When working in the hospital, I intentionally minimize the time I spend on my iPhone because I don’t want people to assume that I’m just checking Facebook or playing Angry Birds.
Even though medical apps and the vast depths of the internet are at my fingertips, it’s just too easy to appear distracted. This represents a subtle, yet meaningful, glimpse of just one reason why I eagerly await the continued evolution of tablet devices for the hospital.
Apple’s iPad has replaced the DVD player as the fastest-selling non-phone electronic device of all time and some analysts predict that as many as 45 million iPads could be sold next year. Not to be left out, competitors from Google (eg. Samsung’s Galaxy Tab), Blackberry (Research in Motion’s PlayBook), Dell’s Streak, and HP are on the way. I expect tablet devices to be a hit in the health care industry because it provides an ideal form factor to bridge the analog to digital transition already taking place.
Visibility For More Than One Person
The small screen size of a smartphone makes it a personal device. You hold it close to your face and cradle it between your hands. In most situations, it’s hard for others to see what you are doing on their phone, making it difficult to share information and easy for others to jump to the wrong conclusions (eg. Angry Birds).
Compare this to tablets, which can be seen at a distance, are public by nature, and can be shared. It’s hard to use an iPad and not allow neighboring people some idea of what you’re doing. While they might not be able to read specific words, they will get a general understanding of your task, whether it’s browsing the web, reading a novel/reference, or checking your mail. In a hospital, this level of transparency goes a long way in building confidence with a patient or co-worker. Also along these lines, it allows for patient education and sharing data between health care staff.
Body Positioning is Key
As EMR’s become mainstream, patient rooms often are equipped with workstations mounted to a wall or anchored on a desk on one side of the room. If a doctor intends to document or input orders during a patient visit, he/she must face the monitor and keyboard, while only occasionally turning to the patient. Even if the doctor uses a laptop that allows them to sit directly in front of the patient, the screen acts as a physical barrier between the two.
Even in the interactions between members of the medical team, workstations (mobile or fixed) provide a degree of isolation. In teaching hospitals, there is rarely more than one workstation at use during rounds because there is a sense of distance that takes place when shifting over to a workstation or wheeling along a computer-on-wheels.
Now envision both scenarios with handheld tablets. A doctor can actively engage the patient while writing or typing on a tablet, no different than they would with a notepad or chart in front of them. A team rounding at a university could have multiple tablets at work: the intern presenting off their device while the attending and resident verify labs and imaging reports on their own, all while staying in the circular huddle.
Hospitals run on paper. Printers, fax/copy machines, and paper shredders are in every corner of every nursing station. Resident physicians scurry around with half-creased stacks of paper in their white coats. Paper is convenient because it is quick to access and it’s easy to write on. However, it’s not easily duplicable or shared, and en masse can become surprisingly heavy. Copy/fax machines help to some degree, but require you to still be in throwing distance of the original. Saving paper and “going green” is actually one of the reasons Stanford School of Medicine gave all their incoming medical students the iPad.
Handheld tablets offer many of the advantages of paper, while remedying some of these deficits. The current generation of tablets such as the iPad are instant-on and offer up to 10 hours of battery life (not including standby time). With the right apps and improved support for pen-like styluses, iPads can become effective hand-written notepads. Whether you have one or twenty patients on your service, the weight of what you carry around would not change. When it comes to patient charts, a single tablet could carry the equivalent of thousands of charts.
Textbooks + Web References + Journals
Reference materials are an obvious outflow of the previous thought, but still warrant their own discussion. Medicine has a very appropriate association with knowledge and education. Whether it’s UpToDate.com, Pocket Medicine, or the New England Journal of Medicine, doctors are constantly utilizing reference tools. Unfortunately, some of these are more portable than others, and doctors must usual settle for one. A tablet computer could easily store all these reference tools in their entirety, and then some.
There are already great apps iMedicalApps has already reviewed for Pocket Medicine and the New England Journal of Medicine. Skyscape has a rudimentary system for viewing many reference tools, textbooks are on their way, and the iPad Appstore is filled with several PDF readers that allow for annotation. Physicians would be able to constantly carry around and even share their own archive of relevant journal articles, all with personalized highlights and annotations.
Tablets Are Computers, Too
Many hospitals already have some degree of functioning EMR’s. As convenient as this may be, it also provides some limitations in that you must go through a hub to access this data, most often in the form of desktop or mobile workstations. Unfortunately, “mobile” in this case usually refers to a large table on wheels. In the same way that many EMR’s offer remote access to physicians from their homes, they could offer similar access to physicians on their personal tablet devices, thereby reducing the need for more workstations. This is already an effective reality in hospitals with EMR’s that are set up to allow Citrix access.
Conclusion: How Soon?
Unfortunately, tablets are still an emerging product at this time, and will require maturation before becoming completely viable. For example, most people prefer to take handwritten notes with a stylus (the digital equivalent of a pen), and the iPad only works with awkward, thick-tipped styluses in order to maximize sensitivity to the human finger. Also, there has not yet emerged a truly satisfying and comprehensive textbook experience yet from publishing companies – although a recent textbook app we reviewed gave us hope. Furthermore, the issue of network security and encryption is one that must be sufficiently addressed before hospitals will sign on.
Hopefully there will come a time when app developers, hardware companies, and hospital IT departments will all be on board, but until then, my tablet will stay at home, the scraps of paper in my pockets will grow, and I’ll continue to struggle to find unoccupied computers at the nursing stations when I round in the morning.