November 5, 2010

iPad program ups resident productivity

The University of Chicago Medical Center (UCMC) is adding a personal touch to its patient care.

A touch screen, that is. Internal medicine residents are now equipped with iPads slung around their necks in an effort to keep residents at the bedside—and away from stationary computers that suck up time spent entering patient information.

After a two-and-a-half month pilot program in which some of the busiest doctors in the UCMC residency program were given iPads and told to use them as their primary device for clinical use, the iPads are now provided for all current residents.

The decision was made primarily to improve efficiency and thus increase bedside time with residents. “The most important point of care and point of learning is at the bedside,” said Bhakti Patel, the chief resident at the UCMC.

According to Patel, participating residents were much more efficient within the first two to three days of the pilot program.

iPads eliminate the need for residents to continually go to a computer to access or enter information into a patient’s file. Before the iPads, nurses who called residents with discrete questions would have to write them down, then try to get to a computer to review the patient’s file, order the necessary tests, and then go speak to the patient.

“For the first time,” Patel said, residents are “delivering care in real time.”

Of 115 residents in the internal medicine program, 105 currently have iPads for use in the hospital, with the rest getting them next week.

Moreover, residents were also able to get more done in the downtime during rounds because they had a computer with them, increasing the amount of time they actually spent with patients.

“Residents were able to really engage in what a physician is meant to do instead of being bogged down by more of the secretarial work,” Patel said.

The University of Chicago Medical School joins other top medical schools in integrating iPads into their curricula. For example, Stanford University School of Medicine distributed iPads to all of its incoming medical students earlier this year.

But medical residents and medical students differ in their responsibilities and abilities. “There is always a tension between taking ownership of your education and your commitment to your patient care,” Patel said.

The residents’ use of the iPad has relieved this tension by allowing students to tend to their patients remotely; they can take iPads with them when they go to medical conferences within the hospital that might have kept them from seeing their patients.

Patients have also responded positively to the use of iPads in the hospital. The iPads help facilitate the communication of lab results, X-rays, and CAT scans. “Patients typically don’t have much access to care,” Patel said, “and now they’re empowered by the information we have at our fingertips.”

Patel said that the hospital tried out the HP iPaq in a residency class five to seven years ago in an effort to make the switch to mobile computing. The devices, according to Patel, had limitations in terms of access to the medical record system. The iPads now have an application specifically that the designed for hospital systems, Epic Company.

Though they’re waiting to see how the program goes with the internal residents, Patel was confident the iPad will be implemented more widely in the hospital. But the device isn’t without its problems.

Patel says that, as always, patient privacy is a concern. She said the IT personnel of the hospital have looked for technical vulnerabilities in the iPad, and installed a security program in each of the iPads that requires encryption of all information that is sent. The program can also wipe the iPads to factory settings if they get lost or stolen.

Another concern is the cleanliness of the device. Although the spreading of infection is a concern with all medical devices, these concerns are all the more pressing with a device that would be as portable and as widely used as the iPad. Patel says that they have tried to address this issue by using a screen protector on the iPad and wiping it with the same sanitary wipes used for stethoscopes and beepers.