Monday, June 9, 2008

The New RIM Blackberry Bold and Primary Care

Living in the home town of Research in Motion (maker of the Blackberry) you get a little treat every now and again. One of them came in 1999 when someone told me to buy stock in the company (which I of course ignored) and the other was to see the new Blackberry Bold last week. The only way to describe the Bold is a cross between an iPhone and traditional Blackberry. It’s got a high resolution screen, keyboard, video, camera, music player, Wi-Fi, GPS and every feature you can imagine. Since 1999 I’ve owned five different Blackberrys and based on my initial impression this one is going to change commerce. The Bold looks like it could be the candidate that will merge the business and consumer applications. Before people reading this blog think I’ve been paid to do a promotion, I’ll get to the point of the article. I and many others have posted about the inefficiencies of EMR and digital note keeping. How clinicians often stop writing notes because it takes them longer to get into and out of the notes section than to see the patient. The Bold’s design, high resolution screen and connectivity has the potential to be able to view a days schedule on Blackberry, pull up the patient the way you normally would and make notes. Because it would be your personal Blackberry, log-in and log-out could be authenticated through the BES server (which connects your corporate email to the Blackberry network) and available on your hip. It has the potential to replace a computer in every room.

Nothing is so easy, however, because pushing data out is one thing (which RIM has mastered) but sending it back is quite another. Part of the problem, as I understand, has to do with authentication. In a digital nervous system there exists an active directory of user names and passwords which grant permissions' to users over a network. This is the reason you can log onto any computer in a clinic without loading your user information first. Blackberry’s would need to authenticate the specific patient entry, send it back through the BES server, into the network and finally into the clinical software. To complicate matters the clinical software often requires its own password. To create a secure zone between your Blackberry and the database that manages patient data is not simple; for now.

With the launch of the Blackberry Bold, RIM also announced the release of their BES Server 5.0 which has something called Blackberry Administrator Service (BAS) and Unified Application Management. Simplified, it means that the BES server may be able to turn your Blackberry into the equivalent of a desktop computer with all of the security and functionality of a wired network but available over a WAN.

The reason I bring this up for smaller clinics is that the cost of EMR is not small and the ROI dubious. RIM has been involved in hospitals but I have not heard of them pushing data into and out of small databases like they do with Exchange. As I found out the hard way, the greatest cost of ownership is not the EMR package but the network and peripherals. One of the reasons our own clinic hasn’t changed to tablets is that both the hardware (tablets & Wi-Fi) and maintenance of a wireless database network is expensive.

Providing a Blackberry to clinicians over a Wi-Fi or WAN is much less expensive than installing and maintaining your own complete network. Plus, RIM has already mastered secure data transmission. If possible, a BES server would simply be installed next to the EMR server and clinicians could access and enter information immediately. Like with any IT roll-out the project should improve quality and efficiency. If it only does one or the other it will be an up-hill battle. If it does neither, the project is doomed. RIM BES Server 5.0 and the Blackberry Bold have the potential to capitalize on the database changes that are occurring because of Health 2.0. Assuming that the back end of Blackberry can be synchronized the Bold looks to be a promising front end which would provide the quality of the tablet in a more cost-effective and efficient manner.


DrWes said...

The only problem I've seen is that RIM has had a few network outages that has affected its performance. Further, the keypad's a bit too small to do a detailed H&P! ;)

Ian Furst said...

I'll have to look up more on the (two, short) outages (not that I'm biased on anything). But there's good research that you can get >60 wpm with the mini QWERTY keyboard from RIM -- here's the full text article