This is a continuation of a recent post where we reviewed Dr. Henry Feldman’s experiences using the iPad as his primary interface during a busy week serving as a hospitalist at Beth Israel Deaconess Hospital (BIDMC) in Boston. Dr. Feldman is also the Chief Information Architect for the Harvard Medical Faculty Physicians.
In this post we interviewed him about his experiences of using the iPad on the wards and focus on three main topics: security, portability, and infection control. In the forthcoming part 3, we will discuss his observations on patient interactions using the iPad and the role of physicians in directing development of clinical applications.
How did you carry your iPad ?
Just in my hand like a book with the Apple case. I thought that on a 14+ hour day it would be tiring, but it never was an issue. I often put it down next to me to write a handwritten note, and I can’t imagine any physician not being near a flat surface once in a while.
Did you ever leave your iPad somewhere by accident ? How would a mobile physician avoid theft or loss ? Do you feel the systems that are currently in place, e.g. “remote-lock”, sufficient for medical grade security ?
I never leave my iPad (just like I don’t leave my wallet or $900 signed cashier’s checks around), and one advantage of course is that with everything web based, nothing is stored on the device. I have a couple of strategies though: I have replaced the lock screen with an image with my photo, “Henry Feldman’s iPad”, my cell and pager. I can remote wipe it, each of the applications of course have a username/password in the hospital, and finally have a lock code, and I use an encrypted network connection. That already exceeds the security that almost any institution places on paper charts.
You described being able to access hospital applications easily since they are web based, can you explain ?
As a large academic institution which has been computerized since the late 60’s (our “Acid Base Advisor” program was written in 1969 and still runs today!!) we have hundreds of systems. There are all sorts of interfaces to these systems, some of which are even terminal based (which you could access on an iOS device, but most folks won’t have that capability). That being said there are really 5 applications that physicians in our hospital use continously, which are WebOMR (our EHR), POE (our CPOE), Personalized Team Census (Signout), E-Ticket (Billing), Web Based Paging, and the ED Dashboard. All of these are web based and essentially work perfectly on the iPad (with some small occasional quirks).
Were there clinical applications which you could not access ?
The one exception program I should mention is WebPACS, which in our medical center is JAVA based, which won’t run on the iPad. There is a PACS [application] for the iPad (the superb OsiriX package [editor note: we reviewed the iPhone app here]), which would require some complicated policy changes [by radiology IT] and some technical changes, but could work.
What improvements can be made to make access to browser based clinical applications on smaller screens
On the iPod/iPhone form factor, while the programs work, they are not really workable (zooming becomes tedious fast), and here is where direct iOS web API would be helpful. Other applications may not work on the iPad but I never interacted with them. Some of our other applications also require citrix, and there is citrix for the iPhone/iPad if you need it.
Did you consider carrying an external keyboard and how often did you use a desktop computer to type in longer progress notes or more complex orders ?
I brought my keyboard to the hospital (the apple keyboard dock as well as the gorgeous “BookArc” iPad stand). They both sat on the shelf for 1 week unused. I used a desktop for writing complex notes such as my admission note and discharge summary, but this had less to do with the keyboard than being able to see multiple web pages at once and I do LOTS of cutting and pasting from data sources to assemble the note. My typical method of writing these notes consisted of doing a “chart biopsy” before seeing the patient, and getting 80% of the admission note written at a desktop. I then went to the patient room and opened the note on the iPad and filled in the details that weren’t available in the computer and details from the patient and my physical exam. I fully wrote letters to physicians or patients (results of studies) using my iPad.
No orders (or even discharge plans) required an external keyboard. I found after 1 beefy paragraph the screen keyboard does feel a tad clunky, but I rarely type more than that except for admission notes and discharge summaries.
How often did you clean or disinfect your iPad ? Are there “medical grade” cases available or do they need to be developed?
I actually cleaned it every few patients explicitly with the disinfecting wipes, and it was constantly bathed in cal-stat, as we “pump-in-pump-out” which meant it had a constant film of alcohol on it during rounds. Infection is certainly a concern, but since we aren’t even taking this as seriously as the NHS in the UK, we still all walk around with petri-dishes we call white-coats, long sleeve shirts, ties, etc. A sealed non-porous surface such as glass or the aluminum case are pretty easily cleaned. A medical grade case might be necessary for ruggedness, of course when it’s your own $900 device, you treat it well…
We hope you enjoyed this portion of our interview with Dr. Feldman – He brings great insights into the possible roles of mobile medical technology for physicians, and we’ll post the rest of our interview with him soon.
What has been your experience using smart phones and tablets for patient care ? We would love to hear stories from actual physicians, and don’t hesitate to reach out to us via our contact page .