AboutA blog about things that make me happy.
While there has been mad speculation and interest in the iPad as a mobile device for physicians in the clinic and the hospital there are few (if any) real world reports of its use in this setting. I practice in academic medicine and had the chance to use the iPad last week while in the hospital caring for inpatients (pediatrics). I was the attending physician working with a great team of medical students and house staff. I give these details since there is such a range of possible use scenarios for the iPad and wide a range of practice scenarios.
The electronic medical record (EMR) system in our hospital is home grown and browser based. It used to be locked into Internet Explorer requiring me to use Parallels to get access on my macs. Recent updates make it accessible via Safari and thus to my happy surprise accessible on the iPad with full features except for medical image viewing (radiology images can be viewed on the desktop and laptops in the hospital). The iPhone cannot handle the density of info on the webpages so the iPad kills that hands down. So off we go.
Using it on the go - I usually don’t carry a laptop during rounds, so the first thing that I noticed was how little I need access to the EMR in general during rounds in the AM. (As the attending I have the team do most of the leg work in getting the data that I need). I took notes on Simplenote which was very convenient for to do lists. My reflex to write on a small index card was still engrained though so by the end of the week it was maybe 50/50. When I needed it throughout the work day, it was snappy and fast. The portability factor was much better than a laptop and was more convenient than grabbing a work station. The login process worked fine and the viewing experience was perfect. If I didn’t access to it for a while I would have to start all over again. I’m wondering with the new iPhone OS if multitasking can preserve my login status better.
The biggest initial downside was my pervasive fear of losing it or forgetting it in a patient’s room. As a doc my workflow is talk to the patients, wash my hands, examine the patient, wash my hands again and move on. If a patient is on contact or respiratory precautions I have to gown and glove and put on a mask as well. Where do I put the device then? Pockets are perfect for an iPhone, note card, or folded paper. iPad is another story. Thankfully, I didn’t lose it, but all doctors know that when things get busy, things can easily get misplaced.
Infection control - Another point related to the above - we know how nasty the screen gets with usual use. Given that I work in a place where infection control is a serious issue (all hospitals are nowadays), I’m not sure that the ipad is the best solution for regular use while working with patients. I found myself putting it by sinks, in trays, on seats. Overall I tried not to take it out much but keep it in the case during rounds. If I find a company selling either cheap disposable styli or autoclavable ones, I might actually invest in it…probably a perfect use case for a stylus.
Let’s say you decided to abuse it or use in settings where you would wear gloves. Oops. Out of luck with the interface.
In the clinic - I also used the iPad in my outpatient clinic and found it equally useful to get access to the EMR system. So I would see a patient, make a plan, write the prescription on the electronic system, and then prin…oops…can’t print prescriptions. Have to go to the workstation to do it. (help Mr. Jobs). While many places have automatic submission of scripts to pharmacies, we do not yet, so rely heavily on printing not only for prescriptions but also for patient instructions and other communication. This has to be fixed. I know of few practices that have not had to print things for patients to communicate information.
Research - As an academic researcher, reading papers on the iPad is a dream. The new Dropbox app is great as it keeps my library of papers I want to read (PDF) and I can read it in a wonderful format. Also use Goodreader with success.
So this is my first pass at iPad use in the medical setting. The key questions going in and the answers based on the experience in my practice setting:
1. Does the iPad have enough computing power for hospital use?
Yes. As quick as the desktops and notebooks. Multitasking would be nice so well see what the new OS brings.
2. Can the iPad replace workstations in the hospital?
No, not yet. Requirement for printing still is a limitation. Order entry is a completely different beast that I didn’t have to deal with. Other caveat is that I don’t need to type alot - still rely on dictating so a heavy typing load was not put to the test. I could edit dictations on the iPad similar to the desktop.
3 . Did the iPad get me access to all the information I needed during the day?
For the most part. Viewing radiology studies was not possible. Beyond that I could access all the databases and online resources I needed.
4. Did the iPad make me more efficient?
Probably not by much. A few seconds here and there that likely added up to a few minutes. Keep in mind we have a pretty robust and kick-butt EMR already I think
5. Did the iPad improve patient care?
Probably not. Since I’m out of training and only prescribe a small subset of meds, I don’t have need to access drug databases as much as I used to. If I had to frequently access resources for drug doses etc this might shave off time. Keep in mind that epocrates (the grand daddy) is not available on the iPad yet.
Anyone else with experience or comments?
Biggest problem with the iPad currently is getting content that you create out of the device. This is something that Apple has to fix in the future. Second problem is getting content into the device that is not dependent on using iTunes (They are going to have to rename that App someday).
My solution to this for text notes which covers >90% of what I routinely need was preached by Merlin Mann and detailed in this link from TUAW.
If you have a Mac and an iPad/Phone:
1. Install Notational Velocity on the Mac (Free).
Play around with this program. The most powerful feature is the search. Start typing any text in the top search bar and it sorts the notes quickly. Each note is an rtf file stored in the folder you choose. Set the folder in your Dropbox and it’s synced with multiple computers.
2. Install Simplenote on the iPad/iPhone. Set up your account for free with Simplenote.
3. In the Notational Velocity preferences enter in your simplenote information and you’re done.
Notes that are made on the desktop are put on your iDevice with online sync. Changes made to files on the Mac or iDevice are synced to the other.
I’ve used this system to track random account numbers, flight information, hotel information for trips, todo’s, notes from phone conversations. Very powerful and quick. Even better…free.
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