When I was in practice as a cardiac electrophysiologist not too long ago, I was on medical device company marketing advisory boards where executives would ask us “Do you think this is something docs would want?” Invariably some on the board would answer for themselves and say “I don’t like that device’s feature, and I don’t think anyone would.” Others, like me might say “It’s a feature I wouldn’t use a lot, but others may find it extremely attractive to have as an option.” Sometimes business developers have to ask themselves who all the ‘users’ of the technology might be, not just the high-profile ones. Sometimes the former far outnumber the latter. I believe that such is the case with electronic health records as well as mHealth technologies. My blog yesterday was about why physicians will love healthcare. Today’s article focuses on other healthcare providers.

In 2009 nurse practitioners (NPs) and physician assistants (PAs) worked with 49% of physicians in the US. Almost 80% of large medical practices and 40% of small ones (1-2 physicians) employed NPs or PAs. These mid-level providers (MLPs) spend significant face time as well as telephone contact with patients, family members, and other caregivers. Therefore, they will also be spending a significant amount of time with the electronic health record (EHR). When mHealth technologies are more common, MLPs will be spending more time than physicians dealing the data and follow-up of those transmissions. This was certainly true in my medical practice when I was utilizing remote monitoring of implanted cardiac rhythm devices.

One of the most important aspects of designing an EHR or mHealth technology is consideration of the workflow. One definition of workflow is “a sequence of connected steps. It is a depiction of a sequence of operations, declared as work of a person, a group of persons, an organization of staff, or one or more simple or complex mechanisms.” Workflow is how a patient travels through the office, how things are done with and to the patient, and how information is reviewed, entered, and processed. It may vary markedly from site to site. It is probably one of the most common reasons why EHRs fly or fail in a specific setting. The flexibility of an EHR should be determined before a system is purchased, and unfortunately it is not in many cases. Workflow should be a consideration with mobile or wireless technologies as well. Whether in the hospital or in the outpatient setting, the majority of persons who will be involved in the tracking and processing of data, as well as communications via messages, will be MLPs. It would therefore be of benefit to design the product with those people in mind as well as the physician. The end user (patient) is always considered in the workflow (installation, usage, transmission features. Clinical input with an eye on workflow is necessary in the development of these products, even though the mHealth technology’s workflow is primarily fixed and far less variable from site to site than EHRs.

This is not meant to be a tutorial on how to develop an mhealth technology, but merely to put into perspective the importance of other key players who will be utilizing these tools. Of course some mHealth technologies will likely be used only by the consumer (for the health and fitness categories, for example), and these comments are not applicable. The above is meant for applications and platforms that are clinically oriented in the diagnosis and patient management arenas. Engineers put forth incredible efforts in designing and developing these tools. But there is no substitute for experience in some way in the clinical field and having that experience shape the functionality of the technology. Mobile health development partnerships like the one that Verizon and Duke University just formed is a great example of technical and clinical design cooperation. Mobile health is the ultimate example, in my opinion of the marriage of technology and healthcare.