Medicine is becoming mobile. Physicians, nurses and other healthcare providers must be able to quickly assimilate and react to an overwhelming stream of data. Tablet technologies, such as the Apple iPad, have been incorporated into the workflows of many clinics, emergency rooms and hospitals. Medical Schools and Residency programs are quickly adapting the technology for teaching. While tablets do present some security challenges, most clinicians who are currently using them tout them as revolutionary and efficient. Moreover, there appear to be many new medical uses for tablet technologies in the pipeline that may forever change the way medicine is practiced.
Tablet Utilization: Pros and Cons
Many hospitals are now using tablet technology to help physicians and other treatment team members prepare and interact with patients while on the move. With healthcare reform and cost containment strategies, many hospital systems are looking for ways to streamline care and cut costs. Potential advantages of tablet use include the ability to improve workflow on rounds, reduce staffing requirements, and increase productivity and efficiency without compromising patient outcomes. In many centers, physicians are able to “sync” their devices wirelessly or via sync stations located throughout the hospital. Rather than moving to a computer terminal to sit down and review labs, consult notes, test results, etc, a team can move through the hallways and discuss these findings via an interaction on the iPad. There is virtually no downtime and less staff is required to see patients in an efficient way. When interacting with patients in their room, caregivers can actually show them images and results and discuss findings with them. In fact, a recent study from the University of Sydney showed that secondary review of radiology study images on an iPad was just as good as a standard LCD computer screen. For patients, it improves education and engagement in the care plan when they are able to see an image or test result as they discuss the finding with their providers. When patients have a better understanding of their medical problem and are able to participate in their treatment plans, outcomes improve. Tablet technology helps facilitate this type of engagement.
Some centers are incorporating their EMR (electronic medical record) into the tablet via a mobile application and this allows for quicker documentation and immediate record of the day’s plan for the patient–available for all team members to access “real time”. The EMR mandates put in place by the federal government have become a burden to many facilities and providers–by interfacing with these technologies via tablet technology, adoption of EMR and efficiency of documentation may improve.
As with any computerized medical record or medical application, security and HIPPA regulatory compliance are always a concern. In addition, the small size and mobility of the iPad device makes keeping the devices in the hospital a challenge. Although several major academic medical centers, including Massachusetts General Hospital have begun to incorporate tablet technologies into their practice, many others have not due to the cost of stocking the institution with the relatively expensive devices. Now, many EMR companies, including EPIC (a major EMR player in academic centers) have created secure applications for tablets and other mobile devices that protect privacy and are HIPPA compliant.
Tablet Technology: Future Applications in Medicine?
At this point, we are only seeing the tip of the iceberg when it comes to mobile technology in medicine. Tablets are very powerful, portable, and user friendly. I believe that these devices will become standard issue in medical schools across the country. Rather than spending 1000 dollars per student on printed materials for a year of medical education, schools such as the Yale University School of Medicine are now issuing iPads to all students and utilizing the iPad for nearly all curriculum related materials. According to the AAMC, tablet technology is being adopted all over the country and is being used to replace reams of learning materials on paper. In a recent survey of medical students published in the Journal of the American Medical Library Association, most students go utilize electronic based medical resources at least once a day and over 35% use a variety of mobile devices to access information.
Applications continue to be developed that have important educational roles in medicine–apps for learning EKGs, reviewing histology, learning pharmacology and others are becoming mainstream and will likely be an integral part of medical education going forward. A recently published study in JAMA: Internal Medicine evaluated the changes in resident efficiency when using iPad devices for clinical work. In the study, the authors found that the utilization of mobile devices improved workflow and both perceived and actual resident physician efficiency. In fact, orders on post call patients were placed earlier–before 7am rounds–likely resulting in improved care and more timely delivery of medications, treatment plans and orders for diagnostic studies.
For patients, tablet technologies may improve their visit experience and may help reduce medical errors. I can foresee a clinic where patients check in for their appointment and are given an iPad to fill out forms and answer a wellness screening questionnaire prior to their visit with their primary care doctor. With more “meaningful use” requirements imposed by government bureaucrats, these electronic screening opportunities will allow clinicians to not only meet regulatory requirements but also continue to spend meaningful time with their patients during a visit. In addition, patients can have the opportunity to review imaging with their clinician at their side and actually “see” what the doctor is able to see.
For physicians, the possible applications of tablet technologies are endless. Ultimately, I believe that these mobile technologies will revolutionize medicine and allow for care to be provided to patients who have previously been underserved. Tablet based electronic patient encounters are on the horizon. As physicians we must ensure that we continue to embrace technology and we must not resist change–medicine remains both a science and an art. We must continue to strive to incorporate BOTH technology and human touch into our patient encounters. Change is coming–we must adapt and embrace these technologies in order to provide our patients with the healthcare and caring that they deserve.