Every year, doctors in training are challenged with significant changes to our healthcare system. While this increasingly complex system is stressed by the business and politics of medicine, future and current physicians are expected to deliver cost-effective care. Today’s physician training model enforces shorter duty hours, demands effective synthesis of enormous amounts of data, and expects the resident physician to thoroughly learn his/her craft.
How can education and patient care be optimized? Many residents believe the iPad is the answer. The interplay between technology and medicine is no short story. Since the inception of the iPad in April 2010, notable institutions like the University of Chicago and Johns Hopkins University have demonstrated its utility in their internal medicine residency programs. In a study published this year by the University of Chicago, the ‘iPad Experience’ was associated with improvements in both perceived and actual resident efficiency.
In an institutional or personal setting, the iPad serves as a personal, mobile computer to which there is continuous access. With this notion, patient care can be enhanced in several ways. Patient’s results can be reviewed quickly and orders can be placed immediately whether you are rounding or in conference/lecture, graphic demonstration of disease processes and management can be educational for the patient and their family, and the doctor-physician relationship can be improved since more time is spent at bedside. From a communication standpoint, the primary team, consulting services, and mid-level practitioners can efficiently coordinate plans so that time is not wasted. Most importantly, critical orders are not missed, care is not diminished during changes in shifts, and patient safety is maximized.
The iPad is clearly beyond just an entertainment device. It’s place in education, politics, business, and now healthcare has manifest itself since its inception. Without a doubt, one of the most integral parts of a residency training program is resident education. The real-time use of the internet and iPad Applications (‘Apps’) can facilitate the practice of evidence-based medicine and aid in the education of healthcare providers. Such Apps as Epocrates for medications, Pocket Body for anatomy, CardioTeach for heart pathology, Rx-Writer for prescriptions, Jibbigo Voice Translator for language-barriers, etc are increasing in number each year and are clearly assistive in daily medical decision making and resident education.
At Johns Hopkins Hospital in Baltimore, MD they have slowly started to phase the iPad into resident physician’s workflows. The Department of Internal Medicine gives each intern an iPad for use in putting in orders during rounds, reading studies, and entering notes. The Department of Surgery, after seeing many of its interns carrying around their own iPads this year has talked about supplying an iPad for each team. Currently, Hopkins uses desktop virtualization software which allows residents to access the hospital EMR from their home computer or laptop. Fortunately, VMWare provides a free application, that once your hospital server address, username and password are entered, gives you access to everything you would normally have on your desktop at work.
There are some obstacles that need to be overcome before iPad use increases in the hospital setting. In some institutions, when residents are rounding on patients from one floor to another, the wireless network routinely drops off and requires the user to reconnect once s/he gets to the next floor. This means that if you are putting in orders as you are walking down the stairs to another unit, you lose your work. This of course could be remedied by either bolstering the wireless network, optimizing the iPad during wireless network hand offs, or buying an iPad with a cellular chip built in so that you are not dependent on the hospital wireless system. None of these options seem attainable from a resident standpoint.
How do we keep the iPad from becoming a vehicle by which MRSA and C. difficile are transferred from patient to patient? (We can’t exactly Purrel the screen!) Should the resident carrying the iPad only be responsible for putting in orders and not be allowed to touch the patient? This may not be practical as many teams are very small and don’t have multiple members to put in orders.
There are also issues of theft and damage to be considered. If a resident brings his her her own iPad to work and it gets stolen, that is certainly on the resident. However, if a department provides each team with an iPad and it gets stolen, what happens then? Does the hospical then ban that resident from holding the next iPad they purchase? How should be iPad be carried by the resident? Many residents currently have a pocket sewn into the inside of their coat to carry their iPads around less openly. All of these issues will continue to be fleshed out as hospitals incorporate new technology into the workplace.
With the increase in healthcare costs and medical information, there is mounting pressure to deliver safe, cost-effective care while maintaining the highest standards of education. This seemingly impossible ideal can perhaps be achieved with the implementation of Apple’s genius product, the iPad. With data and decision making algorithms at our finger tips, reliable care can be delivered quickly, resident education can be improved, and healthcare costs can be contained.
With so much interest in using the iPad in the hospital, the First Aid Team will be initiating a series on the many apps healthcare professionals can use to enhance patient care.
Patel BK, Chapman CG, Luo N, Woodruff JN, Arora VM. Impact of Mobile Tablet Computers on Internal Medicine Resident Efficiency. Archives of Internal Medicine. March, 2012; 172: 436-438.