30 American Nurse Today Volume 9, Number 11 www.AmericanNurseToday.com

SINCE SMARTPHONES were introduced in 2002, a com-munications revolution has taken place. We talk on oursmartphones, we text on them, we take pictures andpost them to social networks, we communicate in 140-character “tweets,” and share our thoughts and eventson our personal networks. We use smartphone applica-tions to monitor our exercise, manage our calendars,and practice our deep breathing. For many people, for-getting their smartphone causes instant panic.

In health care, physicians’ smartphone use hasgrown exponentially. Just 6 years ago, I listened aschief information officers (CIOs) at the largesthealthcare organizations in Texas insistedemphatically that a bring-your-own-de-vice (BYOD) policy would neverhappen in their facilities. Ofcourse, things don’t always goas planned. According to theWolters Kluwer Health 2013Physician Outlook Survey, ap-proximately 80% of physi-cians now use smartphonesin their work.

But in the context of nurs-ing practice, the communica-tions revolution is only now start-ing to make a direct impact. Mostnurses continue to use voice-onlyphones, multiple pagers, or wearablevoice-activated two-way communication devicesprovided by their employers. While we may use smart-phones in our private lives, many of us still use outdat-ed communication devices at work. Or do we?

After visiting healthcare facilities across the country,I’m convinced nurses are in on the communicationsrevolution. I’ve seen them use their own devices—notthose provided by their employers—to text other

healthcare team members (including physicians) out-side the facility, access reference materials, and per-form many other functions on their smartphones thataren’t supported by employer-provided technology.

Is this a problem? For several reasons, increasing useof personal smartphones should raise concern for health-care facilities. (See Infection prevention for smartphones.)

Legal and regulatory compliance The foremost concern is legal regulatory compliance.Despite hospital policies forbidding use of personalphones by employees during work hours, 67% of hos-

pitals reported in 2013 that their nurses usedpersonal devices to communicate and

support their workflow. This means,in effect, that nurses could be vio-

lating federal laws (specifically,the Healthcare Insurance Porta-bility and Accountability Act),hospital security policies, andthe American Nurses Associa-tion’s Code of Ethics. Ifthey’re sending protectedhealth information (PHI) on

their smartphones in a waythat can be linked to a specific

patient, they’re also violating statenurse practice acts. Sending PHI

could lead to loss of employment, fi-nancial fines, jail sentences, and loss of

one’s nursing license. To make sure they’re notjeopardizing their jobs, nurses must determine if theircommunication and workflow habits comply with ap-plicable laws, policies, and procedures.

Cellphone securityWhat about security? Don’t most people secure theirsmartphones? In a word, no. Two of five people sur-

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Evolution or revolution?Smartphone use in

nursing practice Smartphones can aid nurses’ clinical practice, but they must be used

in compliance with laws, policies, and procedures. By Cheryl D. Parker, PhD, MSN, RN-BC, FHIMSS

www.AmericanNurseToday.com November 2014 American Nurse Today 31

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veyed don’t take the most basic smartphone securityprecautions. Criminal hackers are focusing more atten-tion on smartphones than on other electronic devices,according to cybersecurity experts.

A 2013 survey asked 1,000 full-time American workersto describe their personal smartphone use in the work-place. Among respondents who chose health care astheir employment sector, 88.6% said they used their per-sonal phones for work purposes. Among all respondents,39% said they don’t password-protect their phones. Po-tentially more dangerous, 52% used their smartphones onunsecured Wi-Fi networks, such as those at coffee shops.Use of unsecured Wi-Fi is a well-known security vulnera-bility because it can allow for easy phone data theft.

Do you know if your smartphone’s Bluetooth is setto “discoverable” by other devices, such as your hands-free headset? This is another security layer most peopledon’t think about. Data on an employer-owned phoneusually can be deleted remotely if the phone is lost orstolen. This is sometimes called “wiping” or “bricking,”meaning the device is no longer functional because theoperating system, programs, and data have been ren-dered inoperable. But it’s rare that data on individuallyowned devices can be deleted remotely. So even if younever use your smartphone for work, ask yourself ifyou could delete all those pictures, texts, and emails ifyou lost your phone. Do you have a backup of yourphone’s data just in case you have to delete everything?

Who owns the phone?Employers have the greatest control over devices theyown and distribute. But even in a BYOD environment,employers can require installation and use of applica-tions that provide the necessary security. Policies andprocedures help outline what devices are permittedand specify security requirements to ensure passwordprotection. In many cases, the standard four- to six-dig-it password is not secure enough; a hacker could cracka password such as 654256 in less than 1 second.

Policies need to spell out clearly who’s responsiblefor smartphone-related services, including dealing withproblems accessing the facility’s secure network. Em-ployers need to decide which applications are allowed,when updates must be performed to maintain applica-tion security, and what happens if the employee leavesthe organization.

In a BYOD environment, wiping the device in caseof theft or loss becomes an interesting question. If thedevice is storing both organizational and personal data,both types will be lost in the wipe. What are the rightsof the individual and the organization in this situation?This is another area where policies and proceduresmust be made clear to all. If you’re using your person-al device at work, find out if your organization has aBYOD policy and ensure that you’re in compliance.

In the future, certain communication exchanges maybecome part of the electronic health record (EHR). Suchdata, including pictures, shouldn’t reside on smart-

phones no matter who owns them, but instead shouldbe stored on a secure server with audit tracking.

Future of smartphones in nursing Facilities considering use of smartphones for clinicalstaff need to think about clinical communication as partof the patient-care process instead of just replacing cur-rent phones and functionality. Nurses need choices incommunication methods, including secure, encryptedtexting and email. Communication must be put in aclinical context to properly identify the patient, whoshould be at the heart of the communication exchange.Use of pictures, such as of a patient’s wound, shouldbe part of the available communication methods evenif the photos can’t be uploaded to the EHR.

Even more important, just as smartphones give uscognitive support in our personal lives, we need tolook for solutions that do the same in the complexwork of nursing. Just as personal smartphones remindus that our best friend’s birthday is next Saturday, nurs-es could use employer-provided smartphones and tech-nology to help them in clinical practice.

If you’re asked for input on your organization’s nextcommunication solution, consider the issues discussed inthis article. It’s not enough that your phone can sendtexts. Is your phone data secure? Can the phone be dis-infected? Will it survive the rough-and-tumble healthcareenvironment? What’s the vendor’s vision for the future of its platform, and how will it support nursing practice?

Envision the future of smartphones that can assistus both as nurses and in our private lives. And envi-sion yourself using a smartphone in compliance withlaws, policies, and procedures in a way that’s safe and secure. O

Visit www.AmericanNurseToday.com/Archives.aspx for a list of

selected references.

Cheryl D. Parker teaches nursing informatics at the Walden University School ofNursing in Minneapolis, Minnesota. She is chief nursing informatics officer forPatientSafe Solutions, based in San Diego, California.

Infection prevention for smartphonesIt should come as no surprise that mobile phones are dirty.In 2012, The Wall Street Journal randomly chose eight cellphones of office employees to test for bacteria. All of themshowed abnormally high coliform levels, indicating fecalcontamination. And these are the phones of office workers.Imagine what microbes nurses’ phones might carry, givenour work environments.

Recently, products for ultraviolet disinfection for bothpersonal and enterprise use have entered the market. Wa-terproof phone cases allow disinfection with commerciallyavailable disinfecting solutions without damage to the de-vice. Are such disinfecting methodologies available to youat work? Are you disinfecting your phone at home?