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A doctor’s review of rounds with an iPad

3:30 pm by | 10 Comments

In a previous blog I described the potential of the iPad for healthcare. Here’s another installment of that Cool Technology, an in the trenches experience by one of hospitalists and informaticians, Dr. Henry Feldman.

“I just spent a full week as a res-intern-attend on east and decided to try out my iPad (64gb 3G). It was a great experience mostly, and I fully intend to use it from now on. Here are my thoughts (sort of as they came along):

General:

Given that our service was spread out over 4 floors, we did a lot of walking around. Without interns, I did a few admits, many followups, coverage, triggers and discharges, so really got to use all the applications.

I use the “new portal” so I had single sign on. I was on the secure network for wireless. The portal worked well (or as well as it ever did).

In general it was incredibly useful and given that all of our clinical apps are web based it basically all worked perfectly. Probably the most useful was rounding (or the nurse snagging you as you walked by) and during a trigger where I could stay at the bedside and do/see everything and not leave my critically ill patient.

I have the apple case, which means that I can “wedge” the iPad so that it forms a useful keyboard. I typed fairly long notes, but certainly nothing like a DC summary, and it was perfect. On Friday evening had a late discharge, and up on 12R there wasn’t a computer free. I sat at the little round table and did it all sitting there, including all the DC instructions, scripts (except printing as below), etc…

Battery life is epic, and I finally had to charge today at 3pm (Monday), after last charging Thursday night. This is with frequent use for clinical care, along with the inevitable demos one has to give carrying around an iPad (OMG an iPad! Show me a movie, apps, etc…). On average a full 13 hour stretch with heavy use burned 28% of the battery over the week, best 20% worst 35%.

I was worried that it would be “heavy”, but found it wasn’t hard to carry all day (and we really moved around a lot). I propped it up in a tall wedge when sitting at a workstation so I could see email, etc). The apple case did not get slippery, and seemed washable with the infection control wipes (frequent). Alcohol gel on the hands seems to have left a slight white powdery buildup but that wiped off with a damp towel. I found I carried less other stuff.

You definitely will make heavy use of the rotation lock button, and 95% of the time I wanted it in landscape mode.

I did not try the ED dashboard on it, but since Larry is also using an iPad I assume it works.

I have PACS on my iPhone and iPad, but we can only use the Java based WebPACS.

For any provider who is highly mobile this blows the doors off of the COWs (computer on wheels) which is like rolling a file cabinet around. It’s faster, more reliable, insanely long battery life, and goes up stairs (although I have often thought of testing the “down the stairs” mode on the COWS when they run out of batter halfway through rounds on CC7) this is the machine to get. If you are office based, there isn’t a reason for this, but if you round on more than a few patients, then it will be invaluable.

I brought my iPad bookarc (stand) and Keyboard dock, but never used them. Seemed like it is highly unlikely you would ever use them, as it’s just as easy to wedge the iPad and type right on it. I did have my charger in the car just in case, but never needed it.

When there was a bug in a MySQL database being used by folks for chart review, standing there on the wards, I was able to securely get into the MySQL server back in informatics and change the setting. I also needed to update a website text, and was able to do that as well roaming the wards. And I had all the MySQL manuals with me too! As the ultimate test, while walking down the hall I VPN’ed into our server in Dasman and changed a database item there (that’s way off campus!)

When God smote the earth on Sunday, WeatherBug was helpful in knowing when/where would be a good time/way to go home to avoid the get-out-the-ark flood with that get-out-the-ark flood.

The device itself is very fast and wakeup from sleep or app switching is essentially instant

What worked really well:

The secure wireless network handoff was amazing. As I roved around it was seamless (there is a slight dead zone on 11 Reisman as there has been for years) and the best example is that I would use the elevator ride to catch up on news/tech websites, and every time the elevator doors would open it would reconnect and download some more prior to the door closing.

Omr, Poe, eticket worked essentially perfectly (see below in what didn’t work).

Running a trigger with the iPad at the bedside was amazing. Not having to leave the bedside and having OMR and POE right there was awesome (especially as the patient was new to me).

Showing patient’s their EGD/ERCP pics, results/trends and since I have Netter’s on my iPad the anatomy of the procedure, really helped with understanding by the patients. Med reconciliation was easier too. Diet changes were instant on patients (important given the number of ERCP patients we have).

Performance was amazing, with screens updating faster than many of the desktops on the wards.

Updating signout on PTC worked really well. Obviously you can’t print the signout, since there is A) no printing on the iPad and B) your printer isn’t signed into the domain so has no printing location set.

Email is much easier to read/manage on the iPad. My iPhone is pretty good, but in reading something longer about a patient from another provider, the extra real estate was very helpful (and in portrait mode, I can triage the emails much more easily)

What didn’t work so well:

E-Ticket could not add a new diagnosis to a patient’s bill. If you wanted to submit a bill for the same problems as yesterday (or a procedure in addition to today’s bill) that all worked fine. If you tried to add a new one, you always got the first one on the list, regardless of what you picked.

You can’t select “other” for a schedule for a med in POE. Works fine with one of the “standard” med schedules.

There is a wifi dead zone on 11R in the nursing station (that was there before the 5S/11R swap, and many patients in the farther rooms used to complain). It is also down to 1 bar in the back of the 5S nursing station.

Strangely I could not paste the discharge appointments made by CareConnections into the discharge instruction sheet (very strange. It was even hard to select the text).

Like any POE screen on Safari, all the elements (buttons) bizarrely have a black box around them. Never understood what that was. It doesn’t interfere, just looks unattractive. I assume this is a CSS bug somewhere and has nothing to do with the iPad (since it occurs on desktops too).

Discharge instructions are great, but you need to get on a desktop to print the prescriptions as there is A) no printing on the iPad and B) your printer isn’t signed into the domain so has no printing location set (which means you couldn’t get Tray 1 with the controlled paper anyway). Same with personalized team census. You can update, just not print.”

Copyright 2014 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Dr. John D. Halamka

By Dr. John D. Halamka

Dr. John D. Halamka is chief information officer and dean for technology at Harvard Medical School who writes at Life as a Healthcare CIO.
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10 comments
mike
mike

where is netter's available for the ipad? are you using the flashcards, and if so, are they pixelated and blurry? i haven't been able to find the real deal netter's anatomy text book version made for the ipad.

MegaDyne Medical
MegaDyne Medical

The technology of the i pad is amazing. Does this really work?

Henry Feldman
Henry Feldman

I am the original author in John's blog. Our very powerful EHR is home grown at our hospital, and uses purely regular web pages (no remote desktop needed), it also includes our billing application. Other apps included the Netter's Anatomy cards. We also have an institutional license for uptodate.com which I also used. As for cleaning/disinfecting, I wiped it down with the same wipes we wipe everything down with. I have no idea if that does something bad to the iPad, but it seemed just fine, now after many weeks of wiping. The biggest problem I had is the CalStat leaves a film on your hands (OK) and builds up an impressive film on the iPad case (less fun, but washable) As for the Hospitalist Neurologist, I take my notes right into our EHR (via Safari) so I don't use a separate application, but one could use pages I suppose.

Dan Bader MD
Dan Bader MD

I'm more analog than digital but have bitten the bullet to get into the twenty-first century; I have my new Ipad! I'd like to use it to take histories from pts at bedside (I'm a Hospitalist Neurologist) and make a few pertinent observations about the physical findings on exam. Any recommendations for a Note -taking App? Thanks, in advance, for your advice.

Jeremy
Jeremy

Just wondering how you go with infection control? I understand that most healthcare devices need to be disinfectable, and therefore require an IP (Ingress Protection) rating of IP52 or higher? We're also having trouble with IT departments wanting to support these devices, as they prefer remote administration / deployment of updates, etc. The Motion Computing C5v Tablet PC keeps coming up trumps in healthcare...

Phillip
Phillip

What were the apps you used on the iPad?

Tom Benson
Tom Benson

Another vendor here. We are very interested in hearing these sorts of case studies. Thanks!

Jahanzeb Sherwani, Ph.D.
Jahanzeb Sherwani, Ph.D.

Thanks for the informative article. I've always wondered if there's a way to bridge the iPad / desktop gap by using remote desktop. Has any doctor here used such a solution? As it happens, we've built one of the top grossing iPhone / iPad remote desktop apps called iTeleport. iTeleport works with Windows, Mac and a host of other platforms, and we're always adding new features. We'd love to get some feedback from the medical community, and if there are any unmet needs, we'd be able to quickly solve them since we're a lean startup. Feel free to email me for a promo code to our app!

CF
CF

I am curious what software (EHR, others) this physician is using. Some systems, web-based or not, might lend themselves well to iPad usage better than others, so knowing what his UI loomed like would be nice to know.

behold
behold

yet another kiss-steve-ass article. beh!