iPad in the ER, a hands on physician review

I had been anxiously awaiting the arrival of my iPad. This is the form factor I have been asking (begging) of all the vendors for years. I’m very happy to say that it appears to be living up to my high expectations.

The screen is gorgeous. It’s very clear and bright, I had no trouble seeing the screen in bright outdoor light. The machine seems extremely responsive — it reacts immediately to user input and the browser renders pages as fast as my laptop. In landscape mode, its surprisingly easy to type on the on screen keyboard. I wouldn’t call it “touch typing” but the autocorrection fixes almost all of the typos that are introduced when I just let my fingers fly. It turns out to be much easier to enter data than I expected, and in fact this entire review was typed completely on my iPad.

I tested it today during my shift in the ER. Initial tests with our clinical applications went amazingly well. The ED dashboard, WebOMR and Provider Order Entry all appear to function well without modification. The popup blocker does try to get in the way of new windows, but it’s a only a minor annoyance. The EKGs look better onscreen than on paper. It was great having all of the clinical information right at the bedside to discuss with the patient. The only problem was that the increase in efficiency was offset by the patients and family who wanted to gawk at it.

The battery life is one of the most astounding features. I don’t know how they did it but the claimed 10 hour run time might actually be more accurate than the usual inflated claims that I’m used to for mobile devices. The device arrived at full charge and after testing all day and leaving it playing several full length movies the battery still had 40% left. This could easily make it through an entire ER shift on one charge, eliminating the need for hot swappable batteries.

I am a little concerned about how well it will hold up in a clinical environment, particularly the abuse it will get in the ER. The case is very smooth and the rounded bottom makes it easy for it to slide out of a hand or off a table. I don’t get the feeling it will be as forgiving of drops as some better padded (albeit heavier) devices. I’m hoping someone will create a case that has a hand strap on the back.

One problem that plagues all tablets that I’ve used clinically is the difficulty entering strong passwords. The onscreen keyboards of mobile devices makes it much harder to quickly enter numbers, symbols and mixed case and is, in my opinion, one of the biggest barriers to medical tablet adoption. A biometric, or other creative way of addressing this will likely be needed.

From a consumer electronics point of view, I’m also impressed. When just web surfing or watching video I do like that I can just lean back and hold the iPad as I would a book or magazine. My wife found that she preferred the iPad Kindle program to the actual Kindle device.

In summary, I’m very excited — the form factor is close to perfect and it’s robust enough to keep up with a busy ER. I think this is one of the most promising developments in medical mobile computing in a long time.

Larry Nathanson is an emergency physician and published this post on John Halamka’s Life as a Healthcare CIO.

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