Some not so obvious reasons why medical tablets make sense for healthcare use in the Hospital

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.

Paper, Evolved

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.

Author:

David Ahn, MD (@AhnCall)

Staff Writer for iMedicalApps, and 2nd-year Endocrinology fellow at UC San Diego. His primary interests include Diabetes, Fitness/Metabolism, and wearable technology.

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8 Responses to Some not so obvious reasons why medical tablets make sense for healthcare use in the Hospital

  1. drrjv October 19, 2010 at 3:21 pm #

    I’m much happier with typing or using voice to input data into my iPad. Not sure where you get this statement: “most people prefer to take handwritten notes with a stylus”.

    Citrix works fine on the iPad but who wants to deal with the requisite clunky hospital computer systems.

    (So rather than blame the iPad ‘tablet’, blame the current state of hospital software (which seems to be stuck in the ’80′s!)

  2. Itzkoolz October 19, 2010 at 4:33 pm #

    hey drrjv, that’s a good point you make about typing and using voice. with my statement, i meant that people prefer to take handwritten notes with a stylus rather than with their fingertip. for general notetaking, i could see people using voice or typing. personally, i think there are pros and cons to both typing and handwriting.

    typing is great because it is a digital format (you can easily search it, cut and paste text), legible, and quick. handwriting is useful for use when standing (writing on it like a notepad), for liberal arrangement of words on page (eg. writing list of meds on right side of screen and quickly making three columns, etc), and for accuracy of text (i still make more typos on my iPad than a normal keyboard, and autocorrect is unhelpful with medical terminology).

    which app do you use for inputing data? Dragon for Medical? I haven’t used it much because i feel as if the need to cut and paste might be unwieldy until multi-tasking arrives with the next update in November.

    also, I hope you did not get the vibe from my article that I was blaming Apple or the iPad. In fact, I wrote an article already on this blog about why healthcare technology needs to learn from apple. http://tinyurl.com/2ev9s6v I think there just needs to be more app development/refinement and more integration between healthcare technology and iPad technology before it becomes a completely viable use for me. (I’m also severely limited in that my hospital does NOT support Citrix).

  3. Martin Young October 19, 2010 at 11:31 pm #

    I posted a blog on the desirability of touchscreen devices before the iPad was released – and made many of the same points – http://www.kevinmd.com/blog/2010/01/touchscreen-computers-future-electronic-medical-records.html

    Good to see we are on the same page !

  4. Rosa V October 20, 2010 at 7:10 am #

    Thanks for the great article – it’s very exciting to imagine where this technology may lead!

    Right now PracticeLink is actually giving away iPads to fans of their Facebook page. In fact somebody just won one yesterday.
    http://www.facebook.com/practi

  5. Samuel October 24, 2010 at 1:39 pm #

    Ah man! This has been so interesting. I work for a medical publisher and I am tasked with selling apps to the pharma industry. I really understand how the iPad and apps can come into their own and this will make my life so much easier when speaking to the customer. Work is giving me an iPad to showcase this and I am rather excited to see this. What I most want is for patients to feel that they understand what is happening and feel part of the process.

  6. Jack Bauer November 2, 2010 at 6:29 am #

    STYLUS-R-US iPad
    PREDICTION

    I’d only owned my iPad roughly ten to twelve minutes – when I could see it – clearer than you can see this line. Eighty to ninety percent of the companies – stores and businesses around the world – having and using the iPad. And why? The iPad – is literally a legend in its own time – and nothing is going to replace it (though journalist will write stories claiming some new device or another – will give it a run for its money – just to have something to write about).

    What could anyone else build? A larger one? Who wants that? A smaller one? Not happening. People are already in love with the ipads size – thinness and lack of weight. It’s a “zero-one” (super model) in the arena of electronics. It’s easy to carry everywhere. You can connect to the web – one way or another – depending on which model iPad you have – in seconds. No more having to wait till you get home to check your email – and not having to look at small phone screens – to do likewise.

    With the right apps in the iPad, you can text message anyone you wish. When it comes to photos and videos – hey? Nothing whatsoever comes close to the iPad – and I’m certain – the next version out will have both the still shot camera – but HD as well – and maybe even 1080 HD at that.

    Envision if you can – sitting at your favorite restaurant when your server or waitress walks up – iPad in hand. It’s just around the corner. Why? No more paper pads; no more lost pens that have run out of ink – all due to Steve Job’s brilliant iToy – the iPad. With each restaurants own menu in a special restaurant app (some sharp app designer will make) – the server will ask for your choice of food – at which time she’ll click here and click there. If you have a change of mind prior to her departure – she’ll click again and the switch is made. Upon telling her that will be all – she’ll click once more and the selected menu will appear on a large screen in front of the cook. I mean – how much easier – faster and convenient can it be?

    And this medical field? Twenty six and a half minutes of using my iPad – and I was telling my wife – the Doctors – nurses and entire medical field – are going to have a field day with this: WATCH!!!!!!!!!!!!!! Every doctor and medical person in the next 2 to 3 years – will have one – and not know how they ever did without it. It’s just as certain as you’re breathing. Saw it all – way back when.

    Your speeding tickets and red light violations will be quicker and more interesting as the officer stands beside you – as the glare from the sun hitting the back of his/her iPad – shines in your face while they “write-you-up”. By then – they’ll have a printer in their cruiser that prints out the hard copy of the ticket for you to sign (or not!). All of your information about you – including photo – will appear on the iPad screen as he’s making sure you’re not wanted – and you’re – who your ID or you (or lack of) says you are. If their NCIC or DAVID reflects your wanted – he’ll merely have to click one spot on the special law enforcement app – that will send an emergency message to headquarters letting them know – to send back-up (10-94 in Florida) as you have a 10-29 (wanted) subject in front of you – or to send a message to any additional units currently en-route – to speed it up. Mark these words!

    Every store chain – will have iPads for one service or another – but mainly inventory taking. When we walk up to a store employee these days an ask if they have some particular product in stock – most don’t know – while others – more sophisticated – have a PC they can walk to and check. Those days will be gone soon – when they all have iPads as one or two clicks – and the “in-stock” figures will be learn.

    No….I saw it all within minutes of having my first iPad. It couldn’t be plainer. Eighty to ninety percent of the companies – business and stores – will have the iPad in the next 2 to 3 years – and after that – when they start coming down in price – 75% of the worlds population will have them – to do everything from watching TV – movies – scheduling appointments – ordering groceries – etc., etc., etc.

    And we owe Steve Jobs a gigantic thanks for inventing – creating and manufacturing this beauty – because he too – is a legend in his own time – and one of the smartest men I have even seen (on TV) hopefully to meet one day. There’s just one tiny thing Mr. Jobs you forgot. The iPad is a Rolls Royce. But it lacks one thing – to make it five hundred times better: Wheels. The object that makes it roll. The item that makes it dance. The product that Stylus-R-Us invented – created – patented and markets: The ONLY super-soft-touch-stylus on earth.

    The STYLUS-R-US stylus – unlike the PoGo and 100% of the others that require an irritating and hindering downward pressure with each icon strike – STYLUS-R-US stylus requires absolute ZERO downward pressure (ONLY IF USED PROPERLY) to activate anything click on (including your mate – well – almost) Better yet – STYLUS-R-US has two – very special styluses for the iPad – called the iWand and the Roger iWand seen on their web site at http://www.beststylus.com .

    No…Mr. Jobs created a beauty – no doubt. But so has STYLUS-R-US – as their styluses by far – make all others obsolete. Watch their YOUTUBE videos on their site – and you’ll see the saying – “A picture is worth a thousand words” – surface right before your eyes. Yes…in the next 2 to 3 years everyone will have the iPad – but just as certain – they’ll all have the iWands to make them dance and preserve a totally clean.

  7. Backshore1 November 9, 2010 at 4:45 pm #

    DOCTORS – NURSES – HOSPITAL STAFF
    USING iPADS

    Stylus-R-Us has been contacted by countless hospitals around the world asking which stylus would be more beneficial for all medical staff in the hospital environment. The first thing you need to know is – all of our styluses possess the very same – no-downward-pressure tip – providing very fast and accurate data entrée.

    That being the case – selecting ones stylus may be preference – which ever stylus holder you prefer. However – if push came to shove – NOT one of our high-end – more expensive models – would be recommended more than the lower priced CAMRY. And why? It’s thin – strong – light weight and deadly accurate upon striking ANY icon – or character.

    This is to say – writing notes – texting – filling in medical reports – emailing – sliding from page to page – literally – can not be accomplished by anything else in the world at this time – as fast and effectively – as with using the Camry (or the stylus below). This is also the owner and CEO of STYLUS-R-Us choice of daily styluses.

    The Camry is perfect to slip into the Dr. Jacket upper pocket – and be ready to serve the user – better than the finger ever had a chance of doing. This is Stylus-R-Us #1 choice for the hospital environment. However – in expectation of selling out of these in the near future – with the possibility of not being able to locate that pen stock again – second choice would be any of the 7 high-end styluses – as they have the pocket clip – and though are thicker in body size – will serve you well.

    The above – is for medical personnel – who wish to have a stylus in their pocket wearing medical attire. There is another option however – that is fascinatingly awesome for the iPad – provided carrying it in a pocket – isn’t your aim.

    We’re talking about the Camry sensitive – 9” Roger iWand – either in brass or aluminum – (or pink – yellow – black – green – or orange). If you have an iPad case – similar to the cases shown in both the Roger iWand and the iWand pages on this site – the Roger iWand can easily be carried in the case fold (hinge) where it will remain until opened for use. It won’t fall out due to being wedged in.

    There is no doubt about it. If you possess both the Camry and Roger iWand – you will be thoroughly confused which one to take with you to work – as the Roger iWand – makes the iPad dance on its toes!

    Always keep in mind – that if for ANY reason you are not happy with any of our stylus – or anything happens to it (other than getting lost or negligence) – it will be replaced free – for one FULL YEAR.

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