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Have iPad—can travel
How tablets at the bedside save doctors an hour a day
by Bonnie Darves



Published in the February 2012 issue of Today's Hospitalist

WHILE RUNNING BETWEEN PATIENT UNITS is a fact of life for many hospitalists, the 20 hospitalists at Lahey Clinic in Burlington, Mass., have it especially hard. Their daily circuit encompasses nine different inpatient units.

Making matters worse, once they reach a unit, they often have to wait to use a computer. "We have very busy nursing units with desktop computers that are hard to get on because everybody wants to use them," says hospitalist Noah Finkel, MD, Lahey's medical director of information technology.

"And because hospitalists move around so much," he adds, "we
"There's no question that iPad use can improve patient satisfaction."

–Noah Finkel, MD
Lahey Clinic

have to log in each time we go to a different unit. We knew there had to be a better solution."

That better solution came in the form of iPad tablets. After evaluating hospitalists' constant travel and their clinical needs, the hospital conducted a one-month pilot of the iPads last August.

The objective was to find out if giving each physician an iPad would improve not only his or her workflow, but patient care. The pilot turned out to be so successful that hospitalists at the clinic now carry their own iPad—and no longer wait in line for a keyboard.

System modifications
Before iPads were brought into the picture, some hospitalists had been using laptop computers as an alternative to the unit desktops. But physicians found that even laptops had drawbacks.

"Laptop technology is still not there yet" in terms of mobile technology, explains Dr. Finkel, who co-chairs Lahey's medical device committee. The short battery life of most laptops—five hours at best—was simply no match for 12hour shifts.

"For some of our hospitalists," Dr. Finkel adds, "carrying around even something as light as five pounds all day is too much." When the iPad swept the market for personal computing devices, the hospitalists were interested.

The big draws of the iPad are its relatively low weight (1.5 pounds) and long battery life. While the battery is supposed to last 10 hours, many physicians have been able to eke out 12 hours without recharging.
But during the iPad pilot testing, physicians discovered some downsides. Some physicians weren't used to the iPad's trackpad and touch interfaces, for instance, so that presented a learning curve.

And because the hospital uses software designed for PCs, not Macs, the hospital's information systems staff had to find workarounds to accommodate a different operating system.

"There was some hesitation, understandably, from our IS support to move into a product that was Apple-based," says Dr. Finkel, who is also an assistant professor at Tufts University School of Medicine. "They were used to PC-based networking and security."

The fix? Lahey allows physicians using iPads to connect to its clinical systems through Citrix, a software product that enables "outside" computers—including physicians' computers at home—to interface with the hospital network. While the interface was originally designed for desktops or laptops (either PC or Mac) that used a mouse, modifications to the system allowed iPad use.

The IS staff also set up a dedicated wireless network for the iPads, which addressed potential concerns about the speed lag in connecting from an outside system.

No YouTube
Some physicians and staff members wanted to test other tablets in addition to the iPad, but Dr. Finkel says that the iPad won out because of its relatively lighter weight and superior touch interface. While he doesn't want to sound like a commercial for Apple (and didn't begin using an Apple computer until late last year), he says that the iPad is a superior solution for hospitalists.

surprisingly, the introduction of the iPad raised another potential concern: the temptation for "extracurricular" use. To counter that, the hospital has denied physicians access to iTunes or YouTube on their iPads.

"The only reason I could get IS to sign on was that we said we won't give the users access to things they might want to do in their free moments," Dr. Finkel explains. "We said the iPad is to be used as a clinical device and a portal to our clinical systems only." To back that policy up, the iPads' user profiles restrict use on Wi-Fi networks and don't allow application downloads.

Despite all those challenges, the iPad pilot was so successful that the hospital has kept the devices in hospitalists' hands. Over the next year, the hospital will integrate software that runs only on the iPad with its clinical systems.

For the hospitalists, the biggest advantages have been the increased mobility and faster access to clinical systems and patient data. Dr. Finkel estimates that using the tablets may save each physician one hour of wait time in each 12-hour shift.

And Dr. Finkel actually figured out a way to transport his iPad without holding it on his arm. He had his lab coat pocket "reconfigured" by a tailor to accommodate the device, so that he can cart it around hands-free. "It looks a bit funny" he says, "but it's worked out well for me."

More face time with patients
While the hospitalists appreciate not having to wait for a computer, the tablets have delivered many other benefits in terms of patient care. Hospitalists can access chart notes and view the results of imaging and labs, Dr. Finkel reports.

And once the hospital's EHR is implemented, the iPads should enable the hospitalists to reconcile medications at the bedside. "That's much more efficient and safer than doing some kind of reconciliation on paper and then carrying it back to a computer to enter the information," he says.

Dr. Finkel was surprised by one of the initiative's chief benefits: Patients like not only the technology's efficiency, but the extra time it gives them with physicians.

"There's no question that iPad use can improve patient satisfaction," he says. "Patients can see what we're doing and we can tell them while we do documentation in the room."

Typically, Dr. Finkel points out, patients may think doctors spend only a short period every day working on their case "because they don't see us viewing records, calling consultants or PCPs, or talking to residents." Now, however, "because we're using iPads at the bedside, patients see that we're engaged with them."

The iPads also have delivered big pluses in terms of patient management and education. Now, hospitalists can show pneumonia patients changes on X-rays or INR variations that may lead to holding warfarin for a day or two in patients on anticoagulation.

"Patients appreciate it when you take that time at the bedside to show them something," Dr. Finkel says. "It bridges that barrier for a lot of people in the hospital because it can be a very uncomfortable experience. may not feel like they're 'connected' with the medical team. This helps."

Bonnie Darves is a freelance health care writer based in Seattle.


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