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The iPhone & iPad

Tools to Improve Point-of-Care Information and Patient Education

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Acute Care Nurse Practitioner

Trauma Nurse Specialist

Paramedic

Nerd

ANDREW J. BOWMAN

A LITTLE ABOUT ME

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HOW MY BOSS SEES ME

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HOW THE DRUG SEEKERS SEE ME

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HOW THE OLD MEN FROM ECF WISH THEIR NP LOOKED LIKE

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WHAT MY MOM THINKS I DO

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WHAT I WISH I DID MORE OFTEN

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WHAT I FEEL LIKE I DO

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WHERE I WORK

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MY PDA / SMARTPHONE HISTORY

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MY PALM HISTORY

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• Palm V

• Palm Vx

• Palm m505 / m515

• Palm Tungsten C

• Palm TX

NOW WHAT I CARRY

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NURSING USE OF TECHNOLOGY

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• PDA’s (smartphones) are often touted as the “wave of the future” in health care

• That future may not be close at hand for many nurses

• Nurses often must buy their own devices

• “Nurses Taking Technology Into Their Own Hands”

• NurseZone.com - 2003

NURSING USE OF MOBILE DEVICES

• More nurses using mobile devices

• Smartphones, tablets, e-book readers

• 74.6% nurses own smartphone or tablet

• 41.5% own e-book reader• Springer Publishing Company 2011

HANDHELD COMPUTERS IN CLINICAL PRACTICE

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• Perceived benefits

• Enhanced Productivity

• “saves you aggravation of looking for something”

• “don’t have to leave room to look up reference”

• Enhanced Quality of Patient Care

• “timeliness of information”

HANDHELD COMPUTERS IN CLINICAL PRACTICE

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• Personal Barriers to Device Use

• Physical factors

• Age

• Comfort with technology

• Comfort with device

• Preference for paper

HANDHELD COMPUTERS IN CLINICAL PRACTICE

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• Expectations for Future

• “everyday in medicine (and nursing) there is more stuff you have to know and things are more complex”… “electronics are going to be our savior for our sanity and for medical errors”

ACCESS TO CHANGING INFORMATION

• Need access to increasing amount of rapidly changing medical information

• 40,000 MedLine citations added monthly

• 1-2 new drugs each week

• Rapidly increasing diagnostic tests

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EVIDENCE BASED MEDICINE/NURSING

• Need to bring evidence based practice to ED bedside

• “EB (practice) is judicious use of current best evidence in making decisions regarding care of patients” –

Sackett, BMJ, 1996

• 2001 IOM report cites lack of translation of clinical research findings into bedside practice

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PATIENT SAFETY IMPROVEMENTS

• Need to improve safety / reduce errors

• Scope and complexity of clinical Dx and Tx considerations has led to unacceptable rate of medical/nursing errors

• Frenetic pace of ED/ICU increases risk of error

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BENEFITS TO DEVICES AT BEDSIDE

• At the Point of Care

• Access to extensive information

• Integrated “all in one place” functionality

• Up-to-Date, event breaking, clinical developments

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CLINICIAN PERCEPTIONS

• Many users find devices are invaluable addition to clinical practice

• “I’d rather be without my stethoscope than my “device”

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INVOLVING THE PATIENT - INFO

• Anecdotal experience indicates patients accept---AND VIEW POSITIVELY---the use of handheld devices in encounter

• Appreciate that provider is being careful and precise and accessing the “latest information”

• Welcome opportunity to obtain information on the spot

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MEDICAL ERROR REDUCTION

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• US healthcare infrastructure is plagued by numerous core problems

• Fragmented care

• Non-standardized procedures

• Soaring costs

• Millions without insurance

• Unacceptably high rate of medical error

MEDICAL ERROR REDUCTION

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• Healthcare professionals frustrated

• Healthcare providers expected to practice error free

• Virtual avalanche of new medical information combined with the stresses of working in the medical environment almost guarantees that mistakes will occur

MEDICAL ERROR REDUCTION

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• Medical Error as “Misinformation”

• Agency for Healthcare Research and Quality (AHRQ) has noted that insufficient or flawed point-of-care information is a frequent and significant cause of medical error

MEDICAL ERROR REDUCTION

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• Medical Error as “Misinformation”

• Patient Information Problems

• Improper diagnosis, lab values, allergies, drug contraindications, pediatric dosing

• Drug Information Problems

• Dosing miscalculations, potentially harmful drug interactions

• International Pediatrics,18 (2) 2003

PATIENT SAFETY

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• Nearly half serious medication errors result of insufficient information about patient and/or drug

• Another common cause is calculation error

• Implementation of a computerized drug assistance program resulted in 55% reduction in medication errors

• New England Journal of Medicine,348(25), June 2003

MOBILITY EMPOWERS EXCELLENCE

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• The ‘habit’ of checking for current information is key to maintaining excellent clinical practice

• Best way to achieve goal is source of information as mobile as the provider

• Clinical Nurse Specialist, 17(5), September 2003

REDUCE MEDICAL ERRORS

• Skyscape Survey 2004

• 50% medical professionals reported reduction in medical errors by using a mobile device

• 88% check drug references

• 38% check drug interactions

• 78% use more than one clinical reference

CONTINUING EDUCATION

• Highly mobile, “go where you go” continuing education

• Can act as “a virtual stack of books” or as streaming media for learners

• www.healthcmi.com 2012

HOSPITALS USING iPADS

• Massachusetts General Hospital (MGH)

• Nursing and physicians using iPads to enter and review patient information

• New York Methodist Hospital

• Mounted with EKG and other Dx machines to access patient information

• www.padgadget.com 2012

CAN iPAD CHANGE EMERGENCY MEDICINE?

• Operating system & Applications

• Turn on ready to use

• Finger taps and swipes, no pens or styli

• Form factor

• Lightweigt, flat

• Smaller area than paper• www.epmonthly.com 2010

VA USE OF IPADS

• Studying tablet devices and health related apps to improve and coordinate care between providers, veterans and families

• 1000 iPads for “Clinic-in-Hand” program

• Pre-loaded with apps to facilitate communication with provider

• iMedicalApps 2012

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TABLET USE FOR CT

• Tablets used for bedside CT interpretation / sharing

• Resolution comparable to desktop

• No significant discrepancies in interpretation• Emergency Radiology, April 2012

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MORE RECENT USAGE STUDY

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THE ULTIMATE SMARTPHONE

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iPhoneone

EMR VENDORS TARGETING IPAD

• Often difficult to view PC ready electronic medical records on tablet

• Vendors are looking at making iPad friendly versions for bedside data collection and charting

• Personal conversation, Gregg Malkary

• Spyglass Consulting

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DISTRACTIONS CAN OCCUR

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DEVICE ENVY / FRUSTRATION

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SO WHAT DO I USE MINE FOR?????HOW DO I USE MINE?????

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