Ever since the first iPad was released in early 2010, physicians have been adopting tablet devices in droves.
According to a survey by QuantiaMD in May ’11, 80% of physicians surveyed owned a smartphone or tablet and 30% owned a tablet device.
And from this individual adoption, physicians are increasingly using their mobile devices in their clinical duties, creating headaches for many IT managers out there.
As a result, many institutions have begun deploying tablets and smartphones on the enterprise level. My own, Johns Hopkins, recently distributed iPads to many of its internal medicine residents. The VA recently announced plans to purchase 100,000 tablet devices. Much of this enthusiasm is, however, driven by anecdotal experience, surveys, and assumptions of efficiency gains.
The University of Chicago, one of the earliest institutions with a large scale tablet program, published the findings of a study to demonstrate, in more concrete terms, the efficiency gains associated with tablets. In comparing a three month period using iPads to the same period a year prior, they found that patient care orders were placed faster in the course of a patient’s admission.
In addition, a survey of 114 resident physicians found that nearly 80% attested to a perceived efficiency gain of 1 hour per day.
The study comprised of two parts. The first is a subjective survey approximately 4 months after distribution of the iPads. The second part is analysis of the timing of order entry during the first 24 hours of a patient’s admission over a three month period after the iPads were in use in comparison to the same three months one year prior.
The results of the survey generally reflect enthusiastic adoption of the iPads by the residents:
- 75% of respondents use the iPad daily
- 78% of respondents felt it made them more efficient and self-assessed that efficiency gain to be 1 hour per day
- 68% felt that patient care delays were averted
The results of the survey are quite consistent and enthusiastic. Even if the order entry timing results had been neutral, it would be surprising to get that kind of response if they did not find their iPads useful.
The analysis of the order entry is really interesting. They found that there were more orders placed in the first two hours of a patient’s admission after deployment of the iPad (OR 1.06). They also found that a greater proportion of all of the orders placed in the first 24 hours were placed earlier in the patients course, for example 5% more orders by 7AM, with no difference in the total orders placed in that time period.
The authors recognize several limitations of the study, such as the inability to tell whether the orders were entered on the iPad or a desktop. There are also other confounders that may be at play. First, admission order sets change fairly frequently – that or other similar administrative changes would have obvious effects on the results. Second, given that they compared order entry in the same three month period in 2011 and 2010, the people placing those orders were different.
Taking these findings one step further, the next question that comes to mind is whether earlier order entry has some meaningful benefit to the residents, patients, or others.
Evaluating workflow, particularly with the same rigor as other medical research, is incredibly challenging and will undoubtedly be plagued by confounders. Despite that, the folks at University of Chicago have attempted to demonstrate objectively what many of us otherwise have assumed – that tablets help us do our jobs better.
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