mobile healthcare: patient data delivery by jim bloedau

MMoobbiillee HHeeaalltthhccaarree:: PPaattiieenntt DDaattaa DDeelliivveerryy

JJuullyy,, 22000088 MMaarrkkeett TTrraaccttiioonn BBrriieeff

DISCLAIMER Information Advantage Group prepared this report as a general guide and basis for further discussions and diligence on the select area of healthcare—Mobil Healthcare: Patient Data Delivery.

This report includes qualitative and quantitative statements that reflect plans, estimates, data, consensus views and beliefs of vendors, industry experts and commentaries provided by public sources and IAG analysts. Best efforts have been made in assessing the reliability of these statements. IAG disclaims all

warranties, express or implied, as to the accuracy, completeness or adequacy of such information and fitness of this research to a particular purpose. IAG shall have no liability for errors, omissions or inadequacies in the information contained herein or for interpretations thereof. IAG advises that any

discussion or listing of a company or product of any kind in this report should not be deemed to be an endorsement of said company or product. The opinions expressed herein are subject to change without notice.

This report is intended to be one of the many information sources including other published information and analysis of these sources by the reader. The reader assumes the sole responsibility for the selection of

these materials to achieve its intended results. The reader is urged to exercise the utmost discretion making the information enclosed in this report available to others that may need to analyze such material in the course of their evaluations.

Each resource cited in this report is the property of the originating author or publisher and will not be individually reproduced or distributed by the reader.

Copyright 2011 by: IAG LLC 3757 Webster Street, Ste. 306, San Francisco, CA 94123. All rights reserved. Duplication or distribution of this document as presented without express written permission from IAG LLC is

prohibited.

of 28

© 2011 IAG LLC Inc. Non-disclosure: IAG LLC retains all rights to the use and distribution of this document. This confidential and proprietary information must be held in strict confidence and not disclosed to any other parties without the express written permission of IAG LLC, San Francisco, CA 415-346-3860.

Table of Contents (linked)

Hover on section title and ctrl click I. EXECUTIVE SUMMARY................................................................................................................4 II. PROLOGUE ..................................................................................................................................5 III. OVERALL DESCRIPTION ...........................................................................................................6 Mobile Patient Data Delivery Systems – Multiple Applications ....................................................6 The Right Computing Device Is Situation Dependent ..................................................................7 Costs – From Cow Paths to Country Roads ................................................................................7 IV. BENEFITS RETURNS - Quality of Care Leads ...........................................................................8 Financial .......................................................................................................................................8 Operational...................................................................................................................................8 Clinical Effectiveness ...................................................................................................................9 Patent Safety................................................................................................................................9 Workforce Improvement .............................................................................................................10 Patient Perception ......................................................................................................................10 Community Perception ...............................................................................................................10 V. IMPLEMENTED, USED, SERVICED..........................................................................................10 Virtual Private Networks Are the Leading Method of Access – WLAN & Bluetooth the Leading Wireless Tech.............................................................................................................................10 Physician Adoption of Mobile Devices Are Mostly For Personal Use ........................................11 Smartphones Are the Leading Devices Used By Physicians .....................................................11 Extra Work and Age-Dependent Preference Lead Physician Adoption Challenges ..................12 Mobile Nursing Offers Greater Challenges ................................................................................12 Security Concerns – Same as Other Industries .........................................................................13 VI. BUYERS & USERS ...................................................................................................................13 Buying: Decision By Committee - Top Clinical Influencers ........................................................13 VII. MARKET ...................................................................................................................................14 Overall - Mobility Technology Continues Strong Growth............................................................14 Notebooks Dominates Mobile Computing ..................................................................................15 Converged Mobile Devices (CMD) – Leading Handheld Device Market....................................15 HEALTHCARE ...........................................................................................................................16 Strong Growth for Healthcare Wireless Deployment..................................................................16 Mobile Patient Data Delivery Market ..........................................................................................16 VIII. TRENDS – Outside the Walls ..................................................................................................17 ePrescribing ...............................................................................................................................17 Mobile Nursing ...........................................................................................................................17 Home Health Mobility: ................................................................................................................17 Mobile Testing ............................................................................................................................18 Mobile Learning..........................................................................................................................18 RFID & Bar Coding.....................................................................................................................18 Unified Communications – Not Yet Prime Time .........................................................................18 Wireless Skills To Be #1 In Five Years – Healthcare To Lead Demand ....................................18 IX. VENDORS .................................................................................................................................19 X. INFLUENCE & OVERSIGHT ......................................................................................................21 Regulatory ..................................................................................................................................22 Associations ...............................................................................................................................22 Standards ...................................................................................................................................23

of 28


Bibliography.....................................................................................................................................24

II .. EEXXEECCUUTTIIVVEE SSUUMMMMAARRYY

In the hospital, a large part—50%--of many clinical worker’s time is spent moving from one point-of-care (POC) to another capturing data and creating information for documentation purposes. In response to this burden, clinicians are constantly looking for a better way and are increasingly turning to wireless technology to get some relief. As a result, many wireless devices are augmenting or taking the place of paper-based processes and changing the way care is accessed, delivered and documented. The result is a developing technological menu that is redefining “mobile” as the ability to use a small computing device backed by a wireless network—what was once purely a telecom issue is an IT concern today. Mobile Patient Data Delivery (MPDD) systems are one of the more exciting mobile niches. These products provide the infrastructure for integrating, managing, developing and deploying an application that reaches into a hospital’s legacy systems and presents a comprehensive patient view at the bedside on a wireless, handheld device. Although it is early in this market, the total market potential is currently estimated to exceed $443 million. Growth of this market will remain slow and lag the 27% CAGR of healthcare’s billions of dollars wireless market. This lagging market is partially explained by the fact that most physicians carry several mobile wireless devices, their use of these for access to clinical data is spotty and only now just breaking into double-digit percentages. A brighter sign is a recent rash of reported orders by vendors that coincide with their rapid development and release of value-adding modules may be an indication that vendors are reaching the critical mass of utility and value needed to ignite the market. What is clear is that mobile and point of care computing is changing the way physicians and nurses practice and hospitals deliver patient care. By enabling access to clinical information quickly and securely from any location, at any time, the overall efficiency and quality of patient care is improved. Because of this, hospitals will continue to actively deploy and upgrade wireless networks and buy systems that support delivery and management of care inside and, in a response to a strong remote healthcare trend, outside the walls of the hospital.

of 28


II II .. PPRROOLLOOGGUUEE II

Since the concept of radiophones was first discussed by AT&T in 1915 and introduced to our imagination by comic book hero Dick Tracy's wristwatch radio of the 1930s, improved two-way communication via wireless technology has rapidly evolved—particularly for healthcare over the last decade. The first telephone paging system of 1949--designed for doctors--started caving in to pagers in 1974 and cell phones in the 1980s.1 The recent launch of wireless e-mail devices has caused Motorola, which once controlled 85% of the market, to discontinue its paging operations in 2002—a mere three years after introduction of the Blackberry. 2

Since the concept of radiophones was first discussed by AT&T in 1915 and introduced to our imagination by comic book hero Dick Tracy's wristwatch radio of the 1930s, improved two-way communication via wireless technology has rapidly evolved—particularly for healthcare over the last decade. The first telephone paging system of 1949--designed for doctors--started caving in to pagers in 1974 and cell phones in the 1980s.

Of all industries, healthcare is one of the most mobile and documentation intensive. A large part—at least 50% of many clinical worker’s time—is spent moving from one point-of-care (POC) to another capturing data and creating information in the clinical setting for documentation purposes. This documentation is captured and presented in many forms, including:

Of all industries, healthcare is one of the most mobile and documentation intensive. A large part—at least 50% of many clinical worker’s time—is spent moving from one point-of-care (POC) to another capturing data and creating information in the clinical setting for documentation purposes. This documentation is captured and presented in many forms, including: Speech (dictation) Speech (dictation) Free Text (care giver notes) Free Text (care giver notes) Document Imaging (patient contact areas) Document Imaging (patient contact areas) Static and Dynamic Clinical Imaging (x-rays, MRI, PET

scans) Static and Dynamic Clinical Imaging (x-rays, MRI, PET

scans) Electronic Data I/O (bedside testing and monitoring,

lab results, operational input) Electronic Data I/O (bedside testing and monitoring,

lab results, operational input) Waveforms (EEG, ECG) Waveforms (EEG, ECG) Business &Clinical Encoding (XML tagging, ICD-10,

SNOMED, billing codes) Business &Clinical Encoding (XML tagging, ICD-10,

SNOMED, billing codes) Healthcare is also one of the strongest adopters of wireless communications, only lagging transportation and retail, and includes a strong history of early trials and adoption of first generation mobile computers.

Healthcare is also one of the strongest adopters of wireless communications, only lagging transportation and retail, and includes a strong history of early trials and adoption of first generation mobile computers. Because of the evolution of technology and need for greater clinical efficiencies, “mobile” healthcare is beginning a second generation of computing. Today, wireless devices are augmenting or taking the place of early laptop charts and changing the way care is accessed, delivered and documented—inside or

Because of the evolution of technology and need for greater clinical efficiencies, “mobile” healthcare is beginning a second generation of computing. Today, wireless devices are augmenting or taking the place of early laptop charts and changing the way care is accessed, delivered and documented—inside or

II .. PPRROOLLOOGGUUEE

Key Driver For Enterprise MobilityAb e rd ee n Survey, No vemb e r, 2007

16%

18%

32%

33%

48%

LowerService

Frequencies

NewCustomer

Competit ion

MoreRemoteWorkers

LowerOperational

Costs

Better Mgmt.Diffuse

Workforce

1 The recent launch of wireless e-mail devices has caused Motorola, which once controlled 85% of the market, to discontinue its paging operations in 2002—a mere three years after introduction of the Blackberry. 2

Leading Mobile Devices Deployed Accross Work Force(June '08 Survey of CIOs)

4%

5%

15%

19%

43%

49%

ProprietaryMobile Terminals

Pagers

PDA (with orwithout wireless

connect)

Smart Phones(cell phones with

office apps.)

Laptop/Notebook/Tablet

Computers

Cell Phones

of 28


outside the walls of a hospital. Booming numbers of patients, who require care from multiple specialties and the financial need to make their hospital stay as short as possible, are pressuring clinical staff to deliver and document patient care more safely and efficiently. Add to this the persistent shortage of clinical professionals across all specialties and you have a perfect storm that raises the question: How are we going to deliver patient care going forward? In 2008, enterprise mobility has emerged as a strategic initiative among leading health care organizations. Wireless device designers offer a plethora of useful utilities that can be configured to fit a growing number of general and task-specific compact devices. The richness of this technological menu has redefined “mobile” as the ability to use mobile computing devices backed by wireless video, voice and data networks--what was once purely a telecom issue is an IT concern today. This report will focus on mobile patient data delivery (MPDD) market and leading vendors that offer a robust list of modules, integration utilities and portal technology that offers the clinician access from anywhere, anytime.

II II II .. OOVVEERRAALLLL DDEESSCCRRIIPPTTIIOONN

MPDD products provide the infrastructure for integrating to legacy systems and deploying an application that presents a comprehensive patient view at the bedside on a mobile device. Typically, the MPDD solution is presented as a platform that solves the inhouse and remote access, security, administration, personalization and data synchronization issues of mobile computing while allowing access to inhouse patient data.

MMoobb ii llee PPaatt iieenntt DDaattaa DDee ll ii vveerryy SSyyss tteemmss –– MMuull tt iipp llee AAppppll ii ccaa tt iioonnss

These systems are generally an amalgamation of any number of modules and add-on utilities that are not limited to: Clinical Portals – Allows the clinician secure access over the web to essential patient

information. Point of Care (POC) Data Delivery – Essential patient information, as determined by the

hospital or configured by the clinician is delivered at the bedside or accessed remotely. Software modules may include: Patient List Patient Information History and Physical SOAP Notes Labs and Tests Problem List Medication List To-Do List

Charge Capture – Hospital procedure and diagnosis codes are captured more accurately,

easily and alerts assure completeness of charges.

of 28


ePrescribing – Prescriptions can be sent and checked for drug interactions and other related

patient safety issues. Dictation – Mobile device records clinician dictations and sends for transcription. Reference Library – Clinical knowledge from any number of reference libraries can be

accessed remotely or loaded into the mobile device. Provider Directory – A listing of local providers by specialty with contact information. Personal Information Management – schedules, phone numbers and other personal-use data

can be loaded for the clinician’s use. These applications have been developed to interface with most major hospital information systems (HIS) or “best of breed” configurations to offer unified access to patient data from anywhere using a PDA, smartphones, tablet or PC running a Web browser.

TThhee RRiigghhtt CCoommppuutt iinngg DDeevv iiccee IIss SS ii ttuuaatt iioonn D Wireless Devices Common to

Healthcare

Desk & Lap Computers Cart-based vs. Stationary

Computing Devices Tablets PCs PDA Smart Phones Bar Code and RFID Scanners Pagers Wireless Patient Care Devices VoIP Badges Multimedia Players Physiologic Testing &

Monitoring Devices

Deeppeennddeenntt

Currently, there is no one-size-fits-all mobile solution for the clinician. In the hospital, computers on wheels that were taken from room to room were the first wave. They remain common because they offer typing capability and large screen size for rapid viewing of large amounts of data. These systems are hard to displace because of the high comfort level already established.3 From a hardware perspective, the current sentiment is that tablet computers are the best way to facilitate use of technology at the bedside.4 Additionally, what is seen clinically is a variety of handheld devices that have been selected because they were free or bought by the clinician with other personal uses in mind. Knowing this, hospitals are seeking a variety of functions that can be accessed with off the shelf devices, like PDAs and smartphones, with portal-based Web access generally a standard offering.

CCooss ttss –– FFrroomm CCooww PPaatthhss ttoo CCoouunntt rryy RRooaaddss

Noted deployment challenges are dominated by costs that can more than double vendor costs during full roll-out and included: 5

Initial Mobile Hardware Costs – handhelds, tablets, browser capable devices, carts, displays, sync stations

Integration/Software Costs – modules, add-on software, wireless network/upgrades, consulting fees.

Security And Electrical Interference Concerns – security upgrades, wireless audits/upgrades/staffing

Device/Infrastructure Management – additional IT and improved skill sets

of 28


Maintenance, Training and Support – software upgrades and help desk

Professional Services – ongoing vendor support Vendor’s pricing is customized according to the number of physicians, modules and interfaces required by the hospital’s legacy system configuration--because of this, vendors are reluctant to publish estimates for full systems. For software, physician applications and services for stand-alone handhelds generally start at $40 and reportedly rise to at least $250,000 to install in a 500+ bed hospital.6 Physicians generally load additional software to their mobile devices that may include: Medical References for PDAs (numerous by specialty) - $40-$150 purchse price Electronic prescribing - $70/month Charge Capture $50/year Stanford Guide to Antimicrobial Therapy $30 MedCalc (80+ formulas with references and tips) – Free Immunization Guide – Free Coding – Free Many of these utilities are included in the leading vendor’s offerings.

IIVV.. BBEENNEEFFIITTSS RREETTUURRNNSS -- QQuuaa ll ii tt yy oo ff CCaarree LLeeaaddss

Mobile and point of care computing is changing the way physicians and nurses practice and deliver patient care. By enabling access to clinical information quickly and securely from any location at any time, the overall efficiency and quality of patient care is improved when clinicians have access to better information at the point-of-care. 7 8

Biggest Impact Better IT At POC Can Have

1%

2%

4%

16%

76%

Other

Increase LocalCompetitiveness

ImproveRevenues

Improve StaffEfficiency

Improve Qualityof Care

FF iinnaanncc iiaa ll

In the U.S. alone, the cost of information capture and report generation was estimated to be $50 billion annually in 2002.9 An estimated $6.9 billion was saved across the

entire U.S. health care industry, as measured by productivity enhancements, by using wireless technology in the medical field. 10 Additionally, $900 million in savings was realized by reducing inventory loss through

wireless tagging of devices and instruments. 11

Early results for physicians found that every dollar spent on a mobile charge capture system returned $5 to $7 in billed charges.12

OOppeerraa tt iioonnaa ll

31% of health care providers claim to recover at least 50 minutes per day by using enterprise-wide mobility solutions.13

of 28


http://www.lww.com/browsemediaspec/PDA/0,0,133,00.html

http://www.allscripts.com/

http://www.sanfordguide.com/

http://www.med-ia.ch/medcalc

http://www.immunizationed.org/default.aspx

http://www.statcoder.com/

Surveyed physicians stated they access handheld devices 5.4 times per day.14

The time saved using mobile devices allowed them to see an extra 3.8 patients per day.15

Direct input of patient data via a wireless handheld reduces callbacks and follow-ups caused by illegible notes and prescriptions—particularly beneficial in documenting for reimbursement. A clinical trial of a mobile tablet-like device in 2007 produced a 42% improvement in point-of-

care documentation. 16

CCll iinn iiccaa ll EEff ffeecc tt iivveenneessss Nursing Tasks Better IT At POC Can Improve

2%

5%

5%

18%

22%

23%

26%

Suplies &Equipment

Patient CareDevices

Don'tKnow/Other

Communication

MedicalAdministration

Documentation

Care Delivery& Coordination

An American Academy of Nurses (AAN) study itemized nearly 300 workflow issues that proper application of technology could improve. There was no clear consensus with regard to a

single area in which technology could have the most positive impact on workflow. 25% of respondents identified each of the

following broad areas—care delivery and coordination, documentation and medication administration.

Use of a mobile patient data system’s clinical alerts

detect potential problems improved patient outcomes over the 2005-07 including:17 15.6% reduction in mortality/1,000 inpatient

discharges. 13% decrease of cardiac and respiratory arrests for all inpatients. 22% decrease in cardiac/respiratory arrests in non-critical care areas. 38% fewer ICU deaths for medical/surgical patients transferred there with a diagnosis of

sepsis. 35% increase in interventions for congestive heart failure, as encouraged by the Centers for

Medicare & Medicaid Services. 115% increase in responses for critical care support

and assessments. Physicians think digital images and video captured at

point of care by handheld devices could enhance clinical documentation stored in the electronic medical records. 18

PPaatteenntt SSaaffee ttyy

Bar code technologies are well established as beside technology that improves not only patient safety, but operational efficiency. The current market shows that bar coding

technology is most frequently used in laboratories, followed closely by radiology, pharmacy and materials management.19

of 28


Leading Application For Patient SafetyHIMSS Octo b e r, 2007

3%

6%

6%

6%

17%

33%

29%

RFID

PhysicianDocumentation

Other

NursingDocumentation

Bar Coding

eMar (ElectronMedication

Admin.

CPOE

Surveyed physicians thought point of care computing devices pose significant infection control

risks. 20 Poor physician hand washing, multi-tasking at the bedside and ignorance of the potential risk

were viewed as the major causes. 21

WWoorrkk ffoorrccee IImmpprroovveemmeenntt

A clinical trial of a mobile tablet-like device in 2007 resulted in: 22 62% increase in nurse satisfaction with the hardware and related clinical workflow changes.

PPaatt iieenntt PPeerrcceepptt iioonn

Despite surveyed physicians, thinking computing devices used at point of care could interfere with the physician/patient relationship, when patients saw them using hand-helds: 23 71% felt there was better interaction among their doctors and nurses.24 60% felt the potential for medical errors was reduced.25

CCoommmmuunnii ttyy PPeerrcceepptt iioonn

A noted secondary reward was the cascade of cooperation that one mobile implementation catalyzed: 26 Competitive hospitals joined forces and adopted the same mobility solution at the community

level. 80% of the physicians wanted the practice management component after mobile

implementation.

VV.. IIMMPPLLEEMMEENNTTEEDD,, UUSSEEDD,, SSEERRVVIICCEEDD

“We're doing the charge capture portion first as we see that as the meat and potatoes, while the clinical side will follow, like desert.

Allistair Erskine VCUHS Chief Medical

The mobile IT infrastructure between acute and ambulatory arenas continues to coalesce with VPNs and WLAN the leading technologies. Physicians are carrying up to three to four mobile devices—smartphones are quickly becoming the most popular--mostly for personal use and reference. Advanced computing, like e-prescribing or patient data access, from these devices is very sparse with the exception of younger physicians or those mandated to do so by their employer. Because of the enterprise impact and need to generate clinician buy in, a demonstration pilot is the path most often taken when deploying a mobile patient data system. Equipment and staffing costs and slow adoption by clinicians lead the list of deployment and maintenance challenges.

VV ii rr ttuuaa ll PPrr iivvaa ttee NNeettwwoorrkkss AArree tthhee LLeeaadd iinngg MMeetthhoodd oo ff AAcccceessss –– WWLLAANN && BB lluueettooootthh tt hhee LLeeaadd iinngg WWii rree lleessss TTeecchh

2008 studies showed: 27

of 28


Healthcare Use Of Wireless Technology

29%

40%

75%

48%

45%

20%

26%

2.9%

3.7%

16.6%

17.5%

19.8%

28.3%

11.2%

WMAN

UWB

Zigbee

RFID

WWAN

Bluetooth

WLAN

CAGR 2005-2010 % Share 2010

Network access was provided by: 28

73% - VPN access. 43% - Citrix Remote desktops. 35% - offer portal access

41% of respondents use roaming desktops.

85% of healthcare respondents stated that they are looking to use tablets or mobile devices.

PPhhyyss iicc iiaann AAddoopptt iioonn oo ff MMoobb ii llee DDeevv iicceess AArree MMooss tt llyy FFoorr PPeerrssoonnaa ll UUssee

A survey of 1,200 physicians showed that use of handhelds more than doubled between 2001 and 2006—about 50%.29 The most common uses were: 30

Drug Reference Database Prescription Dosage Calculators Continuing Medical Education Product Updates

A recent survey of physicians revealed that the choice of a computing device at point of care

was most importantly dependant on: 31 Physician’s Personal Preferences Location Urgency Of The Situation Tasks To Be Performed Complexity Of The Applications To Be Used

SSmmaarr ttpphhoonneess AArree tthhee LLeeaadd iinngg DDeevv iicceess UUsseedd BByy PPhhyyss iicc iiaannss

A November 2007 survey of physicians revealed the most common clinical patient data computing devices and their overall acceptance:32

Leading Mobile Device Usage In Healthcare

19%

81%

59%

41%

53%

63%

VoIP

Pager

SmartPhones

Doctors Nurses

Smartphones: 75% of physicians are using them.

Mostly for personal tasks—very few are using them for back office access to patient data. 33

Less than14% of physicians were using smartphones to access single function clinical applications to manage patient data, prescribe medications or charge capture in 2007.34

Tablet Computers: Too big and heavy; too short of a

battery life for a full shift in the acute care setting. The ambulatory care setting is enthusiastic for them

because it is a different workflow environment than acute care. Physicians can control the environment; short distance

to docking stations; physicians financially invested in the technology.

Most felt that handwriting recognition not ready for prime time.

of 28


PDA Use In Healthcare(Healthcare Informatics Survey, Summer, 2006)

Admin.14%

Diagnostic Tests21%

Other23%

Patient Treatment

42%

Mobile Computing Carts: Mostly used by nursing, but as stationary units in the hall rather that

room to room. 76% of acute care nurses interviewed using mobile clinical carts reported the carts remain

abandoned in the hallway where they are being used as a fixed location terminal. 35 In 2007, physicians preferred to use a full size terminal and keyboard to access clinical

information systems at point of care. 36 Business class computers are not well suited to meet the heavy demands of a healthcare

environment. 37 Wall-Mounted PC (flat panel displays): With multiple large screens-most favored by

physicians in intensive care areas. Large screen area fostered efficient review of large amounts of patient data. Video and image capture at the bedside is promising.

EExxtt rraa WWoorrkk aanndd AAggee--DDeeppeennddeenntt PPrree ffeerreennccee LLeeaadd PPhhyyss iicc iiaann AAddoopptt iioonn CChhaa ll lleennggeess

Clear demarcation of mobile use exists between generations of physicians. While there are some older physicians who never learned to type: At least 80% of the younger physicians who are members of the American College of

Cardiology (ACC) are using advanced mobile devices. 38 35% of medical schools are now requiring the use of at least a PDA in the third and fourth

year.39 85% of physicians are independent and only affiliated with a hospitals—they could take their

business elsewhere if mandated to use technology—despite this position, the trend is for mandated use. 40

Mobile technology has physicians taking too many extra steps—reverting to old ways: 41 Electronic charge capture reverting to the old super bill—a paper based checklist. To much electronic communication has physicians developing blocking and workarounds to

lessen the pressure—like answering services and office staff screening email. 42

MMoobb ii llee NNuurrss iinngg OOff ffeerrss GGrreeaatteerr CChhaall lleennggeess

Greater challenge and complexity is found in nursing’s experience with mobile computing. A December 2007 survey of nurses showed: 43 64% believed their wireless infrastructure not reliable

enough to support point of care computing solutions. Nurses reported logging in/out of systems upwards of

80 times per day. Nurses are concerned about the usability and portability

of computing devices deployed at point of care. Mobile carts are large and bulky making them

difficult to maneuver within the confines of a patient’s room.

Provisioning enough PCs across the enterprise to provide sufficient access to the systems was a problem—space and expense were the key limiting factors.

of 28


Leading Application of Mobile Devices In Healthcare

6%

8%

10%

11%

11%

14%

Asset Mgmt. &

LaboratoryManagement

Drug DeliverySystems

Patient Admit &Discharge

Records/DocumentManagement

MedicationAdministration

Tracking

Clinical information systems are being used, but not always in real-time or at point of care.

Often double-documentation is the practice--documenting first on paper at point of care and then re-entering into the electronic medical record.

Surveyed nurses believe their hospitals lack the appropriate technical infrastructure to support point of care computing including: 44 reliable networks systems interoperability across the continuum of care security requirements that do not impede nursing productivity

SSeeccuurr ii tt yy CCoonncceerrnnss –– SSaammee aass OOtthheerr IInndduuss tt rr iieess

Security concerns are universally shared across all industries. End User's Perception Of Threats - General

Ge ne ra l Surve y Ap ri l, 2008

17%

18%

18%

21%

24%

33%

31%

TheftPortable

Media

Phishing

VirusProtection

InternalData Theft

ExternalBreaches

TheftMobile

Devices

InternalUsers

41% of non-healthcare CIOs surveyed June 2008 survey recognized that security is a top challenge in developing and executing mobile strategies. 45

A May, 2008 study derived from research conducted

by the Computing Technology Industry Association (CompTIA), noted theft and other security concerns are rising for use of hand-held devices and lap computers by remote and mobile workers:46 60% stated that security issues related to the use of

hand-held devices for data access and transfer have significantly increased over the past 12 months.

55% of those surveyed said that security issues have significantly increased for wireless networks over the last year.

33% have developed security awareness training for employees 90% of organizations that have implemented this training for remote and mobile workers

believe security breaches have been reduced.

VVII .. BBUUYYEERRSS && UUSSEERRSS

Pan-mobility solutions for patient care cross all clinical departments and are often daunting in scope. Leading clinical stakeholders must champion these projects—particularly the Chief Nursing Officers (CNO) and Chief Medical Information Officer (CMIO)--typically a physician. The final decision rests with the capital equipment/services buying committee.

BBuuyy iinngg:: DDeecc iiss iioonn BByy CCoommmmii tt tteeee -- TToopp CCll iinn iiccaa ll IInn ff lluu eenncceerrss

Clinicians remain hesitant to adopt mobile solutions unless they can clearly see a way to (in order): save time, make money or raise the quality of care.

Funding for mobile computing finds strong competition from: Electronic Medical Records (EMR) Computerized Physician Order Entry (CPOE) Picture Archiving and Radiology Information Systems (PAC/RIS)

of 28


Because most are soft dollar returns, the argument for mobile devices weakens under the

weight of ROI and total cost of ownership analysis. Building out wireless networks that support a wide range of enterprise-class solutions like

wireless data, VOIP and RFID and integrating departmental systems is proving difficult. Although physicians and nursing are the primary users of mobile patient data devices, the

technology will effect most departments and require committee approval that may consist of: CEO CIO CFO CMIO CNO Nurse Informaticist Pharmacy Chief Laboratory Chief Radiology Chief Risk Manager Compliance Staff IT network/mobility experts

Primary users of Mobile Solutions are:

Staff and affiliated practice physicians who make rounds at hospitals Hospital pharmacists Hospital nurses

VVII II .. MMAARRKKEETT

OOvveerraa ll ll -- MMoobb ii ll ii tt yy TTeecchhnnoo llooggyy CCoonntt iinnuueess SStt rroonngg GGrroowwtthh

With many people having both private and work related wireless accounts, the number of U.S. wireless subscribers should eclipse the total number of people (307 million) in the US over the next several years.

0

50

100

150

200

250

300

350

400

450

1985 through 2007

Millions of U.S. Wireless Subscribers

255M9.98% CAGR 2002-2007

Just released 2008 Mobility Survey of CIOs uncovers

significant penetration of mobile devices in the workplace:

47 Nearly 50% of employees are equipped with cell phones

and nearly 20% with smart phones.

An early 2008 survey showed ample room for unified communications and devices: 48 8% of frequently traveling business people rely solely on

their mobile number. Carrying multiple and often redundant devices is their

first choice over a unified communication/computing device.

of 28


Global Mobil Computing Market(Billion)

$52.0

$57.0

$62.0

$67.0

$72.0

$77.0

$82.0

$87.0

$92.0

2005 2006 2007 2008 2009 2010 2011

$55.6

$88.9

7.0% CAGR

NNootteebbooookkss DDoommiinnaatteess MMoobb ii llee CCoommppuutt iinngg NN

The largest share of the $88.9 billion global mobile computing market belongs to notebook computers.49 The largest share of the $88.9 billion global mobile computing market belongs to notebook computers. In 2006, notebook computers held 84% of the total global market. In 2006, notebook computers held 84% of the total global market.

They are expected to reach more than 96%, worth $69.2 billion by the end of 2011.50 They are expected to reach more than 96%, worth $69.2 billion by the end of 2011. Virtually all the mobile computing device vendors reported good rewards from the total sale of

342 million devices that produced $1.15 billion in 2007: a 15.8% increase over 2006.51 Virtually all the mobile computing device vendors reported good rewards from the total sale of

342 million devices that produced $1.15 billion in 2007: a 15.8% increase over 2006. The 2008 projections for handset market growth have been reduced from 13.5% to 12%.52 The 2008 projections for handset market growth have been reduced from 13.5% to 12%.

The global PDA market continues its market slide with a 53% decline between Q4’06 to Q4’07. The global PDA market continues its market slide with a 53% decline between Q4’06 to Q4’07.

ConvergedConverged

ootteebbooookkss DDoommiinnaatteess MMoobb ii llee CCoommppuutt iinngg

49

50

51 52

CCoonnvveerrggeedd Mobile Devices (CMD) – Leading Handheld Device Market Mobile Devices (CMD) – Leading Handheld Device Market

CMDs are the result of mobile technologies coalescing with handheld personal information managers (PIM) of the past to produce a synergistic marriage of voice (telephony), data (wireless) and video (static and dynamic). The first version, Handspring, was introduced in 2000 and the iPhone is the latest popular example. This trend has caused HP and Palm to see annual double-digit declines in their traditional handheld lines while Nokia and Research In Motions (Blackberry) have enjoyed CAGRs in the hundreds of percent.

Projected CMD Market(Units Shipped)

376M

125.0

175.0

225.0

275.0

325.0

375.0

2007 2008 2009 2010 2011 2012

Million Units

Shipped

24.7% CAGR2007-2012

125M

Where Healthcare Is Planning Increased IT

Spending(Survey March 2008 =- IDC)

Hardware60%

Software70%

Services30%

In the general market, mobile carriers, content creators, device makers, software developers and new media players, like Google, see the increasing demand for a variety of business applications integrated into handheld devices as critical to their mobile aspirations. Converged mobile devices continue strong product

growth in the wireless industry. Healthcare Wireless Market

(May, 2008: Bluetooth, RFID, Zigbee UWB WWAN, WMAN, WLAN & Others)

$2.7

$10.0

$1.8

$7.0

$0.0

$2.0

$4.0

$6.0

$8.0

$10.0

2005 2006 2007 2008 2009 2010 2011 2012

Billions

27.8% CAGR2005-2012

Smart phones’ CAGR of 15.7% promises the highest growth with project revenues of around $17.8 billion. 53

Competitive pressures have driven the price of a smart phone down to $200, making smart phones more affordable to a broader base of users—clear evidence that vendors are focused on providing greater utility to differentiate their products. Worldwide smartphone sales in the first quarter

of 2008 totaled 32.2 million units, a 29.3 percent increase from the previous year.54

of 28


http://en.wikipedia.org/wiki/Converged_device

HHEEAALLTTHHCCAARREE

Hospitals are actively deploying wireless networks and buying systems that call for active physician usage. The problems is that despite most physicians carrying a mobile device, utilization of hospital mobile patient data applications for access, either wirelessly or through synching stations, to clinical data is only just now breaking into double-digit percentages.

SStt rroonngg GGrroowwtthh ffoorr HHeeaa ll tthhccaarree WWii rree lleessss DDeepp llooyymmeenntt

In 2003, 25% of US hospitals had deployed wireless technology—current projections see this level to be 90% by 2010.55 As of Spring 2008, the market has shown a 23% CAGR that will increase to make it a $10

billion market by 2012. 56 $300,000 is the average to be spent on wireless technology by healthcare organizations

over the next two years according to a 2007 survey of healthcare IT professionals.57

MMoobb ii llee PPaatt iieenntt DDaattaa DDee ll ii vveerryy MMaarrkkeett

Claims that healthcare is nearing a tipping point in the deployment of mobile patient data delivery technology is premature for a number of reasons including: Although consensus points to the market just now entering double-digit market penetration,

there are few indications that the systems being deployed are much past information databases or charge capture.

Leading vendors have been around for about ten years and are just now entering the double

digit millions of dollars revenue stream. Revenues for the two leading vendors: Hoover’s reports $7.6 million in 2007 revenues serving 14,000 physicians ($543 per

physician) for PatientKeeper; which also claims 10% of the market and to have quadrupled revenues.

Thompson Reuters (MercuryMD) reported $10 million in 2005 revenues at time of acquisition in 2006.

Given the above, the following extrapolations are based on published case studies, vendor revenue and vendor claims of market share.1 Based on market performance, the total market potential is currently estimated to exceed $443

million. Growth of this market will remain slow and lag the 27% CAGR for overall wireless growth in

healthcare. Recent rapid module development by the leading contenders and their claimed increases in

revenues may be an indication that vendors are reaching the critical mass of utility value needed to ignite the market.

1 A $250,000, 534 bed installation ($468/bed) Approximately 800,000 practicing physicians Approximately 802,000 community hospital beds

of 28


VVII II II .. TTRREENNDDSS –– OOuuttss iiddee tthhee WWaall ll ss VV

In healthcare, we can expect numerous wireless applications crossing every specialty and locality where care is delivered. Many of the future applications will be mobility-intensive, in that they will be focused on delivery and management of care outside the walls of the hospital. This trend will drive additional applications with many being purpose-specific at first then another round of device consolidation. As the number of utilities that can be consolidated into a single device increases, it is expected that the general adoption curves will also increase. This will also precipitate and even higher growth in cost for deploying and managing wireless technology.

In healthcare, we can expect numerous wireless applications crossing every specialty and locality where care is delivered. Many of the future applications will be mobility-intensive, in that they will be focused on delivery and management of care outside the walls of the hospital. This trend will drive additional applications with many being purpose-specific at first then another round of device consolidation. As the number of utilities that can be consolidated into a single device increases, it is expected that the general adoption curves will also increase. This will also precipitate and even higher growth in cost for deploying and managing wireless technology.

eePPrreessccrr iibb iinngg e

40% of physicians use systems that range from Computerized Physician Order Entry (CPOE) to mobile devices to prescribe medication:58

40% of physicians use systems that range from Computerized Physician Order Entry (CPOE) to mobile devices to prescribe medication: Although they may be using technology, often prescriptions are printed out rather than sent

electronically. Although they may be using technology, often prescriptions are printed out rather than sent

electronically. Physicians feel that there are still too many steps involved for ePrescribing. Physicians feel that there are still too many steps involved for ePrescribing. A July 2006 Institute of Medicine (IOM) report attributed 1.5 million patient injuries each year

to medication errors and asked physicians to adopt e-prescribing by 2010. A July 2006 Institute of Medicine (IOM) report attributed 1.5 million patient injuries each year

to medication errors and asked physicians to adopt e-prescribing by 2010.

MMoobb ii llee NNuurrss iinngg M

86% of acute-care nurses are using devices to access reference materials—including drug databases, manuals and medical calculators—and make informed patient decisions.59

86% of acute-care nurses are using devices to access reference materials—including drug databases, manuals and medical calculators—and make informed patient decisions.

Nurses spend almost 50% their time documenting their treatments. Nurses spend almost 50% their time documenting their treatments.

78% of nurses use IT at the patient's bedside to cut down on first writing the information on paper and then transferring it to electronic reports. 60

78% of nurses use IT at the patient's bedside to cut down on first writing the information on paper and then transferring it to electronic reports.

36% of nurses adopting this practice are using products to capture vital signs data that is automatically upload it to the patient’s electronic record. 61

36% of nurses adopting this practice are using products to capture vital signs data that is automatically upload it to the patient’s electronic record.

53% of nurses use devices (mostly bar coding) to ensure positive patient identification required for medications, blood transfusions and specimen collection. 62

53% of nurses use devices (mostly bar coding) to ensure positive patient identification required for medications, blood transfusions and specimen collection.

HHoommee HHeeaa ll tthh MMoobb ii ll ii tt yy :: H

A growing number of clinicians are traveling to patients’ homes, which requires remote connectivity to improve communication and to keep patient records up to date.

A growing number of clinicians are traveling to patients’ homes, which requires remote connectivity to improve communication and to keep patient records up to date. 7.6 million U.S. patients require home care in some form—

spending on this is projected to double by 2013.63 7.6 million U.S. patients require home care in some form—

spending on this is projected to double by 2013. Expect growth in round the clock quality monitoring and

instant data access from complex devices like monitors for cardiac, respiratory and neurological parameters.

Expect growth in round the clock quality monitoring and instant data access from complex devices like monitors for cardiac, respiratory and neurological parameters.

94% of home health nurses use computerized mobile devices in patient’s homes.64 94% of home health nurses use computerized mobile devices in patient’s homes.

II II II .. TTRREENNDDSS –– OOuuttss iiddee tthhee WWaall ll ss

Remote Access In Healthcare(Healthcare Informatics Survey, Summer, 2006)

Admin.25% Patients

15%

Other2%

Practioners 58%

ePPrreessccrr iibb iinngg

58

Moobb ii llee NNuurrss iinngg

59

60

61

62

Hoommee HHeeaa ll tthh MMoobb ii ll ii tt yy :: “We need to be paying attention to this movement because healthcare will be moving increasingly into the home….”

63

64

of 28


MMoobb ii llee TTeess tt iinngg

The POC testing device market will continue to expand outside the acute care arena due to the need to test for: 65 1000+ infectious diseases Drug consumption Toxins in food and agricultural products Genetically modified organisms Cancer markers Biothreat agents Allergens and immune response levels Human recognition

Much of this testing with be done by nonprofessional personnel using handheld devices or in a

lab on bench instruments. This trend is driving the need for easy to use platforms that can readily transfer to the acute

care setting.

MMoobb ii llee LLeeaarrnn iinngg

Continued strong growth in mobile learning products and services is fostering the movement of knowledge building events, content, tools, and applications from the desktop to handheld devices. The overall market is showing a 27.3% CAGR which is expected to produce $1.5 billion by

2011.66 The US healthcare sector mobile learning market is $96 million (May 2006) and showing

a 23.5% CAGR that will produce $276.5 million by 2011.67

RRFFIIDD && BBaarr CCoodd iinngg

The overall RFID market is estimated to reach $9.7 billion by 2013 and show a 15% CAGR for the 2008-2013 period.68 RFID in the healthcare industry is getting good traction during its early stage

The healthcare market for RFID would reach more than $1 billion by 2010 and $3.1 billion by 2012. 69

Growth in the healthcare market will occur as issues of network infrastructure scalability, interoperability, and the relatively high costs of implementation are resolved.70

The adoption of mobility applications has been helped by increasing usage of bar-code

technology for medication administration, charge capture and patient identification . 71

UUnnii ff iieedd CCoommmmuunniiccaatt iioonnss –– NNoott YYeett PPrr iimmee TT iimmee

Despite the buzz about and availability of Unified Communications (UC) systems, clinicians are cobbling together a variety of mobile devices to suit their needs. 67% of clinicians interviewed carry two or more mobile communications devices (mobile

phones, pagers, etc.), allowing them to communicate with specific networks of people or perform certain job functions. 72

WWii rree lleessss SSkk ii ll ll ss TToo BBee ##11 IInn FF iivvee YYeeaarrss –– HHeeaa ll tthhccaarree TToo LLeeaadd DDeemmaanndd

of 28


http://en.wikipedia.org/wiki/Unified_communications

A global survey of IT decision makers concluded the

need for mobile and wireless skills is expected to show the highest growth rate and become #1 over the next five years.73 Those needing wireless skills the most were: 74

63% - healthcare 63% - education

With skill shortages and escalating costs, it is

expected that a large portion of future wireless hardware sales will be bundled into managed services agreements. 75 When compared to wireline, the costs to manage

wireless services and devices is nearly 10 times more. 76

Mix Wired/Wireless Networks Across All Healthcare Enterprises

(Healthcare Informatics Survey, Summer, 2006)

Fully Wireless

5%

No Wireless

23%

Wireless & Hard Wired

72%

Enterprises outside of healthcare face two major challenges in supporting wireless mobility: 77 64% - struggle with escalating costs for services 57% - think supporting devices as a close second priority.

IIXX.. VVEENNDDOORRSS

Most of the vendors offering mobile application only offer one or two applications and typically are small informational providers (e.g. drug formularies) or application specific (e.g. charge capture/personal schedule for physicians,). There are only a handful of vendors offering a reasonably robust listing of applications that incorporate integration and workflow engineering to present a comprehensive picture of patient data at POC. Of these, consensus and analysis point to PatientKeeper and Thompson Reuters Healthcare (acquired MercuryMD). PatientKeeper is clearly the more aggressive vendor in the market and may be the leader by revenues due to recently reported deals closing and new product releases. Thompson Reuters is a leader in information applications for healthcare and acquired MercuryMD in 2006—little is published about their success with this acquisition, however, they have been the leading favorite of KLAS survey respondents for the last six years. Of special note is the HIS developers response to the demand for mobile capabilities. Here again, PatientKeeper has integrated with most of these systems, partnered with the leaders (Cerner, GE, Sage) and leading electronic medical record vendors while others HIS developers (McKesson, Siemens, Dairyland) have developed their own limited mobile capabilities. Most of the remaining vendors below have been in business less than ten years, are venture funded and present some interesting options. Other than Thompson’s acquisitions of MercuryMD, there are no signs of consolidation reported.

of 28


http://www.patientkeeper.com/

http://www.micromedex.com/products/cxnavigator

Market Distribution of Vendors Based on Annual Revenue When Available 2

Vendor Annual Revenue When Available

[in millions] PatientKeeper physician portal essential clinical results ePrescription ambulatory order entry monitoring patient ID

$7.6M (for 2007, Hoover’s

current report) Claims about 10% of

market Highly rated in Gartner’s

Magic Quadrant for being able to execute a strong vision

KLAS market leader Microsoft Healthcare User

Group award (2006) Extensive Partners List

includes the largest hospital and physician software vendors: Cerner GE Sage (formerly Medical

Manager)

Thompson Reuters Healthcare (formerly MercuryMD) –Xpert Navigator Delivers information direct from the hospital's various HIS system components – including: demographics laboratory results medication lists radiology results pathology reports consults and other transcribed reports

$10M (2005) 2007: sixth year in a row as

Top KLAS Mobile Data Health Data Management's

third annual Nursing Information Technology Innovation Award in recognition of its groundbreaking early detection efforts—used Thompson system.

KLAS market leader

IQMax – Enterprise platform offering: Charge capture Clinical results

Founded 1999; privately held.

of 28


2 Source: Publicly available records

http://www.patientkeeper.com/

http://www.patientkeeper.com/news_and_events/press_releases/2002/03182002.html

http://www.patientkeeper.com/news_and_events/press_releases/2007/08142007.html

http://www.patientkeeper.com/news_and_events/press_releases/2008/02252008Sage.html

http://www.patientkeeper.com/news_and_events/press_releases/2008/02252008Sage.html

http://www.micromedex.com/products/cxnavigator

http://www.iqmax.com/solutions.html

Market Distribution of Vendors Based on Annual Revenue When Available 2

Vendor Annual Revenue When Available

[in millions] Dictation Prescription Formulary Collaborative Media MedAptus – leading charge capture vendor Add on modules include: Anesthesia Communication Rounding List Dictation Clinical Results Clinical Content Electronic Prescribing BI Analytics

70% growth in 2007, founded 2003?

Cogon Systems MPI Portal Medication Consolidated medical records

U.S. Army selects Cogon

Systems to develop advanced clinical decision support tools for hand held computers

New Age Systems

Founded 1986: system integrator with mobile applications;privately held.

XX.. IINNFFLLUUEENNCCEE && OOVVEERRSSIIGGHHTT

Numerous regulatory and standards authorities are increasingly putting pressure on IT leadership to ensure patient and business data is securely maintained. Clearly, the need to monitor for compliance to these regulations is changing the way healthcare operates: 78 60% healthcare organizations now employ a Chief Compliance Officer (CCO) 40% of IT decision-maker are spending 11-40% of their time on compliance 91% acknowledge HIPAA regulations influence or strongly influence IT purchasing decisions

of 28


http://www.medaptus.com/solutions

http://www.cogonsystems.com/Solutions.ashx

http://www.newagesystemsinc.com/about.html

RReegguu llaa ttoorryy

The more relevant regulatory considerations for mobile patient data delivery are focused on privacy and security including: HIPAA Regulations: Regulations covering electronic security and transmission of patient information require documented and tested business continuity and security plans. 45 CFR 164.512 9(f): This rule states that the legal process in obtaining a court orders and the

secrecy of the grand jury process must protect the individual’s private information. 45 CFR 164.502(f): The final HIPAA rule changed the protections afforded to the deceased,

obligating covered entities to guard the health information of a deceased individual in the same manner as a living one.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO): They have the power to suspend accreditation if security and disaster management programs are not in place. National Institute of Standards and Technology (NIST) SP800-30: Sets statutory responsibilities under the Computer Security Act of 1987 and the Information Technology Management Reform Act of 1996 (specifically 15 United States Code (U.S.C.) 278 g-3 (a)(5). The May 2007 IRS memorandum clarified that hospitals may donate up to 85% of the cost of electronic health records (EHR) software to physicians, as permitted by legislative exceptions to the anti-kickback statute and Stark Federal Physician Self Referral law. It further stated, that the EHR items or services must be software, information technology and/or training services necessary to create, maintain, transmit, or receive electronic health records, and must be used “predominantly” for this purpose. Those hospitals that do not assure compliance with this ruling risk losing their 501c3 nonprofit status.

AAssssoocc iiaa tt iioonnss

American Telemedicine Association is the leading resource and advocate promoting access to medical care for consumers and health professionals via telecommunications technology. Continua Health Alliance is comprised of over 135 technology, medical device and health care industry leaders dedicated to making personal telehealth a reality. Continua is working to establish a system of interoperable personal telehealth solutions that empower people and organizations to better manage health and wellness. CTIA-The Wireless Association represents all sectors of wireless communications – cellular, personal communication services and enhanced specialized mobile radio. Its mission is to expand the wireless frontier and advocate on behalf of their membership before the Executive Branch, the Federal Communications Commission, Congress and state regulatory and legislative bodies.

of 28


http://www.dhhs.gov/hipaafaq/index.html

http://www.dhhs.gov/hipaafaq/permitted/law/505.html

http://www.business-recovery-planning.com/whyplan.shtml

http://www.jointcommission.org/

http://csrc.nist.gov/publications/nistpubs/800-30/sp800-30.pdf

http://www.antitrustattorneys.com/publications/articles/1107.pdf

http://www.atmeda.org/about/aboutH.htm

http://www.continuaalliance.org/home

http://www.ctia.org/aboutCTIA

SSttaannddaarrddss

The Certification Commission for Healthcare Information Technology (CCHIT) provides certification that vendors products are HIPAA compliant out of the box PCI Security Standards Council is a newly formed as an enforcement arm of the credit card companies to help healthcare do a better job protecting cardholder information. ASTM Continuity of Care Record is a core dataset to be sent to the next healthcare provider whenever a patient is referred. This promises to bring an end to physicians having incomplete information by providing the necessary information to support continuity of care with the hope of reducing medical errors.

of 28


http://www.cchit.org/choose/index.asp

https://www.pcisecuritystandards.org/

http://69.7.224.88/viewnews.aspx?newsID=772

of 28


BB iibb ll iiooggrraapphhyy

1 Cook, B. (2008, June 9). Twilight of the beeper: Today's technology offers other ways of keeping connected. Amednews.com. Retrieved 6/08/08 from: http://www.ama-assn.org/amednews/2008/06/09/bisa0609.htm 2 Cook, B. (2008, June 9). Twilight of the beeper: Today's technology offers other ways of keeping connected. Amednews.com. Retrieved 6/08/08 from: http://www.ama-assn.org/amednews/2008/06/09/bisa0609.htm 3 Lawerence, D. (2008, February. CIOs Will Need To Support An Arrayof Mobile Devices and Applications. Helathcare Informatics. Retrieved 6/9/08 from: http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=D42E8348C5DA471885DA65251A42F580 4 (2007, October). HIMSS Vantage Point. HIMSS. Retrieved 6/15/08 from: http://www.himss.org/content/files/vantagepoint/pdf/vantagepoint_200710.pdf 5 Schou, J. (2008, June 4). Health Care Embraces Mobility. H&HN. Retrieved 9/13/08 from: http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/Article/data/Spring2008/080604MW_Online_Schou&domain=HHNMOSTWIRED 6 Nelsen, m> (2001, July 31). Doctors trade clipboards for PDAs. Informationweek. Retrieved 7/2/08 from: http://www.informationweek.com/news/showArticle.jhtml?articleID=6505867 7 (2008, February). IT & Clinical Workflow. HIMSS. Retrieved 6/16/08 from: http://www.himss.org/content/files/vantagepoint/pdf/VantagePoint_200802.pdf 8 Schou, J. (2008, June 4). Health Care Embraces Mobility. H&HN. Retrieved 9/13/08 from: http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/Article/data/Spring2008/080604MW_Online_Schou&domain=HHNMOSTWIRED 9 Waegemann, P. (2002, June). Healthcare Documentation:A Report On Information Capture And Report

Generation. Medical Records Institute. Retrieved 6/9/08 from: http://www.medrecinst.com/finalreport.pdf 10 Entner, R. (2008). The Increasingly Important Impact of Wireless Broadband Technology and Services on the U.S. Economy. Ovum. Retrieved 6/9/08 from: http://files.ctia.org/pdf/Final_OvumEconomicImpact_Report_5_21_08.pdf 11 Entner, R. (2008). The Increasingly Important Impact of Wireless Broadband Technology and Services on the U.S. Economy. Ovum. Retrieved 6/9/08 from: http://files.ctia.org/pdf/Final_OvumEconomicImpact_Report_5_21_08.pdf 12 Waqlpert, B. (2002) Software to help your billing—and your bottom line. American College of Physicians. Retrieved 7/2/08 from: http://www.acponline.org/clinical_information/journals_publications/acp_internist/handhelds/nov02/billing.htm 13 Schou, J. (2008, June 4). Health Care Embraces Mobility. H&HN. Retrieved 9/13/08 from: http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/Article/data/Spring2008/080604MW_Online_Schou&domain=HHNMOSTWIRED 14 Schou, J. (2008, June 4). Health Care Embraces Mobility. H&HN. Retrieved 9/13/08 from: http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/Article/data/Spring2008/080604MW_Online_Schou&domain=HHNMOSTWIRED 15 Schou, J. (2008, June 4). Health Care Embraces Mobility. H&HN. Retrieved 9/13/08 from: http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/Article/data/Spring2008/080604MW_Online_Schou&domain=HHNMOSTWIRED 16 Schuernberg, B. (2008, April 1). Point of Care Part I: The Evolution Of Mobile Hardware. Health Data Management. Retrieved 6/11-0 from: http://www.healthdatamanagement.com/issues/2008_49/26002-1.html?portal=mobile_tech 17 Anderson, H. (2008, April 1). The Nursing Information Technology Innovation Award. Healthdatamanagement.com. Retrieved 7/2/08 from: http://www.healthdatamanagement.com/issues/2008_49/25998-1.html?page=1 18 Malkary, G. (2007, October). Point of Care Computing for Physicians. Spyglass Consulting. Retrieved 6/9/08 from: http://www.spyglass-consulting.com/spyglass_whitepaper_POC_physicians.html

http://www.ama-assn.org/amednews/2008/06/09/bisa0609.htm




http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=D42E8348C5DA471885DA65251A42F580



http://www.himss.org/content/files/vantagepoint/pdf/vantagepoint_200710.pdf

http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/Article/data/Spring2008/080604MW_Online_Schou&domain=HHNMOSTWIRED


http://www.informationweek.com/news/showArticle.jhtml?articleID=6505867

http://www.himss.org/content/files/vantagepoint/pdf/VantagePoint_200802.pdf



http://www.medrecinst.com/finalreport.pdf

http://files.ctia.org/pdf/Final_OvumEconomicImpact_Report_5_21_08.pdf

http://files.ctia.org/pdf/Final_OvumEconomicImpact_Report_5_21_08.pdf

http://www.acponline.org/clinical_information/journals_publications/acp_internist/handhelds/nov02/billing.htm







http://www.healthdatamanagement.com/issues/2008_49/26002-1.html?portal=mobile_tech


http://www.healthdatamanagement.com/issues/2008_49/25998-1.html?page=1

http://www.spyglass-consulting.com/spyglass_whitepaper_POC_physicians.html

of 28


19 (2007). HIMSS Annual Report on US Hospital IT Market. HIMSS Analytics. Retrieved 6/16/08 from: http://www.himss.org/foundation/docs/2007AnnualReport.pdf 20 Malkary, G. (2007, October). Point of Care Computing for Physicians. Spyglass Consulting. Retrieved 6/9/08 from: http://www.spyglass-consulting.com/spyglass_whitepaper_POC_physicians.html 21 Malkary, G. (2007, October). Point of Care Computing for Physicians. Spyglass Consulting. Retrieved 6/9/08 from: http://www.spyglass-consulting.com/spyglass_whitepaper_POC_physicians.html 22 Schuernberg, B. (2008, April 1). Point of Care Part I: The Evolution Of Mobile Hardware. Health Data Management. Retrieved 6/11-0 from: http://www.healthdatamanagement.com/issues/2008_49/26002-1.html?portal=mobile_tech 23 Malkary, G. (2007, October). Point of Care Computing for Physicians. Spyglass Consulting. Retrieved 6/9/08 from: http://www.spyglass-consulting.com/spyglass_whitepaper_POC_physicians.html 24 Schou, J. (2008, June 4). Health Care Embraces Mobility. H&HN. Retrieved 9/13/08 from: http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/Article/data/Spring2008/080604MW_Online_Schou&domain=HHNMOSTWIRED 25 Schou, J. (2008, June 4). Health Care Embraces Mobility. H&HN. Retrieved 9/13/08 from: http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/Article/data/Spring2008/080604MW_Online_Schou&domain=HHNMOSTWIRED 26 Lawerence, D. (2008, February). Facilitating Physicians. Healthcare Informatics. Retrieved 6/9/08 from: http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=BCD8514449F24489A95568DCB6C590D7 27 (2008, May 27). Healthcare IT Study Finds Mobility and Convenience Key to Productivity. Business Wire.com. Retrieved 6/9/08 from: http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20080527005334&newsLang=en 28 (2008). 2008 Identity Management Trends in Healthcare Survey Research Brief. Iprivata.com. Retrieved 6/9/08 from: http://www.imprivata.com/custom/confirmation/resource/research/2008_id_mgmt_trends_healthcare.pdf 29 Raths, D. (2007, February). Handhelds Get a Grip. Healthcare Informatics. Retrieved 6/09/8from: http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=6529D6C30B054CC0B08979DC71A8B677 30 Raths, D. (2007, February). Handhelds Get a Grip. Healthcare Informatics. Retrieved 6/09/8from: http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=6529D6C30B054CC0B08979DC71A8B677 31 Malkary, G. (2007, October). Point of Care Computing for Physicians. Spyglass Consulting. Retrieved 6/9/08 from: http://www.spyglass-consulting.com/spyglass_whitepaper_POC_physicians.html 32 (2008, June 25). Point of Care Computing: How Mobile Computing is Poised to Revolutionize Patient Care. Vendome. Retrieved 6/25/07 from: http://209.196.57.219/ME2/dirmod.asp?sid=7D6DBF0E417542D1BD2B73CAE9E1218A&type=gen&mod=Core+Pages&gid=E99F54C9E28F45859AA8FFA56BFE7BC9 33 Raths, D. (2007, February). Handhelds Get a Grip. Healthcare Informatics. Retrieved 6/09/8from: http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=6529D6C30B054CC0B08979DC71A8B677 34 (2007, October 8). 65% Of Physicians Fear Infection Risk By Using Mobile Computing Devices At Point Of Care — 160% Increase From 2005. Spyglass Consulting. Retrieved 6/9/08 from: http://www.spyglass-consulting.com/press_releases/SpyglassPR_POC_for_Physicians.v1.4.pdf 35 (2008, December 17). 64% Nurses Believe Wireless Infrastructure Not Reliable To Support Point Of Care Computing Solutions. Spyglass Consulting. Retrieved 6/9/08 from: http://www.spyglass-consulting.com/press_releases/SpyglassPR_POC_for_Nursing_v1.2.pdf

http://www.himss.org/foundation/docs/2007AnnualReport.pdf










http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=BCD8514449F24489A95568DCB6C590D7



http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20080527005334&newsLang=en

http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20080527005334&newsLang=en

http://www.imprivata.com/custom/confirmation/resource/research/2008_id_mgmt_trends_healthcare.pdf

http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=6529D6C30B054CC0B08979DC71A8B677







http://209.196.57.219/ME2/dirmod.asp?sid=7D6DBF0E417542D1BD2B73CAE9E1218A&type=gen&mod=Core+Pages&gid=E99F54C9E28F45859AA8FFA56BFE7BC9





http://www.spyglass-consulting.com/press_releases/SpyglassPR_POC_for_Physicians.v1.4.pdf


http://www.spyglass-consulting.com/press_releases/SpyglassPR_POC_for_Nursing_v1.2.pdf

of 28


36 (2007, October 8). 65% Of Physicians Fear Infection Risk By Using Mobile Computing Devices At Point Of Care — 160% Increase From 2005. Spyglass Consulting. Retrieved 6/9/08 from: http://www.spyglass-consulting.com/press_releases/SpyglassPR_POC_for_Physicians.v1.4.pdf 37 (2008, December 17). 64% Nurses Believe Wireless Infrastructure Not Reliable To Support Point Of Care Computing Solutions. Spyglass Consulting. Retrieved 6/9/08 from: http://www.spyglass-consulting.com/press_releases/SpyglassPR_POC_for_Nursing_v1.2.pdf 38 Raths, D. (2007, February). Handhelds Get a Grip. Healthcare Informatics. Retrieved 6/09/8from: http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=6529D6C30B054CC0B08979DC71A8B677 39 Raths, D. (2007, February). Handhelds Get a Grip. Healthcare Informatics. Retrieved 6/09/8from: http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=6529D6C30B054CC0B08979DC71A8B677 40 (2008, June 25). Point of Care Computing: How Mobile Computing is Poised to Revolutionize Patient Care. Vendome. Retrieved 6/25/07 from: http://209.196.57.219/ME2/dirmod.asp?sid=7D6DBF0E417542D1BD2B73CAE9E1218A&type=gen&mod=Core+Pages&gid=E99F54C9E28F45859AA8FFA56BFE7BC9 41 (2008, June 25). Point of Care Computing: How Mobile Computing is Poised to Revolutionize Patient Care. Vendome. Retrieved 6/25/07 from: http://209.196.57.219/ME2/dirmod.asp?sid=7D6DBF0E417542D1BD2B73CAE9E1218A&type=gen&mod=Core+Pages&gid=E99F54C9E28F45859AA8FFA56BFE7BC9 42 (2008, June 25). Point of Care Computing: How Mobile Computing is Poised to Revolutionize Patient Care. Vendome. Retrieved 6/25/07 from: http://209.196.57.219/ME2/dirmod.asp?sid=7D6DBF0E417542D1BD2B73CAE9E1218A&type=gen&mod=Core+Pages&gid=E99F54C9E28F45859AA8FFA56BFE7BC9 43 (2008, December 17). 64% Nurses Believe Wireless Infrastructure Not Reliable To Support Point Of Care Computing Solutions. Spyglass Consulting. Retrieved 6/9/08 from: http://www.spyglass-consulting.com/press_releases/SpyglassPR_POC_for_Nursing_v1.2.pdf 44 Malkary, G. (2007, November). Point of Care Computing for Nursing. Spyglass Consulting. Retrieved 6/9/08 from: http://www.spyglass-consulting.com/spyglass_whitepaper_POC_nursing.html 45 Currier, G. (2008, June 12). Mobility Boosts Worker Productivity, Customer Service. CIOInsight. Retrieved 6/19/08 from: http://www.cioinsight.com/c/a/Research/Affirmative-Action/?kc=EWWHNEMNL061908STR3 46 (2008, May). Hand-held Device Security Concerns Rise. Health Data Mangement. Retrieved 6/9/08 from: http://www.healthmgttech.com/enews/2008_may/feature-1.aspx 47 Currier, G. (2008, June 12). Mobility Boosts Worker Productivity, Customer Service. CIOInsight. Retrieved 6/19/08 from: http://www.cioinsight.com/c/a/Research/Affirmative-Action/?kc=EWWHNEMNL061908STR3 48 Leo. (2008, February 20). Converged Mobil Devices Still Not In for Business People. The Mobile Weblog. Retrieved 6/10/08 from: http://www.mobile-weblog.com/50226711/converged_mobile_devices_still_not_in_for_business_people.php 49 (2007, April 9). Mobile computing market to reach $88.9 billion by 2011. BCC Research. Retrieved 6/10/08 from: http://www.computerproducts.globalsources.com/gsol/I/Laptop/a/9000000085777.htm 50 (2007, April 9). Mobile computing market to reach $88.9 billion by 2011. BCC Research. Retrieved 6/10/08 from: http://www.computerproducts.globalsources.com/gsol/I/Laptop/a/9000000085777.htm 51 (2008, January 25). Handset Sales Strong in Q4 07. Mobile Enterprise. Retrieved 6/11/08 from: http://mobileenterprisemag.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=29C4ADE430D842CDB6BEF6447546BADC 52 (2008, January 25). Handset Sales Strong in Q4 07. Mobile Enterprise. Retrieved 6/11/08 from: http://mobileenterprisemag.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=29C4ADE430D842CDB6BEF6447546BADC

















http://www.spyglass-consulting.com/spyglass_whitepaper_POC_nursing.html

http://www.cioinsight.com/c/a/Research/Affirmative-Action/?kc=EWWHNEMNL061908STR3


http://www.healthmgttech.com/enews/2008_may/feature-1.aspx



http://www.mobile-weblog.com/50226711/converged_mobile_devices_still_not_in_for_business_people.php

http://www.mobile-weblog.com/50226711/converged_mobile_devices_still_not_in_for_business_people.php

http://www.computerproducts.globalsources.com/gsol/I/Laptop/a/9000000085777.htm


http://mobileenterprisemag.com/ME2/dirmod.asp?sid=&nm=&type=news&mod=News&mid=9A02E3B96F2A415ABC72CB5F516B4C10&tier=3&nid=29C4ADE430D842CDB6BEF6447546BADC




of 28


53 (2007, April 9). Mobile computing market to reach $88.9 billion by 2011. BCC Research. Retrieved 6/10/08 from: http://www.computerproducts.globalsources.com/gsol/I/Laptop/a/9000000085777.htm 54 James, G. (2008, June 18). Best Sales Tool: Smartphone or Notebook? BNET. Retrieved 6/19/08 from: http://blogs.bnet.com/salesmachine/?p=345&tag=nl.rSINGLE 55 (2008, May 9). Can Wireless Technologies Rescue U.S. Hospitals? PRNewswire. Retrieved 6/9/08 from: http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/05-09-2008/0004810292&EDATE= 56 Pizzi, R. (2008, May 12). Healthcare wireless market to approach $10 billion by 2012. healthcare IT News. Retrieved 6/13/08 from: http://www.healthcareitnews.com/story.cms?id=9242 57 (2007, April 18), Industry Report Assesses Market for Wireless Technologies in Healthcare. PRInside.com. Retrieved 6/11/08 from: http://www.pr-inside.com/industry-report-assesses-market-for-r97409.htm 58 (2008, June 25). Point of Care Computing: How Mobile Computing is Poised to Revolutionize Patient Care. Vendome. Retrieved 6/25/07 from: http://209.196.57.219/ME2/dirmod.asp?sid=7D6DBF0E417542D1BD2B73CAE9E1218A&type=gen&mod=Core+Pages&gid=E99F54C9E28F45859AA8FFA56BFE7BC9 59 DerGurahian, J> (2008, January 4). Nurses on point-of-care IT usage: study. Modern Healthcare. Retrieved 6/15/08 from: http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080104/REG/263244359 60 DerGurahian, J> (2008, January 4). Nurses on point-of-care IT usage: study. Modern Healthcare. Retrieved 6/15/08 from: http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080104/REG/263244359 61 DerGurahian, J> (2008, January 4). Nurses on point-of-care IT usage: study. Modern Healthcare. Retrieved 6/15/08 from: http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080104/REG/263244359 62 DerGurahian, J> (2008, January 4). Nurses on point-of-care IT usage: study. Modern Healthcare. Retrieved 6/15/08 from: http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080104/REG/263244359 63 Huvane, K. (2008, May). Points of Care. Healthcare Informatics. Retrieved 6/15/08 from: http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=479E16367D68466A9F12560EA2C6DF36 64 DerGurahian, J> (2008, January 4). Nurses on point-of-care IT usage: study. Modern Healthcare. Retrieved 6/15/08 from: http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080104/REG/263244359 65 Faulstich, K. (2007, July). Developing rapid mobile POC systems Part 1: Devices and applications for lateral-flow immunodiagnostics. DeviceLink. Retrieved 6/15/08 from: http://www.devicelink.com/ivdt/archive/07/07/010.html 66 Adkins, S. (2007, January). The US Market for Mobile Learning Products and Services: 2006-2011 Forecast and Analysis. Ambient Insight. Retreved 6/15/08 from: http://ambientinsight.com/Resources/Documents/AmbientInsight__MobileLearning_Market_Forecast_ExecutiveOverview.pdf 67 Burger, J. (2006, May). The US Healthcare Market for Mobile Learning Products and Services: 2006-2011 Forecast and Analysis. Ambient Insight. Retrieved 6/15-08 from: http://ambientinsight.com/Resources/Documents/AmbientInsight_Healthcare_MobileLearning_ExecOverview.pdf 68 Farrell, J. (2008, May 30). Market realities to shape HIT growth through 2013. MobileHealthWatch. Retrieve6/12/08 from: http://www.mobilehealthwatch.com/index.php?mod=news&id=2008060207140278083500&pid=20080122152625 69 Monegain, B. (2007, August 9). Hospitals not ready for RFID – yet. Healthcare IT News. Retrieved 7/3/08 from: http://www.healthcareitnews.com/story.cms?id=7586 70 Monegain, B. (2007, August 9). Hospitals not ready for RFID – yet. Healthcare IT News. Retrieved 7/3/08 from: http://www.healthcareitnews.com/story.cms?id=7586 71 Schou, J. (2008, June 4). Health Care Embraces Mobility. H&HN. Retrieved 9/13/08 from: http://www.hhnmostwired.com/hhnmostwired_app/jsp/articledisplay.jsp?dcrpath=HHNMOSTWIRED/Article/data/Spring2008/080604MW_Online_Schou&domain=HHNMOSTWIRED


http://blogs.bnet.com/salesmachine/?p=345&tag=nl.rSINGLE

http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/05-09-2008/0004810292&EDATE

http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/05-09-2008/0004810292&EDATE

http://www.healthcareitnews.com/story.cms?id=9242

http://www.pr-inside.com/industry-report-assesses-market-for-r97409.htm

http://www.pr-inside.com/industry-report-assesses-market-for-r97409.htm



http://modernhealthcare.com/apps/pbcs.dll/article?AID=/20080104/REG/263244359




http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=E3EC2A8000454A258DF3AA343FDBDA9E&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=479E16367D68466A9F12560EA2C6DF36





http://www.devicelink.com/ivdt/archive/07/07/010.html

http://ambientinsight.com/Resources/Documents/AmbientInsight__MobileLearning_Market_Forecast_ExecutiveOverview.pdf

http://ambientinsight.com/Resources/Documents/AmbientInsight__MobileLearning_Market_Forecast_ExecutiveOverview.pdf

http://ambientinsight.com/Resources/Documents/AmbientInsight_Healthcare_MobileLearning_ExecOverview.pdf

http://ambientinsight.com/Resources/Documents/AmbientInsight_Healthcare_MobileLearning_ExecOverview.pdf

http://www.mobilehealthwatch.com/index.php?mod=news&id=2008060207140278083500&pid=20080122152625

http://www.mobilehealthwatch.com/index.php?mod=news&id=2008060207140278083500&pid=20080122152625





of 28


72 Atohi, C. (2007, December). Use of Mobile Communication Grows but Remains Fragmented Says Spyglass Study. Digital Healthcare. Retrieved 6/16/08 from: http://www.bio-itworld.com/hitw/newsletters/2006/12/12/24230?Itemid=35728&terms=medical+device 73 Sacco, A. (2008, April, 9). Mobile/Wireless Skills to Top IT Manager Most Wanted Lists. CIO. Retrieved 6/10-08 from: http://www.cio.com/article/338413/Mobile_Wireless_Skills_to_Top_IT_Manager_Most_Wanted_Lists_ 74 Sacco, A. (2008, April, 9). Mobile/Wireless Skills to Top IT Manager Most Wanted Lists. CIO. Retrieved 6/10-08 from: http://www.cio.com/article/338413/Mobile_Wireless_Skills_to_Top_IT_Manager_Most_Wanted_Lists_ 75 Basili, J. (2007, January 7). The Real Cost of Enterprise Wireless Mobility. Aberdeen Group. Retrieved 6-19-08 from: http://www.aberdeen.com/summary/report/benchmark/Mobility_Management_JB_3822.asp 76 Basili, J. (2007, January 7). The Real Cost of Enterprise Wireless Mobility. Aberdeen Group. Retrieved 6-19-08 from: http://www.aberdeen.com/summary/report/benchmark/Mobility_Management_JB_3822.asp 77 Basili, J. (2007, January 7). The Real Cost of Enterprise Wireless Mobility. Aberdeen Group. Retrieved 6-19-08 from: http://www.aberdeen.com/summary/report/benchmark/Mobility_Management_JB_3822.asp 78 (2008). 2008 Identity Management Trends in Healthcare Survey Research Brief. Iprivata.com. Retrieved 6/9/08 from: http://www.imprivata.com/custom/confirmation/resource/research/2008_id_mgmt_trends_healthcare.pdf

http://www.bio-itworld.com/hitw/newsletters/2006/12/12/24230?Itemid=35728&terms=medical+device

http://www.bio-itworld.com/hitw/newsletters/2006/12/12/24230?Itemid=35728&terms=medical+device

http://www.cio.com/article/338413/Mobile_Wireless_Skills_to_Top_IT_Manager_Most_Wanted_Lists_

http://www.cio.com/article/338413/Mobile_Wireless_Skills_to_Top_IT_Manager_Most_Wanted_Lists_

http://www.aberdeen.com/summary/report/benchmark/Mobility_Management_JB_3822.asp



http://www.imprivata.com/custom/confirmation/resource/research/2008_id_mgmt_trends_healthcare.pdf

mobile healthcare: patient data delivery by jim bloedau

Health & Medicine