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digoxin
29th January 2010, 11:42 AM
I have been thinking a bit since the launch of the iPad about how it could be a breakthrough product in areas where a good robust portable device fill an unmet need.

I work in the medical field and have previously worked in large hospitals. A lot of how hospitals work is to do with gathering and sharing information among a team and different teams as well as with the patient. I can see how the iPad could be an ideal portable device where a laptop or palm pilot device had major deficiencies. I know that that there are other medical related people on mactalk and interested to hear your thoughts and ideas.

It is likely that in the future digital patient notes will make way for traditional paper files. The iPad may with further refinement be the perfect portable device in this environment. Currently if you are admitted into hospital you are allocated a paper file which follows you around hospital. Lets say you are in the ward it stays in the ward office and is accessed and written onto by the various people in the team that look after you.(Eg Doctors, nurses, physiotherapist etc). Each person will need to physically find the file and write in it. The hassle is when the file is misplaced or you want access it and someone else is using it. Often the latest information(eg blood result/x-ray reports) is not filed in there because it takes time for the ward clark to print out that stuff and file it.

So instead of having one physical patient folder why not have a 'virtual' digital patient folder which is in the cloud/hospital central network. Anyone with the appropriate clearance can access it from any of the computer terminals. The iPad would be the perfect portable device for staff to carry around to access any of your patients digital file from anywhere in the hospital.

The screen is large enough to read and enter notes. You can view ECGs, x-rays or other radiology fillms on it. You can order test on the run. You can read through old history notes without having to look for the physical history folder. You can update the drug chart digitally where information about drug interactions /dosage can be obtained easily. The latest journal articles and clinical guidelines are there on your fingertips. Wifi / 3G should allow onsite as well offsite use.

It is also large enough to use as a patient education tool with multimedia content. Eg. Mr Smith is having a knee joint replacement. In the bedside the doctor can show Mr Smith his knee x-rays and talk through what the operation is involved with diagrams and pictures on the iPad. Often information is conveyed from doctor to patient in a verbal manner which is often misunderstood because of the jargons and medical terms use. It is much easier for the patient to understand information when visual information is also used.

The other problem with information in hospital is making it up to date and readily available. For example the medical team might see a patient and decide he needs an x-ray , a visit from the physio and changing his diet to diabetic diet. Usually to carry this out the junior doctor will ring up radiology and fill in a paper form to organise the x-ray, ring up the physio to organise a time. The nurse will then change the bed card to diabetic diet card and ring up catering to inform them of the change. If you have got 20 patients in the team that is a lot of time running around ringing people to book and change things. This could all be done on iPad in an instant. You might figure out that Radiology is fully booked this afternoon so we will organise the physiotherapist to come in the afternoon and have the x-ray in the morning. Catering would alerted immediately about the change of dietary plans.

There are obviously a few obstacles that need to be considered. How do we keep the network secured and running 24/7 with sufficient redundancy? Legally handwritten copies are required for medication charts/scripts/consent forms... Is it too ambitious to go paperless?

DagrtheSnide
29th January 2010, 11:52 AM
One thing countering all this "cloud" is that it is difficult to ensure patient's privacy.

And viewing/diagnosing x-rays on this device is not ideal.

johnq
29th January 2010, 12:53 PM
I think you are right digoxin, and I have also been exercising the grey matter similarly.

The key I think is view the device as a READER primarily, and a content creation device secondarily. If the need is to have access to gobs of stuff to read or view, and note taking a smaller part of the overall need then I think its a real winner. I can easily see how reading books/magazines/newspapers/web pages can be extended to other reference material and medical note are an obvious choice. Notebooks and netbooks simply wont cut the mustard in that world because of form factor and ease of use issues (the need for a mouse or track pad or whatever).

Interestingly, in that environment lack of camera/usb/gps etc is largely irrelevant.

lavo
29th January 2010, 03:08 PM
Will be interesting to hear Rasta's and DrChoy's comments on this subject, especially Dr Choy's as he used to specialise in PDA's for doctors while studying to be one!

Cybix
29th January 2010, 03:18 PM
I'm a Systems Analyst for the W.A. Health Dept, I pretty much support applications state-wide.

We have literally only just purchased and set up a couple of new iMac's and iPhones to start developing on. We've also now pre-ordered twenty iPad's. We certainly see the value in the medicine/health area.

We've got a lot of ideas and uses, a lot of the ideas are to extend functionality we already have in existing applications. Catering, bed-side, ED triage, lab results, pharmacy, warehouse (linen stock), dietetics, radiology, consultancy, etc.

docjolly
29th January 2010, 03:41 PM
I'm a medico who works in health informatics. My immediate thought when I saw this was that it's one step closer to a portable solution for bedside e-health in hospitals.

I agree it will be a great platform for reviewing notes, ECGs, radiology etc., and for performing point and click tasks such as ordering tests. I think it will be the first lightweight portable device with the UI, screen real estate, connectivity and battery life combo to really make this practical.

The real test however is input. Part of the reason e-health has penetrated the GP world so fully is that GPs sit at a desk in front of a keyboard. Hospital doctors take notes on the fly (have you ever noticed the poor intern scribbling in a patient chart by the hospital bedside?). I'm don't know that typing on a virtual keyboard on the iPad is a practical solution. It will take some clever software development (that leverages off the iPad touch based UI) if the iPad is going to solve the 'note taking' problem.

motef
29th January 2010, 04:28 PM
And viewing/diagnosing x-rays on this device is not ideal.

Why?

will
29th January 2010, 04:35 PM
I will be looking very closely at one for my work - education.

From what I have read it could make an outstanding e-clipboard with iwork spreadsheets.......gosh!

digoxin
29th January 2010, 04:39 PM
I'm a Systems Analyst for the W.A. Health Dept, I pretty much support applications state-wide.

We have literally only just purchased and set up a couple of new iMac's and iPhones to start developing on. We've also now pre-ordered twenty iPad's. We certainly see the value in the medicine/health area.

We've got a lot of ideas and uses, a lot of the ideas are to extend functionality we already have in existing applications. Catering, bed-side, ED triage, lab results, pharmacy, warehouse (linen stock), dietetics, radiology, consultancy, etc.

This sounds great and do keep us up to date. Might be a great way to get more macs into the system.

Spent most of my hospital years at RPH and it must be those come in on Sunday night and look for missing x-rays to display for Monday 7 AM X-ray meetings that has got me thinking.

digoxin
29th January 2010, 04:52 PM
The real test however is input. Part of the reason e-health has penetrated the GP world so fully is that GPs sit at a desk in front of a keyboard. Hospital doctors take notes on the fly (have you ever noticed the poor intern scribbling in a patient chart by the hospital bedside?). I'm don't know that typing on a virtual keyboard on the iPad is a practical solution. It will take some clever software development (that leverages off the iPad touch based UI) if the iPad is going to solve the 'note taking' problem.

Very good points. Still early days but it looks promising. Handwriting or speech recognition might facilitate this. Although it would have to be a very good handwriting to learn the bad handwriting doctors are known for.

I work as a GP and we have been trialling successfully using laptops to go for home visits and nursing home visits. Currently using a Macbook Air and 3G dongle to connect back to Windows based setup with Hamachi. The 3G iPad would have been an even more compact setup except that it doesn't run Mac OSX.

decryption
29th January 2010, 04:57 PM
Very good points. Still early days but it looks promising. Handwriting or speech recognition might facilitate this. Although it would have to be a very good handwriting to learn the bad handwriting doctors are known for.

I work as a GP and we have been trialling successfully using laptops to go for home visits and nursing home visits. Currently using a Macbook Air and 3G dongle to connect back to Windows based setup with Hamachi. The 3G iPad would have been an even more compact setup except that it doesn't run Mac OSX.

Hamachi is by LogMeIn, who have a good iPhone app (that no doubt will be ported to the iPad, or at the very least, will work on the iPad unmodified), so you might be in luck :)

digoxin
29th January 2010, 05:08 PM
Hamachi is by LogMeIn, who have a good iPhone app (that no doubt will be ported to the iPad, or at the very least, will work on the iPad unmodified), so you might be in luck :)

Will have to check this out. Thanks. I could have used the iPhone all along instead a laptop although the screen is way too small.

tom5955
29th January 2010, 05:19 PM
I think with a really good application that can handle all the information in a cloud way would really work, especially if it was to go along with a program on the computers.

It would have to incorporate handwriting recognition because i think note taking would take too long without it.

Forms could be pre made and come with the app, or presets could be made and distributed for different sections of the hospital.

motef
29th January 2010, 06:11 PM
Hamachi is by LogMeIn, who have a good iPhone app (that no doubt will be ported to the iPad, or at the very least, will work on the iPad unmodified), so you might be in luck :)

I use the Logmein iphone and love it.

Couldnt live without it

motef
29th January 2010, 06:13 PM
Spent most of my hospital years at RPH and it must be those come in on Sunday night and look for missing x-rays to display for Monday 7 AM X-ray meetings that has got me thinking.


You needed a PACS!

stab
30th January 2010, 08:51 AM
This is a great read for those of us with no knowledge of medical itc systems etc.
Can't wait to hear more when those iPads arrive Cybix!

docjolly
30th January 2010, 09:11 AM
Handwriting or speech recognition might facilitate this.

I'm not sure these will be the way forward. I think it's more likely to be along the lines of sophisticated templates that use a lexicon like OpenEHR (http://www.openehr.org), which will reduce the vast majority of bedside note taking to a point/touch/click affair.

Cybix
30th January 2010, 09:14 AM
You needed a PACS!

we do have PACS

regarding xray's on the iPad.... It just doesn't have the horsepower. You need at least gigabit ethernet to successfully view x-rays on the device, not to mention the current system in place uses -very- expensive greyscale display panels to properly display the x-rays (I do not know the tech details). Probably something to do with the resolution, contrast, etc, etc.

docjolly
30th January 2010, 02:36 PM
we do have PACS

regarding xray's on the iPad.... It just doesn't have the horsepower. You need at least gigabit ethernet to successfully view x-rays on the device, not to mention the current system in place uses -very- expensive greyscale display panels to properly display the x-rays (I do not know the tech details). Probably something to do with the resolution, contrast, etc, etc.

Depends what you are trying to do. True that a radiologist reporting films needs a full res DICOM image on CXR sized expensive grayscale LCDs - and perhaps there should be one set of these on every ward (like viewing boxes of old on the wall). But a good quality jpeg of a couple of hundred kB on something like an iPad would produce surprisingly good results and would no doubt be fine for bedside use.

Lutze
30th January 2010, 02:44 PM
I've got a co-worker who's wife is a GP in the Perth area. Her practice use Mac's entirely.

I've not had a chance to talk to her about any of this yet, but the IT guy they have there is pretty clued up it seems.

~Coxy
1st February 2010, 11:19 AM
Why [would diagnosing XRay images on an iPad be bad]?

Becuase it's a low quality, glossy screen. Imagine if the giant tumour that the doc sees in the image is actually the reflection of a smoke alarm on the roof behind him.

Lutze
1st February 2010, 11:36 AM
Becuase it's a low quality, glossy screen. Imagine if the giant tumour that the doc sees in the image is actually the reflection of a smoke alarm on the roof behind him.

You've missed the point entirely.

The idea is to show the person who has been x-rayed a copy of it - not the doctor to use for diagnostics.

Cybix
1st February 2010, 12:15 PM
You've missed the point entirely.

The idea is to show the person who has been x-rayed a copy of it - not the doctor to use for diagnostics.

No offence, but showing patient's their own x-rays on an iPad is an epic waste of time... the Health dept is already slow enough as it is....

Lutze
1st February 2010, 02:16 PM
No offence, but showing patient's their own x-rays on an iPad is an epic waste of time... the Health dept is already slow enough as it is....

I'm sure it is... but I'm just trying to point out that the negative comment about using an iPad because of a glossy friken' screen is just as bad.

I'm sure that if there are uses for it then it will be used. I know my boss is waiting to see what they can do and might be tempted to get them if they work well enough.

TracerB
1st February 2010, 02:23 PM
I've also been looking in to the potential of the iPad in the medical field, especially in relation to bedside information & data entry in hospitals.

I myself do not work in this area, but have a couple of friends who do and it has always impressed me that the the systems and processes that are in place for the presentation and recording of information seem so antiquated.

Stories of requiring to re-enter data when a patient is moved from department or ward to another, missing clipboards, wrong clipboards attached to patients beds, indeterminable handwritten notes, etc. have always led me to thought that there could be a better solution.

One of the reasons my friends have identified technology has failed to deliver via bedside is the incapability to have a reliable network connection.

Some of the challenges they have stated around networks in hospitals are:

1. Cost of retrofitting hardwired network ports to every bed
2. Cost of 802.11 installations and coverage not reaching every bed location
3. Cost of 3G and coverage not reaching every bed location (sensing a theme here ;))
4. Risk of wireless interference with older medical equipment and cost of replacement of older medical equipment with ones that are effectively shielded

With the iPad being predominantly a device for displaying networked information and also due to absence of adding external storage devices (if only they had included a USB or SD card reader [don't mention the dongle that's not really a solution for hospital use], it could have most of these issues), how do you see the iPad being successful in the hospital field?

The other issue to overcome would be the old cost benefit analysis - $600 iPad vs $2 clipboard - how would you justify the extra $598 expenditure + dollar investment in the ecology to support it?

marc
1st February 2010, 02:32 PM
The other issue to overcome would be the old cost benefit analysis - $600 iPad vs $2 clipboard - how would you justify the extra $598 expenditure + dollar investment in the ecology to support it?

$598 of a doctor's time doesn't buy you much. The iPad would only have to be 3 mins quicker for a regular task to pay for itself pretty soon...

HarbieBoys
1st February 2010, 10:45 PM
I work in a specialist practice, and enter most notes directly into a medical records system. Patient feedback is generally, but not always, positive. Comments include the noise of typing is distracting, potential privacy concerns, and intermittently focussing on the screen (on the flipside of this, other patients find the fact I can touch type whilst looking at them a distraction).

I think the issue of whether the iPad will be useful for medical imaging will only be addressed by measuring specificity / sensitivity against the 'gold standard' (but speculation is kind of fun...).

Cybix
1st February 2010, 11:44 PM
I'll tell you right now the iPad will be no good for X-ray data... maybe we can put the x-ray topic to rest? You need serious bandwidth and high resolution greyscale displays for x-ray.

Other medical imaging, sure! anatomy, etc.... no problemo.

There are SO many uses for the iPad in Health.... even if only for 'push' results, or 'results on demand'... (labs, etc)... right at the bedside, admission, triage.

The biggest two problems will be:

a) loss or theft of devices
b) connectivity (as mentioned, wifi/3G issues on campus)

Price isn't really an issue when you think about the cost of other equipment in the industry.

There is already a really large number of medical/health apps available.. from drug info, anatomy, medical dictionaries, and dietary apps. Even neat stuff that interfaces with medical equipment.... I've heard obstetrician's talking about apps and i/o that allows them to monitor the progress of baby delivery on an iPhone. Neat.

Out of any professional industry out there, I'd have to say health/medical is right up there for iPad use. Not to mention sales, art, photo, portfolio, data capture, etc.

The most important thing in Health when it comes to I.T is integrity and security of patient information.

If a staff can take a patient's meals requests, bedside, on an iPad, instead of the patient filling out a shitty old card with a pencil which half the time isn't legible, or is wrong, and that patient get's the correct meal each time, then in my opinion, that's a win. Especially important with special requirements (diabetes, fasting, etc)

so many uses! I really need to compile a list. Going to be working on some proof-of-concept soon for work....

gareth
2nd February 2010, 02:52 AM
article here iPad, anyone? Hospitals looking at the mobile device - Health, Fitness & Medical News - sacbee.com (http://www.sacbee.com/296/story/2500747.html)

Nightwish
2nd February 2010, 03:03 AM
iPad in our pathology lab would be so good. :D Would save so much paper (having requests electronically sent to us) and I wouldn't have to get up off my ass and get to a PC when a doctor rings :-P

digoxin
2nd February 2010, 10:08 AM
I've also been looking in to the potential of the iPad in the medical field, especially in relation to bedside information & data entry in hospitals.

The other issue to overcome would be the old cost benefit analysis - $600 iPad vs $2 clipboard - how would you justify the extra $598 expenditure + dollar investment in the ecology to support it?

Thanks for your input. It would be a real challenge to retrofit it and cost wise it probably need to be used in a newly built hospital where you can start with a clean slate. For example the new Royal Children Hospital in Melbourne or the proposed Fiona Stanley Hospital in Perth. You would consider running a dual system and have 'digital' trial in a small part of the hospital like CCU/ICU or OT with paper backup in case wifi/network/power was down.

digoxin
2nd February 2010, 10:17 AM
I work in a specialist practice, and enter most notes directly into a medical records system. Patient feedback is generally, but not always, positive. Comments include the noise of typing is distracting, potential privacy concerns, and intermittently focussing on the screen (on the flipside of this, other patients find the fact I can touch type whilst looking at them a distraction).


I have the same issues as you. I hate typing while taking the patient's history. I still write on small pieces of leftover paper while taking the history and then spend a few minutes typing it in while I get the patient get ready for examination. For example we now use an electronic BP machine so I use that time to type. I have thought often of using a wacom like device and using handwriting recognition to input notes but haven't found anything that is reliable enough.

digoxin
2nd February 2010, 10:20 AM
I'm not sure these will be the way forward. I think it's more likely to be along the lines of sophisticated templates that use a lexicon like OpenEHR (http://www.openehr.org), which will reduce the vast majority of bedside note taking to a point/touch/click affair.

Agree. A lot of cases that come through hospital fit in clinical pathways that lends it self well to template setups. Eg elective joint replacements, coronary syndromes, strokes.

digoxin
2nd February 2010, 11:36 AM
The most important thing in Health when it comes to I.T is integrity and security of patient information.



Totally agree this is crucial. How do we make sure that only those who need access get it?(?password/fingerprint/retina scan/swipe card) How do we prevent or realise that we have entered the wrong notes/results into the wrong patient's file?

To me the paradigm shift is moving from where the notes are not a single patient folder but located in centralised network/cloud where many people can access or add information at the same time. For example in many units take Cardiology for instance the Registrar/SR/Fellow usually has the hands on responsibility for the patients in the unit but ultimate responsibility lies with the Consultant Specialist who might just attend a morning/evening wardround/team meeting. He/she would spend the rest of the time consulting privately and be offsite. With a 3G ipad she could log in to the hospital network and basically access the patient digital file with the old/current notes/blood results/ECGs in one screen. It would also be great for team meetings where everyone in the team can read the patient file and add input in real time while discussing the case.

Cybix
2nd February 2010, 12:08 PM
Totally agree this is crucial. How do we make sure that only those who need access get it?(?password/fingerprint/retina scan/swipe card) How do we prevent or realise that we have entered the wrong notes/results into the wrong patient's file?


OTP (one time password, via sms), or securID style randomly generated passcodes, melded with the required network user account (AD authentication).

You could probably also code apps to only allow certain patient information to be accessible if you are connected to xyz wifi AP... and if on 3G, you only get access to ...whatever.. information. It is without a doubt the greatest concern.

skullnbones
11th May 2010, 12:28 PM
I an anaesthetist in public and private practice. My use for an iPad would be multifold:

1. Looking up techniques for ultrasound-guided blocks with videos (or even just photos if the videos were to be flash). I have done this on the iphone and of course it needed a bit of pinching and peering to see the details. (I'm writing this, by the way, on a precariously balanced aluminium MacBook tethered to my iPhone by Bluetooth, which is less than ideal).

2. Browsing journal articles online via the Anaesthetic College web site. The only limitation of this is that I couldn't download them to the iPad (AFAIK) but I would have to do so later on the MacBook.

3. A billing solution I'm looking at looks like having an online portal, which I could use with Safari and have my bills sent to the health funds (or patients) even before I finish the list. I could of course do this on the MacBook but space is at a premium, especially with my laptop potentially falling off my lap if I need to get up in a hurry.

4. I, like any other anaesthetist, read the paper, so this is of course an advantage.

5. I have a number of reference books on my iPhone which would render better on an iPad.

6. I have all the item numbers for private billing on my iPhone which would also be nicer to use on the iPad (or at least nicer in terms of justifying the tax deduction).

7. I have a number of teaching videos to show registrars, for which I could use the iPad either in theatre or the anaesthetic bay.

8. There are loads of other useful medical apps for iPhone which would work on iPad.

I am not interested in keeping patient records on the iPad. I know one surgeon who uses the iPhone to photograph every operation report he writes, but that is a bit hard core for me. Besides, he might write on the form, but the IP to the record belongs to the hospital, not him. If the notes are accurate and the hospital (records department) isn't incompetent or corrupt, they will be there to truly represent his actions if they need to be dug up later on.

HumanMedia
12th May 2010, 01:08 AM
I'm working on a bunch of medical apps for iPhone and 99% done on the first iPad universal binary update. It looks gobsmackingly good in full 1024x768 motion video. We have more apps underway covering uses people have mentioned above and more.

So yes it's all coming...

anarchron
12th May 2010, 01:46 AM
I'm currently doing a year of research at Johns Hopkins Division of Health Science Informatics. We've made some progress lately with the creation of our very own in-house iChart application for the iPad. It's a very simple application portal that links to the hospital's Electronic Medical Record system that stores patient data. What we're hoping to do is to replace, or at least substitute the bedside clipboard and the manila folders filled with paper records.

Right now, it does enterprise-wide authentication to secure data privacy and also presents you with patient information on request. We're also developing a daily goals checklist module to facilitate better inter-staff communication which we hope will help increase patient safety. In addition to that, we're also building a module that taps into the Pathology Information System to pull lab data specific and graph them out to visually present the information. Last, but not least, we're also developing a really cool replacement for DICOM that does all the hard-work of connecting and retrieving DICOM images from the PACS system and processing DICOM images on the cloud to reduce bandwidth requirement needed for streaming images to the iPad. Thin of it like Google Maps for DICOM images. It makes total sense for thin-client devices like the iPad since the maximum resolution you can see is only 1024x768. Therefore, we do all the image scaling on the server-side and stream the visible tiles to the user. To reduce bandwidth even further, we're looking at using the image post-processing capabilities on the iPad such as CoreGraphics to improve performance and reduce bandwidth required.

LithgowLights
12th May 2010, 04:09 AM
Totally agree this is crucial. How do we make sure that only those who need access get it?(?password/fingerprint/retina scan/swipe card) How do we prevent or realise that we have entered the wrong notes/results into the wrong patient's file?

Before anything can be done for a patient, a small bluetooth scanner scans the nurse/doctors ID card's barcode to ensure the correct access is given (Include a pin code for them too, if they have not logged in in the previous X minutes IMHO).

Then they scan the barcode on the patients wrist band, and maybe even bed position. This then gives the doctor/nurse or even cleaner or orderly the access they need to do their part of the job. Weather it be noting fluids in/out, pain levels, injections given etc, it could all be noted and typed up, with a scan of the same barcodes at the end to complete the work.

It certainly would make things much easier, but is not a total replacement for existing ways, but it could be slotted into the way the system works, and would ultimately increase productivity

LithgowLights
12th May 2010, 04:12 AM
If the notes are accurate and the hospital (records department) isn't incompetent or corrupt, they will be there to truly represent his actions if they need to be dug up later on.

Tell that to my wife. She wishes that they had electronic records dating back to her birth, as the records department at the hospital where she was born have lost about 6 months worth of paper birth records.

kyte
12th May 2010, 05:04 AM
It is likely that in the future digital patient notes will make way for traditional paper files.

Sooner than you think. In the HNE community teams, paper files have already been supplanted by an electronic file. We've been using the system for 7 years. Most of us hate it with a passion.



The iPad may with further refinement be the perfect portable device in this environment. Currently if you are admitted into hospital you are allocated a paper file which follows you around hospital. Lets say you are in the ward it stays in the ward office and is accessed and written onto by the various people in the team that look after you.(Eg Doctors, nurses, physiotherapist etc). Each person will need to physically find the file and write in it. The hassle is when the file is misplaced or you want access it and someone else is using it. Often the latest information(eg blood result/x-ray reports) is not filed in there because it takes time for the ward clark to print out that stuff and file it.

We also have a system for inpatient/hospital records, which is not a replacement for the paper file etc, but in it there is a record of all investigations, all admissions/presentations. Discharge summaries, referral letters etc, can be written within it, but as yet, not the daily notes from ward staff.

Somewhere between what we use in the community, and whats used in the hospital, there must be a common system which does it all. Sadly, we don't have it. the Gods of Bean decreed that two mutually exclusive systems should be used so there's only minimal communication between the two (the hospital system can see that there have been contacts in the community but no actual information is passed...so they have no idea what kind of contact it was... and since they insist that we make an "appointment" for every single thing we do for a client or in relation to a client, even minimal stuff like discussions are recorded)



So instead of having one physical patient folder why not have a 'virtual' digital patient folder which is in the cloud/hospital central network. Anyone with the appropriate clearance can access it from any of the computer terminals. The iPad would be the perfect portable device for staff to carry around to access any of your patients digital file from anywhere in the hospital.


We would LOVE this... or something that makes sense of the fragmented electronic systems we currently work with.

...

Is it too ambitious to go paperless?

Probably. Our IT department has conniptions every time I ask if I can have a Mac instead of a crappy outdated PC. "Too insecure" they say. If they ever do this thing you dream of, it will probably be with a windows based system. At least in our area.

muzz
10th June 2010, 11:30 AM
Is anyone aware of an iPad app that supports forms, or at least a custom background for a page to apply text/diagrams etc to? PaperDesk looks good but I'd like to load an assessment form and write/draw in the appropriate sections. While notes for individual clients could be kept on the iPad with PaperDesk, I wouldn't want to use their server due to privacy/security issues but if there is an app that supports the above, as well as storage/retrieval form a server in some form (even email) then that would suit me perfectly. Handwriting recognition is not necessary. I'm not sure how printing from the iPad is progressing.

Cheers.

smarm
10th June 2010, 07:50 PM
I'm an Anaesthetic Registrar (who travels around the country a bit doing retrievals) and the iPad has been the perfect mobile device for me. Having all my textbooks loaded electronically via Goodreader using dropbox/mobileme is fantastic. Still using the iphone to log my cases via iGasLog though.

The benefits of having access to youtube/net etc to check videos on ultrasound techniques and regional blocks is invaluable.

To the other anaesthetist on this board, check out SonoAccess for great regional ultrasound videos.

DJY
10th June 2010, 08:18 PM
Is anyone aware of an iPad app that supports forms, or at least a custom background for a page to apply text/diagrams etc to? PaperDesk looks good but I'd like to load an assessment form and write/draw in the appropriate sections. While notes for individual clients could be kept on the iPad with PaperDesk, I wouldn't want to use their server due to privacy/security issues but if there is an app that supports the above, as well as storage/retrieval form a server in some form (even email) then that would suit me perfectly. Handwriting recognition is not necessary. I'm not sure how printing from the iPad is progressing.

Cheers.

Have you looked at Bento? I'm also keen to do this - with custom forms, and to record stats / sessions. I'm yet to start working on this but I'm hoping Bento allows me to do this.

skullnbones
10th June 2010, 10:32 PM
I'm an Anaesthetic Registrar (who travels around the country a bit doing retrievals) and the iPad has been the perfect mobile device for me. Having all my textbooks loaded electronically via Goodreader using dropbox/mobileme is fantastic. Still using the iphone to log my cases via iGasLog though.

The benefits of having access to youtube/net etc to check videos on ultrasound techniques and regional blocks is invaluable.

To the other anaesthetist on this board, check out SonoAccess for great regional ultrasound videos.

Are you with CareFlight?

It would have been good for me when I was with them in late 2008. I'm an anaesthetist now, so the regional stuff on NYSORA, USRA etc will be very helpful. I've got sonoAccess on the iPhone. The iRVG also works on iPad (this is a "part III" app ;)). The company who developed iRVG is also developing an online version of their billing software that will be optimised for iPad. If the offline version is purchased now, they will migrate all the pt data to the online portal, once it is released, without any further licence charges.

I was planning on getting one in September or so, but I think I will get it before the end of the FY. It's fully tax-deductible.

ThePookaMacPhellimey
13th June 2010, 04:41 PM
I am a CICM, ACEM and ACRRM senior reg type.

I've an interest in Retrieval which draws all that lot together.

I have worked with health information systems in the Royal Melbourne, St Vincents Melbourne, Southern Health and the Ambulance Victoria system (VACIS).

I am some sort of apple tragic but born too long ago to be truly tech educated and I cannot type.

I am working in an ICU at the moment and we are going outside the hospitals health systems to purchase just one iPad on the education budget.

In some ways its a proof of concept.

In some ways its not.

We will be trying to see what uses we can make of the iPad and I would dearly love to hear the suggestions of everyone and anyone interested?

For example.....I plan to facilitate my ward rounds by syncing the compressed jpeg images of the early morning xrays for immediate end of bed viewing.

I take the point of the guys (Cybix) above who clearly have some knowledge of the radiology systems. We use "centricity" and view compressed files on our desk-top screens as a default. I am not sure how much clarity we will lose after that by getting a few dozen files onto to iPad.

I have yet to figure out the best app to use for that task?

Any suggestions?

That is just the beginning though...

We can use it to show the likes of the SonoAccess app and any useful YouTube video.

We can use it to collect data for simple things like billing for private insurance patients.

I would love to hear more about what anarchron is doing in Johns Hopkins?

One of the things I wanted to try to create was a series of procedural folios.

For example consider a subclavian central venous catheter. A folio might include anatomy teaching, procedural technique video tutorials, Safety Checklists (drawing heavily on the work of Prof Peter Pronovost) subsequent tutorials (CVP, CVSaO2, Swan Ganz catheters, complications, diagnostic imaging confirmation.......) .

I could use these for the registrars to reinforce supervised training and establish good practice.

What other things do you folks think we could use our iPad for??

anarchron
13th June 2010, 11:23 PM
Unfortunately, there were many shortcomings with the iPad that made many of us rethink the applicability of iPads in the hospital setting. Firstly, data entry is extremely difficult and slow for the iPad and in many instances pen and paper based systems were nearly twice as fast as trying to do data entry on the iPad which posed a problem for us trying to integrate it with the busy workflow of many of the staff. Secondly, the size of the iPad made it very cumbersome and less portable than the iPhone or other smartphones whilst not providing much more benefit except for more screen real-estate space which mainly resulted in a flatter navigation hierarchy. Many people complained that the iPads didn't fit in the white coat pockets that are so common with doctors in the US. With some proper design, iPhone applications could perform just as well as iPad applications. Thirdly, we found that physically securing such a valuable object such as an iPad was just a security nightmare and politically it was just not feasible.

I suppose the third point isn't that much of a problem if you're willing to bring in your own iPad. However, as the iPad isn't really a necessity like a mobile phone and it is still fairly expensive for the average user, I don't envisage wide uptake of it in a hospital setting to provide justification for hospitals to create institution specific applications that tap into the electronic patient record systems or the radiology services. This may be overcome if hospitals purchased iPads en masse for its staff to use if they somehow manage to overcome point three.

smarm
14th June 2010, 05:55 AM
I am a CICM, ACEM and ACRRM senior reg type.

I've an interest in Retrieval which draws all that lot together.


Pretty sure I was reading a profile about you in the ARV bulletin a few days ago, as I was trying to work out how someone could training under all those colleges! :D

smarm
14th June 2010, 05:58 AM
Are you with CareFlight?

It would have been good for me when I was with them in late 2008. I'm an anaesthetist now, so the regional stuff on NYSORA, USRA etc will be very helpful. I've got sonoAccess on the iPhone. The iRVG also works on iPad (this is a "part III" app ;)). The company who developed iRVG is also developing an online version of their billing software that will be optimised for iPad. If the offline version is purchased now, they will migrate all the pt data to the online portal, once it is released, without any further licence charges.


Yep. Do the odd shift with them up north. Be nice to have an offline version of the NYSORA stuff to go through when travelling.

Bethany
16th June 2010, 02:52 PM
I am a midwife, and I think the iPad will be a great tool for community nursing and medical services. Getting visit information online rather than by fax, uploading data back to the hospital. Definitely the way of the future. I know there are paperless GP offices, so I am sure that it can be done

crumpethead
16th June 2010, 04:48 PM
Most pathology labs provide internet access for doctors to access patient's results. Probably not so significant for medical staff working from their practice, but when called outside office hours or for GP's doing a house call it would be great.

As others have mentioned, I think the iPad would be somewhat risky to use to record clinical findings etc. I'm concerned about how easy it would be to select the wrong field, select the wrong record or make an incorrect entry.

ThePookaMacPhellimey
18th June 2010, 01:37 PM
Pretty sure I was reading a profile about you in the ARV bulletin a few days ago, as I was trying to work out how someone could training under all those colleges! :D

rumbled!!!

&

i'm still trying to work out the same thing

Padholdr
22nd June 2010, 03:22 PM
Has anyone seen any mounts that are made for the iPad in the medical field? I own a company that is making iPad holders for auto and home and I'm curious if there is a need in the medical field for a mount.

Shaxbon
23rd June 2010, 11:44 AM
Firstly, data entry is extremely difficult and slow for the iPad and in many instances pen and paper based systems were nearly twice as fast as trying to do data entry on the iPad which posed a problem for us trying to integrate it with the busy workflow of many of the staff.

Couldn't this problem be overcome by using a Stylus Pen?

Surely if there was to be an application that is on the iPad it would obviously allow the pulling up of a patients file whereby a Doctor or a Nurse could quickly right down any notes which would then be saved to a Patients electronic file.

My Father is a surgeon and all of his patients files are now stored electronically and he would absolutely love to be able to access and write to these files instead of hand writing his notes for his secretaries to then scan this in manually.

novice
23rd June 2010, 12:16 PM
What a great topic! I am an experience software engineer who has been trying to get into the health industry for the past 8 months (with little success).

I have a huge interest in technology in the health industry and think this is an excellent topic with some really good points and idea being posted.

Just to add to the technology debate, i think Health staff take up of a totally technology based solution is tough. And understandibly so, concerns over privacy and loss of data are at the forefront of their minds. Not to mention data errors.

Having said that, there have been private data on various networks for years, with no issue. Technology exists to protect data, and we trust these every day (just look at on line banking as an example).

Loss of data is another, but again, industries such as the banks, insurance etc deal with this every day, without issue. Medicare is the same, just think of all that data that is so important, and it has the appropriate strategies and infrastructure in place to combat these things.

Also, incorrect data is important. This could lead to loss of life, and its very easy to point to technology if something like this happens. What's forgotten, is that far more deaths occur now due to not even sharing important patient information and goes un-noticed.....so we should consider how the net gains far out way the risks, risks that already exist and happen.

I would love nothing more than to be involved in technology in hospitals (hopefully one day soon i can find a suitable job and switch from my current work!), and think that there is so much to be gained from utilising technology in the right way.

anarchron
23rd June 2010, 06:39 PM
Couldn't this problem be overcome by using a Stylus Pen?

Surely if there was to be an application that is on the iPad it would obviously allow the pulling up of a patients file whereby a Doctor or a Nurse could quickly right down any notes which would then be saved to a Patients electronic file.

My Father is a surgeon and all of his patients files are now stored electronically and he would absolutely love to be able to access and write to these files instead of hand writing his notes for his secretaries to then scan this in manually.

The problem is that many systems and applications are not designed from the user's perspective i.e. they are built and designed by Software Engineers/Programmers who think they know what doctors need while doctors articulate very poorly what they want.

In my time at Hopkins, I've seen nurses scramble to get paper towers to write patient notes on because it was so much quicker than entering it into the electronic patient record system at that moment. Sure, they had to reenter it later on, but the extremely poor UI and human interface of these systems made it difficult for nurses to capture the data fast enough.

Also the problem with stylus pens is the question of how good and accurate our handwriting recognition software is currently (not to mention the truth behind the ugly handwritings that doctors have). The main reason for having an electronic patient record system is that everything entered is indexable and searchable.

drzeus
26th June 2010, 06:10 PM
Also, incorrect data is important. This could lead to loss of life, and its very easy to point to technology if something like this happens. What's forgotten, is that far more deaths occur now due to not even sharing important patient information and goes un-noticed.....so we should consider how the net gains far out way the risks, risks that already exist and happen.



A very insightful post for some-one who doesn't work in the industry, well done. I'm a medico and I can tell you, you are totally correct. The media and politicians are quick to go on about privacy and electronic errors.....trust me, as you correctly pointed out the MASSIVE benefits in patient safety far outweigh the rare errors.

The ability to have RAPID access to a patients file, especially their investigations and history from other hospitals would be an absolute God-send. Yet the stupid civil libertarians are too obsessed with privacy to realise the massive cost savings financially and in human lives that such a system would bring.

MissionMan
26th June 2010, 07:52 PM
I have been thinking a bit since the launch of the iPad about how it could be a breakthrough product in areas where a good robust portable device fill an unmet need.

I work in the medical field and have previously worked in large hospitals. A lot of how hospitals work is to do with gathering and sharing information among a team and different teams as well as with the patient. I can see how the iPad could be an ideal portable device where a laptop or palm pilot device had major deficiencies. I know that that there are other medical related people on mactalk and interested to hear your thoughts and ideas.

It is likely that in the future digital patient notes will make way for traditional paper files. The iPad may with further refinement be the perfect portable device in this environment. Currently if you are admitted into hospital you are allocated a paper file which follows you around hospital. Lets say you are in the ward it stays in the ward office and is accessed and written onto by the various people in the team that look after you.(Eg Doctors, nurses, physiotherapist etc). Each person will need to physically find the file and write in it. The hassle is when the file is misplaced or you want access it and someone else is using it. Often the latest information(eg blood result/x-ray reports) is not filed in there because it takes time for the ward clark to print out that stuff and file it.

So instead of having one physical patient folder why not have a 'virtual' digital patient folder which is in the cloud/hospital central network. Anyone with the appropriate clearance can access it from any of the computer terminals. The iPad would be the perfect portable device for staff to carry around to access any of your patients digital file from anywhere in the hospital.

The screen is large enough to read and enter notes. You can view ECGs, x-rays or other radiology fillms on it. You can order test on the run. You can read through old history notes without having to look for the physical history folder. You can update the drug chart digitally where information about drug interactions /dosage can be obtained easily. The latest journal articles and clinical guidelines are there on your fingertips. Wifi / 3G should allow onsite as well offsite use.

It is also large enough to use as a patient education tool with multimedia content. Eg. Mr Smith is having a knee joint replacement. In the bedside the doctor can show Mr Smith his knee x-rays and talk through what the operation is involved with diagrams and pictures on the iPad. Often information is conveyed from doctor to patient in a verbal manner which is often misunderstood because of the jargons and medical terms use. It is much easier for the patient to understand information when visual information is also used.

The other problem with information in hospital is making it up to date and readily available. For example the medical team might see a patient and decide he needs an x-ray , a visit from the physio and changing his diet to diabetic diet. Usually to carry this out the junior doctor will ring up radiology and fill in a paper form to organise the x-ray, ring up the physio to organise a time. The nurse will then change the bed card to diabetic diet card and ring up catering to inform them of the change. If you have got 20 patients in the team that is a lot of time running around ringing people to book and change things. This could all be done on iPad in an instant. You might figure out that Radiology is fully booked this afternoon so we will organise the physiotherapist to come in the afternoon and have the x-ray in the morning. Catering would alerted immediately about the change of dietary plans.

There are obviously a few obstacles that need to be considered. How do we keep the network secured and running 24/7 with sufficient redundancy? Legally handwritten copies are required for medication charts/scripts/consent forms... Is it too ambitious to go paperless?

I'm actually busy doing some work in this field at the moment and unfortunately it won't be with ipads or any tablets of any kind. There should be a presentation happening to the Health industry in the next month or two, and I'm more than happy to send you a link to the invite (there will be a public webcast) when it happens.

The biggest problem with ipads as an input device is they are too slow. I.e. its not as quick for a doctor walking around bed to bed quickly writing in charts. Its not to say ipads won't be possible for doctors and nurses to access information, but right now, it would actually slow down doctors as an input device and they wouldn't accept it.

pklement
26th August 2010, 01:50 PM
Hi all,

I also see a huge potential to optimize processes in the hospital, in order to save cost and improve the quality of care. We are currently looking into this topic on a global level. I think of of the key elements to fulfil this vision is to integrate of the siloed systems in a hospital in order to enable a automated workflow that is currently done manually.

I'm also currently working on a Business Process Reference Model for Healthcare, that will certainly reflect these process changes and can be used as a collection of best practises. Those of you who are interested please send me an e-mail.

Cheers,
Peter