BYOD in Healthcare

Definition: Bring your own device (BYOD) has become a leading approach in healthcare settings. BYOD is a term that refers to the implementation of patients’ own mobile devices in clinical trials and healthcare practice. Note that only in the US, 95% of people own a cell phone, while 75% own a computer. From smartphones to laptops, the BYOD movement embraces the latest innovations in mobiles solutions and technological services to engage participants and clinicians. With increased familiarity and reduced costs, BYOD can facilitate patient-doctor communication and interoperability.

Transition from paper-based to electronic data: There’s no doubt that mobile technology facilitates doctor-patient communication, data collection, and statistical analysis. In fact, according to data, 80% of healthcare workers use tablets in practice, followed by smartphones (42%). With the inevitable transition from paper-based to electronic data, it’s no surprise that a vast majority of experts and sponsors turn to electronic clinical outcome assessments (eCOA) (“9 Key Factors to Evaluate When Considering BYOD”). Although provisioned devices (provided to the subjects) are still widely used to collect electronic data, the use of BYOD in healthcare research and practice is increasing in popularity.

History of BYOD and IT consumerization: Interestingly, BYOD in healthcare settings is not an isolated phenomenon. Since mobile technologies have become an integrated part of people’s lives, the consumerization of information technology (IT) is more than logical. We should mention that the term BYOD was introduced in 2004 when a voice over Internet Protocol (VoIP) service allowed businesses to use their own devices. In 2009, companies started allowing employees to bring and connect their own mobile devices to work. Two years later, BYOD became a leading term in marketing strategies, marking the new consumer enterprise. Note that BYOD can lead to an increase in productivity and a decrease in hardware costs. In addition, research shows that BYOD has numerous benefits across educational settings, as well as other industries.

Benefits of BYOD: BYOD is an effective approach in healthcare settings and clinical trials as it allows subjects to provide medical information via their own internet-enabled device. It’s not a secret that recruiting participants and collecting data are among the most challenging aspects of research. With numerous benefits, BYOD is preferred over traditional methods. For instance, users can either access an online platform or download a medical app. The BYOD approach has been implemented even in Phase II and Phase III clinical trials. Some of the major benefits include:

• Access to data in real-time: Just like with any eCOA and provisioned devices, BYOD ensures access to high-quality medical information. As data collection occurs in real time, 24/7, errors and bias are minimized. As a result, clinicians have access to accurate and valid data.
• High engagement: Studies show that BYOD boosts engagement and improves compliance. Via SMS, notifications, and emails, doctors can establish a good relationship with their patients and monitor non-compliance. In addition, up-to-date images and visuals can help people track their condition and progress over time.
• Usability: BYOD means accessibility. Since a vast majority of people own and use a mobile device on a daily basis, experts can reach a wide range of participants. According to data, there are approximately 2.5 billion smartphone users today; and these numbers are increasing. By not carrying an additional device and having optimal familiarity, training costs can only decrease.
• Better user experience: Customized options improve the user experience. mHealth apps, in particular, are gaining more and more popularity. Interestingly, statistics show that 105,912 apps in the Google Play store and 95,851 apps on the iTunes app store are marketed as health apps (Bol et al., 2018).
• Productivity: The implementation of BYOD in practice improves clinicians’ productivity. By having access to real-time data, experts can access reports 24/7, which benefits decision-making. In fact, electronic health records (EHRs) that contain data about patient health, demographics, medications, and lab tests, can improve medical workflow.
• Cost-effective: By implementing the BYOD approach in research, experts can reduce training costs and improve resource efficiency. When a patient brings their own device, there’s no need to store tech gadgets on-site or deal with logistics.
• Limited site involvement: Automatic updates and online platforms eliminate the need for site involvement and the burden of commuting. What’s more, with the integration of Help buttons, patients can find online support, which can boost participation and outcomes.
• Advanced features: Mobile devices are equipped with numerous advanced features (such as GPS, barcode scanning, etc.). For instance, GPS options can help researchers monitor a patient’s location and activities in a study in which activity levels are used as an endpoint. BYOD gives access to reports which are available in different formats (e.g., PDF) across different devices (e.g., Android). While clinicians can access biomedical research to provide support, users can connect their devices with other wellness and fitness wearables.

Challenges in the implementation of BYOD: Although BYOD is increasing in popularity, there are a few challenges researchers need to overcome in order to implement BYOD in clinical trials (Marshall, 2014). Researchers need to create a good study design, taking in account patient rapport, data accuracy, and technical aspects (e.g., screen size). Factors, such as lack of a mobile device, demographics, reimbursement, and IT use support, should also be considered. Note that one of the major concerns is data security and HIPAA regulations.

Risks associated with BYOD: Possible risks in clinical research are alarming. Data security and patient privacy are among the major concerns. Since medical data is sensitive, networks must be protected. Virtual sandboxes can be installed on a device to protect apps that deal with medical data. Thus, clinicians won’t breach HIPAA policies, support staff won’t access certain services, and patients will access a hospital’s patient portal only for relevant information.

BYOD in healthcare practice and aspects to consider: With its numerous benefits, BYOD is becoming one of the most effective approaches in research. When implementing BYOD in practice, clinicians and IT specialists should consider the following aspects in order to overcome challenges and possible risks (“9 Key Factors to Evaluate When Considering BYOD”):

• App-based and web-based BYOD: Experts must decide on either an app-based or web-based BYOD. mHealth apps, as stated above, are increasing in popularity. They allow patients to complete a wide variety of PRO’s, including diaries, reports, and reminders. App-based BYOD can benefit populations that use smartphones on a daily basis, as well as the administration of simple questionnaires. Note that unexpected events (e.g., changing phones) should be considered. Web-based BYOD, on the other hand, allows patients to enter data through a web browser (e.g., Chrome) via their own devices (e.g., PC). They are effective in Phase IV studies and in a large number of patients. Note that web-based questionnaires can automatically resize according to the screen size of any patient’s mobile device.
• Usability and availability: BYOD can improve usability. Nevertheless, although some patients prefer BYOD over provisioned devices, experts should consider patients who need additional training or have privacy concerns. Note that with the increasing range of mobile devices on the market, staff may also need additional training to provide support – regarding OS, brands, and study schedules. Also, although more and more people use technology on a daily basis, researchers need to make sure that enrollment is not biased by mobile device ownership (e.g., age and location). In fact, experts can employ a combined approach, and provide a provisioned device to subjects without a personal device. Note that to ensure accuracy and safety, provisioned devices have their calling and browsing options disabled and run only study software.
• Compliance: In research, eCOA reveal high levels of compliance (over 90%). Yet, when compared to other eCOA, BYOD can improve the user experience. To set an example, a study with 89% BYOD usage revealed compliance rates at 91.5% (“9 Key Factors to Evaluate When Considering BYOD”). Another study about the use of probiotic supplement showed that there’s a difference between provisioned devices and BYOD regarding compliance and engagement. Participants (n=87) were assigned to use a mobile application or no intervention. The mobile application subjects were additionally randomized into two groups: BYOD and a provided smartphone. Results revealed that BYOD is feasible in healthcare: the BYOD subgroup showed higher engagement, use of an application, and frequency. Nevertheless, when designing a clinical study, experts should consider the fact they can’t control or lock down personal devices (Pugliese et al.)
• Costs and training: BYOD can result in lower research costs. Although provisioned devices are widely used in research, experts agree that training, maintenance, and delivery can be costly. BYOD, on the other hand, can eliminate additional costs and logistic obstacles, as well as improve the user experience. Note that although BYOD can reduce costs associated with delivery and provisioned devices, sponsors still need to consider factors, such as training of staff, availability of support (e.g., support desk), and burden on participants. Since participants are using their own devices, sponsors should include reimbursements for all the data sending costs.
• Regulations and privacy risks: Before implementing BYOD in research, sponsors must ensure data consistency, quality, and transparency (Marshall, 2014). Note that even screen size may lead to bias. The stage of the study can also affect the implementation of BYOD. Therefore, experts must always consult regulatory bodies, follow existing regulations, and maintain clear documentation. Researchers should also establish a good relationship with the owners of the original questionnaires and get the owner’s permission to migrate the tool onto an electronic platform. Most of all, privacy concerns must be addressed. In fact, when it comes to privacy concerns, BYOD can ensure safety. Protection features (e.g., unique PIN) and encrypted data can improve the security of any software.

BYOD checklist: Creating a good study design is one of the major factors for scientific success. Apart from the aspects described above, researchers should consider the following checklist (“9 Key Factors to Evaluate When Considering BYOD”):

• The phase of the study
• Type of questionnaires (including items and images)
• Type of data (e.g., symptoms, data reported by patients)
• Frequency and duration of data collection
• Data collection (e.g. on-the-go)
• Characteristics of the population and the geographical situation (e.g., access to technology, shipping costs)

Clinical trials with BYOD: Research proves that BYOD is an effective approach in practice, considering patient management, compliance, and satisfaction. Based on Google Analytics, the findings from the randomized trial described earlier revealed that the BYOD subgroup showed higher engagement with the intervention, more application sessions per day, and longer sessions. Interestingly, the BYOD subgroup showed a significant effect of engagement on drug compliance in the end-line period of the trial. In fact, interviews revealed that BYOD users found it easy to integrate the mobile application into their daily routines (Pugliese et al., 2016).

With the effects of IT consumerization in real life, there’s no doubt that technology facilitates industries. Mobile devices have become an integrated part of people’s lives and business strategies. In healthcare, in particular, BYOD can lead to an increase in productivity, engagement, compliance, high-quality data, real-life communication, and cost-effective research. By considering data type, BYOD-related training, demographics, and privacy risks, experts can manage the successful implementation of BYOD in clinical trials in accordance with safety and ethical regulations.

Most of all, BYOD can improve user experience and well-being. Patients can bring their own device, which eliminates the need for carrying an additional device or training. Real-life data, smooth doctor-patient communication, and online support can only improve patient outcomes and quality of life. In the end, patients are the core of research and digital health.

Bol, N. Helberger, N., & Weert, J. (2018). Differences in mobile health app use: A source of new digital inequalities? The Information Society: An International Society, 34 (3).

Pugliese, L., Woodriff, M., Crowley, O., Lam, V., Sohn, J., & Bradley, S. (2016). Feasibility of the “Bring Your Own Device” Model in Clinical Research: Results from a Randomized Controlled Pilot Study of a Mobile Patient Engagement Tool. Cureus, 8 (3).

Marshall, S. (2014). IT Consumerization: A Case Study of BYOD in a Healthcare Setting. Retrieved from  https://timreview.ca/article/771

9 Key Factors to Evaluate When Considering BYOD. Retrieved from https://resources.crfhealth.com/ebooks/9-key-factors-to-evaluate-when-considering-byod