Recently, physicians at the University of Chicago published a research letter in the Archives of Internal Medicine detailing their experience with the routine use of iPads by internal medicine residents during their regular duties.
What they documented was that use of the mobile device was objectively associated with faster order entry after patient admission and the subjective assessment that it saves up to one hour per day for each resident.
In our recent article reporting on the research paper we agreed that rate of order entry is a reasonable proxy for increased workflow efficiency but also noticed the study raised many interesting questions. Bhakti Patel, MD is the first author of the study was kind enough to talk to iMedicalApps about the research and to share some of the interesting findings that did not make it into published article.
Some of the questions that I asked of Dr. Patel, currently a critical care-pulmonology fellow at the University of Chicago, were:
- when & why did you decide to study the use of iPads?
- how did you choose the study setting?
- what were some of the hurdles in initiating the trial?
- how did you decide what security & infection control measures to use ?
- how were the devices managed?
- what do you plan on doing next?
Read below to learn more about this groundbreaking study on the use of mobile devices by hospital based physicians.
Dr. Patel started by asking what is the fundamental issue, that “a lot of people in medicine are realizing that our decisions are becoming very data driven and that data is now housed in computers”. Furthermore, doctors are fundamentally mobile, clinical medicine is not practiced behind a desk. Therefore, this critical data also needs to be mobile. Thus, we need to “allow providers to be at the bedside to make these decisions and yet still be able to access the data.”
In 2010, Dr. Patel was one of the the chief residents for internal medicine at the University of Chicago when the concept of using personnel mobile computing was beginning to be discussed. In part, the study was motivated by the observation that residents were already trying to connect to the hospital EHR via their iPhones using the mobile Citrix app. As Dr. Patel put it, “necessity is the mother of invention” and residents “desperate to get something done” would take advantage of the mobility of an iPhone despite the “clunkiness of trying to connect remotely through Citrix” on a small device.
At that time, some of the residents and faculty including program director, Jim Woodruff, MD and Vineet Arora, MD, set up an informal task force to look at the idea. An initial pilot launched in September of 2010, remarkably only five months after the iPad came on the market.
At that point, only five iPads were purchased. These were given to “the busiest residents on service” to make sure they would be used and to see how they impact efficiency. Dr. Patel said the reason that the iPad was chosen was that “at the time that was the main tablet on the market.”
The task force also included leadership from infection control and also information technology and met weekly during the pilot process and then again to plan for the deployment once the decision was made to proceed with a larger trial.
Dr. Patel noted that UC is very “data driven and so when you are trying to say that something is worth doing you have to you know show them that it is”. Some people were “skeptical” because the devices are a significant investment and not without risk.
Not only that, the department had tried smart phones and PDAs before and that “we have this PDA graveyard now because they were not helpful for people or they only had one function.” So, “we had to prove it to make it possible”, initially with the pilot and later with the fuller study.