythm strip – clinicians choose the beats used for analysis. In addition, the dynamic ECG layout functionality grants full control over how leads are rendered, providing the option to see all 12 or 15 leads for the ECG or selectively, in various comparative layouts and zoom levels.

AirStrip Cardiology can help clinicians detect changes in mV signal as low as .05 mV (0.5 mm). That’s a twentyfold increase in amplitude detection over paper tracings. End users clearly see sub-millimeter variations, as well as being able to visually scan all 12- or 15-leads at once and see any relative deviations.

In terms of playback control, marking the grid with the measurements coming from GE Marquette® 12SL™algorithms, we also allow play modes for the 10 second digital segment to be full, 1/2, 1/4, or 1/8 speed, as desired. Added features such as user-driven lead selection, maintaining relevance across leads with synchronized pinch and zoom, make this exponentially more interactive. Now that’s meaningful mobility.

[1] http://en.wikipedia.org/wiki/File:ECG_Paper_v2.svg
[2] http://en.wikipedia.org/wiki/File:12leadECG.jpg
[3] © 2010. AirStrip Technologies. All rights reserved