Recently, we had the chance to check in with Dr. Henry Feldman. He had posted a detailed summary of his experiences using the iPad as his main interface while rotating on service for a week as a hospitalist at Beth Israel Deaconess hospital (BIDMC) in Boston. Dr. Feldman is also Chief Information Architect for the Harvard Medical Faculty Physicians. His report was published on Dr. John Halamka’s great blog “Life as a Healthcare CIO” on June 11.
In part 1, we summarize his initial report which was enthusiastic on several important fronts. The summary of the following report includes his experience with the hospital wireless networks, using his hospital’s electronic health record system, interacting with patients using the iPad and how the battery life fared with clinical use. Later, in part 2, we will post an interview with Dr. Feldman to get more detail on his experiences.
Most important, was that he had a nearly seamless experience accessing his hospital clinical applications wirelessly. He wrote:
The secure wireless network handoff was amazing. As I roved around it was seamless (there is a slight dead zone on 11 Reisman as there has been for years) and the best example is that I would use the elevator ride to catch up on news/tech websites, and every time the elevator doors would open it would reconnect and download some more prior to the door closing.
He also reported that accessing clinical applications at his hospital was seamless, adding “[p]robably the most useful was rounding (or the nurse snagging you as you walked by) and during a trigger where I could stay at the bedside and do/see everything and not leave my critically ill patient.”
However, apparently most of the vital clinical applications (EHR, order entry, signout) at his hospital were designed to run in a browser so they already run “natively” on the iPad. Nevertheless, this should put EHR vendors on notice to create user interfaces that are easily adaptable for mobile devices.
He also found the iPad useful for communicating with patients:
Showing patient’s their EGD/ERCP pics, results/trends and since I have Netter’s on my iPad the anatomy of the procedure, really helped with understanding by the patients. Med reconciliation was easier too. Diet changes were instant on patients (important given the number of ERCP patients we have)
As for the device, he said that typing brief notes was not a problem with the glass keyboard and that the Apple plastic cover worked well and could be disinfected frequently. Not surprisingly, he raved about the battery life:
Battery life is epic, and I finally had to charge today at 3pm (Monday), after last charging Thursday night. This is with frequent use for clinical care, along with the inevitable demos one has to give carrying around an iPad (OMG an iPad! Show me a movie, apps, etc…). On average a full 13 hour stretch with heavy use burned 28% of the battery over the week, best 20% worst 35%.
In part 2 of this post, we will interview Dr. Feldman to learn more about his background and how he sees the iPad and future similar devices evolving into important tools for the mobile physician.
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.
