Friday, June 11, 2010

Cool Technology of the Week

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):

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."


@rdjfraser said...

Awesome post! I'm sitting in bed reading s few last articles on my iPad and just have to say I love it. Many people will say it is the same as a new exercise bike, 'works great for the first week or month, but eventually it will just colllect dust'. I'm hoping it will be much longer though, I really do love it. Also the real reason I wanted to comment is I believe you can remotely print remotely. I do that with my laptop and I've see epps that can too.

I definitely think the iPad is a game changer. I love it and plan on posting a lot about how nurses might be able to use it.

Thanks for the post, great read.

Anonymous said...

Very informative post. Thanks for being so thorough. Our medical library just got some of these for clinical librarians to use when rounding and they sent out the link to your blog for us to read.

Henryhbk said...

rdjfraser, my comment on printing, was specifically related to our EHR and how it prints. We do server based printing from within the application (when I sign a discharge prescription it goes to the ward's secure prescription paper printer where I am sitting, not the location of the patient, and same for many other things).

You could certainly redesign the printing architecture to support awareness of where this workstation is via WAP location, but that's not how the system today works.

The Krafty Librarian said...

Great post, I keep referring to it when I want to point out that not all hospital IT departments are afraid to allow iPads. Unfortunately many still do not allow them or iPhones to be institutional devices.

Anonymous said...

I'm interested to know what your ID department say about portable devices used in patients' rooms. Do they expect you to wipe it down from room to room? Does BIDMC ID department have a policy on this??