How do you implement the iPad in the hospital setting for patient care and properly distribute it to a large group of physicians — all at once?
The University of Chicago’s Internal Medicine residency program tried this last year, and came up with a great blueprint for others to see.
Chicago’s Medicine residency garnered national headlines this past year with their use of the iPad for patient care. They have some great resources on their website that are public, showing how they have tackled many of the concerns of implementing a tablet based tool in the clinical setting.
The topics range from using the electronic health record Epic on the iPad — to Security, infection control, iPad accessories, purchasing apps, and more. The various manuals are focused on the internal medicine residency program’s implementation of the iPad, and while some aspects are focused on the medical education use, the manuals can be extrapolated by hospitals or other medical educators trying to implement an iPad based curriculum or iPad based patient care scenario.
Topics featured in the manual: (Links to manuals are at end of the summary)
Using an EMR with the iPad:
- The manual shows how to use Citrix, a virtual desktop app, for using an electronic health record. In the University of Chicago’s case, their house EMR is Epic.
- For those wondering how Epic works and functions using Citrix, the manual does a great job of breaking this relationship down, even showing you how you can find local printers.
- Some of the advantages they have found using the iPad and Epic: Can address patient issues while in conference, ability to discharge patient’s on rounds, patient education.
Large hospital systems and small medical offices alike are shifting over to electronic records en masse, with increasing adoption of portable platforms to use these systems. Many residency programs are now beginning to give tablets (such as the iPad) to their residents to encourage the use of electronic charting and prescribing during their training. As the use of tablets, laptops, and other portable devices grows, there is an increasing concern of unauthorized access into the devices.
At the recent Mobile Health Expo, this topic was the focus of Earl Reber, representing a company that specializes in security for networked medical devices. According to him, the average number of connected clinical devices per patient has tripled in the last 2 years alone. And, he says, the fact that healthcare has fallen behind in this area could pose dangers to patients as well as their confidential information.
As mobile devices become increasingly powerful, their applications in healthcare can be expected to grow. Recently, an app called MelApp was launched by the Health Discovery Corportation, a “molecular diagnostics company that uses patent protected advanced mathematical techniques for personalized medicine.” The app claims to apply these techniques to skin lesions by analyzing photographs, taken by the iPhone, to assess risk for melanoma.
On the surface, the functionality, while advanced, sounds reasonable. The classic teaching for assessing malignancy risk for a lesion that looks like melanoma is ABCD – asymmetry, borders, color, diameter. Those are all features that are analyzed by looking at the lesion and all seem like parameters that could be assessed by a computer using a high-resolution image with a large reference database.
Using a relatively cheap smart phone, the Samsung Behold II, and an add on peripheral, researchers at MIT have created a device that can detect cataracts. Why is this a big deal? Because cataracts is often detected during a slit lamp examination — and those of us who have used a slit lamp are painfully aware of how large and cumbersome they are — and definitely not mobile.
This peripheral add on device costs a mere $2.00, whereas a slit lamp device costs as much as $5,000. Moreover, where a slit lamp device needs a skilled operator, this device does not. It utilizes a prompt on the phone to actually tell the operator their diagnosis (refer to video).
Cataracts is one of the leading causes of treatable blindness. Devices such as this one truly show the potential of mobile health, and how mobile technology can be utilized in broad prevention efforts across the globe. (read more)
The editors of thisismynext, formerly at the respected Engadget, have sources on record saying a new iteration of the iPad will be released with a 2048 x 1536 pixels resolution display, almost double the current pixel display — and will be dubbed the “iPad HD”.
They adamantly state this will not be the new iPad 3, rather, a premium version of the iPad aimed at professionals who could utilize a higher pixel density display — something physicians like myself would welcome, mainly for viewing radiology images on the iPad.
There is currently one medical radiology app that is FDA approved for the iPad — Mobile MIM. We reviewed Mobile MIM extensively earlier this year. But there are other medical image viewers for the iPad that are currently awaiting FDA approval, such as OsiriX and ResolutionMD.
Step 2 Clinical Knowledge (CK) is the second board exam in the USMLE series testing clinical knowledge, and one that many medical students have to pass before graduating and obtaining their medical degrees. While generally not considered to be quite as high-stakes as USMLE Step 1, it can nonetheless be a pretty daunting hurdle.
McGraw-Hill – a company well known to most medical students as publishers of the First Aid series – presents this review app for the iPhone. They created USMLE Step 2 CK DejaReview (and a similar app for Step 1 for students preparing for their board exams. But could the app compete in a market with so many study aids already out there?
Advanced Cardiac Life Support (ACLS) is a critical aspect of medical care, yet can intimidate many physicians-in-training. Whether in code situations for surgical inpatients, new arrivals to the emergency department, or even fellow passengers at an airport, mastery of ACLS algorithms is vital for all healthcare professionals, and can mean the difference between life and death.
In the past, we have explored how the use of mobile medical technology by healthcare professionals may improve outcomes in these situations. Specifically, we have discussed how a randomized control trial suggested that the iResus app, developed by the European Resuscitation Council, enhanced the performance of ACLS-certified physicians in simulated cardiac arrests.
Of course, the first half of the equation—obtaining ACLS certification—is a prerequisite for actually carrying out ACLS algorithms. Most physicians & paramedics and many nurses are required to obtain ACLS certification, the guidelines of which are set by the American Heart Association or the European Resuscitation Council. The ACLS Review app from Limmer Creative seeks to “help students pass the test.” Limmer Creative, founded by paramedic and EMS veteran Dan Limmer, has developed review products that include several other mobile apps, including Paramedic Review and EMT Review.
Read below the jump to learn how ACLS Review can help you master ACLS algorithms.
In April of this year, I made a friendly wager with a friend that the Blackberry Playbook would be the bestselling iPad competitor of the Spring/Summer. My justification looked something like this: a) consumers are looking for smaller, more portable tablets and b) Blackberry has a faithful (yet dwindling) consumer base. I did concede though that Android tablets would, as a category, outsell the Playbook.
I purchased my Playbook with high hopes for its 7 inch form factor: small enough to carry around on a daily basis, yet large enough to comfortably display websites and replace papers/books I carry in my white coat pocket. Read on to find out whether my search for the ideal hospital tablet ended with the Blackberry Playbook.
The medical app industry is a big business, but the apps are no longer the product – the physicians, nurses, and other healthcare providers who use them are. In the first part of this series, we examined some of the financial forces driving the medical app industry. Our focus then was Epocrates, the veritable founder of the industry. As is clearly stated in their recent SEC statement, Epocrates primary revenue stream has become the pharmaceutical industry and as such a key goal has become to further grow their user base by enhancing their free offerings.
Now, one might be tempted to say that this is just one company or even that it is just limited to free apps. An expected counter-example would be Skyscape, which probably has the largest cache of apps of any developer and nearly all for fee. As a private company, there isn’t much financial data available nor is the website particularly forthcoming, but it does appear that the company has been enjoying some success. A deeper look however suggests they in fact have more in common with Epocrates than you may think.
By: Ankur Gupta, MS2
An acute exacerbation of heart failure is not much different from drowning, except in this case the fluid filling up the lungs is due to back pressure from a failing left ventricle. In many cases, these episodes are preventable – and with 670,000 sufferers of congestive heart failure and an annual cost of $29 billion, prevention is critical. And as any internist or cardiologist knows, successful prevention hinges on effective outpatient monitoring and management, which is far easier said than done.
In May, the UCLA School of Nursing along with the UCLA Wireless Health Institute published a study on a system to remotely monitor for symptoms indicative of CHF related decompensation. Dubbed WANDA, the system uses wireless devices to track weight, blood pressure, activity levels, and the Heart Failure Somatic Awareness Scale (HFSAS). The goal and idea are simple enough – catch early signs of an exacerbation, intervene, and keep patients at home.
With so much of a medical student’s future at stake, it’s natural that preparation for the USMLE can be big business accompanied by big expenses. While we were fairly impressed with Kaplan’s USMLE Mobile Step 1 Qbank and accompanying app, we were less impressed with the price of admission which boiled down to an expensive rental fee. The Qbank subscription fee even prompted some of us to reminisce about the halcyon days of the previous millennium when money plopped down for education meant receiving a hardcopy textbook with the information contained therein forever in one’s possession.
At $24.99, USMLE Step 1 Déjà Review is a significantly cheaper option than Kaplan’s offering, with the bonus of knowing that the 4518 concepts presented within are yours in perpetuity, provided that you’re still using an iPhone in the future. I’ve deliberately used the word “concepts” over “questions” for a reason; while Kaplan’s offering consisted of meticulously designed USMLE-style questions complete with multimedia, Déjà Review felt more like a large stack of flash cards. While 4518 physical flash cards would be a nightmare to go through, this app provides the organizational framework that enables students to go through sections methodically, or randomly quiz themselves.
In South Africa, there is no shortage of diversity. Immigrants, natives, city-dwellers and tribal members share a landscape that ranges from cosmopolitan to provincial. However, even in rural areas where basic infrastructure may be lacking, people can now stay connected to family and keep up on global events through their cellphones. Thus, the mobile technology boom has led to a leap-frog effect on communication.
Now, taking advantage of this mobile infrastructure, South Africa has started to roll out a series of new projects aimed at improving access and lessening the burden on the health system.