Powerful examples of using the iPad on the wards

I recently completed a two week tour of duty on the wards in July with new residents, interns, and students.

Attending (serving as the supervising doctor for the team of residents, interns and students) in July can be challenging, but also one of the most rewarding clinical experiences as a faculty member.  The interns and residents are eager to learn and your teaching may have a more lasting impact as the residents and students are just forming the habits that will become the foundation of their clinical practice.

Over the last six years, I actually request to be on service in July for this reason.  Despite all the recent concern about the “July effect”, attendings are often hovering closer and more involved in patient care than in other months.  This July, I also took that opportunity to test the iPad on the wards to experience firsthand how it stacked up.

Well, it certainly lived up to the hype!  Here are some of the powerful examples of what I was able to do with the iPad while I was on service.

  • Point of care teaching. On rounds, I was able to use MedCalc to show my team and calculate Ranson’s criteria for a pancreatitis patient, the San Francisco syncope score on a patient in the ER, and to correct the sodium (pseudohyponatremia) for a patient presenting with DKA.  I also used UpToDate (institutional subscription) to review the ARA criteria for lupus and rheumatoid arthritis for patients with these conditions.  (of course I did not do this on post-call days when the clock was ticking).
  • Preparing for teaching rounds. At home in the evening, I could look up an article that was relevant to a specific patient and bookmark it on the iPad.  Then, the next day, instead of wasting paper and time on the time-honored tradition of photocopying articles before rounds, I could pull up the bookmark for community-acquired pneumonia and show the team the relevant graphic or passage in a paper.  Then, with one quick stroke, I could email the team so they had the link to review later that day.
  • Immediate access to a computer – One morning, I found all the workstations occupied and I needed to text page my team.  From the hall, I simply opened my iPad and used the “shortlink” to the paging system to let my residents know where I was.  Likewise, at a multidisciplinary case management rounds, I made use of the time waiting my turn by completing my billing through using the STAT-ICD9 coder app.  I also looked up narcotic dosing in Epocrates for a patient’s prescription (in Illinois only physicians with permanent licenses can write narcotic prescriptions in case you’re wondering).
  • Access to the medical record. Our hospital uses Epic, so using the Citrix iPad client, I could access the medical record from anywhere on the hospital wireless.  However, the Epic interface is often clumsy if you don’t have tiny fingers making me wonder what my male counterparts would do!  We’re currently working on getting a stylus to try to improve use of Epic.
  • Stay in touch with my team throughout the day. In the middle of a late afternoon workshop that I teach in, I was listening to a presentation when I got a text page. I just opened the link to our paging system to answer the question which averted the need to go hunt for an open phone.
  • Balancing clinical work with your academic work. Unfortunately, email for an academic physician does not stop when you’re on service … it just accumulates, resulting in stress and delay.  With the iPad, I stayed on top of my inbox while walking to and from the wards or during idle time on the wards waiting for my team or for patients to return from tests.  My research project manager also noted that I was not as behind on her emails.  In today’s email game, anything to improve your email is worth it.
  • Leisure and relaxation. For any healthcare worker, relaxation to unwind and be well rested for the next day is key.  When I got home from work, my iPad turned into the quintessential leisure tool.  I could use Flipboard to catch up on my Facebook friends or Twitterfeed that I missed through the day.  I could catch up on news ranging from the latest in the Gulf oil spill to Lindsay’s jail sentence so that I did not feel like was in “the fog of wards.”  I also used UrbanSpoon to find a restaurant for our off-service dinner and then Maps to figure out how to get there.

However, before we embrace the iPad as the panacea to all of our technology woes in healthcare, there are some hindrances that weneed to think about.

  • Security. Unlike my trusty clipboard, you cannot leave your iPad on the workstation or counter as you go into the room.  Then, when you go into the room, it’s a challenge finding a location for it while you examine patients.  For this reason, I did not carry the iPad with me every day and only used it on days that I knew I wasn’t going to be overwhelmed with new admissions.  The iPad does not fit in our white coats.  After some thought (including buying new coats), the most ideal solution was to use a shoulder strap.  My personal favorite is a fashionable tan leather stitching that was on overstock.com.  Now, I can take my iPad with me every day.
  • Infection risk. As one tweeter put it, will your iPad (or iPhone) become the iGerm?  It is important to use a disinfectant to keep the iPad clean.  After a few days on the wards, my iPad was covered with fingerprints carrying who knows what … so I wiped it down with some disinfectant cleaner and it looked new and shiny again.  The shoulder strap also works here since I would wear the iPad and put on my contact isolation gown on over the iPad keeping it protected.
  • Multiple windows. Currently, the iPad does not have the ability to have multiple windows open.  This is the most disabling feature of the iPad.  If you are in medical record, you have to log back in if you decide to access UpToDate.  While you could access all of the hospital intranet on the Citrix client, it is slower than the iPad’s native apps and not as nice.
  • Wireless access. Fortunately, our hospital has a very good network.  Unfortunately, it does not work in all areas of the hospital (my office, spotty in stairwells) and sometimes I have to switch to the University wireless which requires a log in each time I access it which can be somewhat challenging.

While this is my n of 1 experience, we are currently piloting the iPad with 5 residents to ascertain its value as a point of care clinical and educational tool.  We provided the residents with fully loaded iPads with a variety of apps for our residents to test.  Apparently, we are not the only ones with this idea.  Recently, Stanford University School of Medicine announced that every entering student would receive an iPad.  Time for iMedSchool & iResidency?

Vineet Arora is an internal medicine physician who blogs at FutureDocs.

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