The iPhone & iPad

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

2
ANDREW J. BOWMAN
Acute Care Nurse Practitioner
Trauma Nurse Specialist
Paramedic
Nerd
3
A LITTLE ABOUT ME

4
HOW MY BOSS SEES ME

5
6
HOW THE DRUG SEEKERS SEE ME

7
8
HOW THE OLD MEN FROM ECF WISH
THEIR NP LOOKED LIKE

9
10
WHAT MY MOM THINKS I DO

11
12
WHAT I WISH I DID MORE OFTEN

13
14
WHAT I FEEL LIKE I DO

15
16
WHERE I WORK

17
18
19
MY PDA / SMARTPHONE HISTORY

20
21
22
MY PALM HISTORY
• Palm V
• Palm Vx
• Palm m505 / m515
• Palm Tungsten C
• Palm TX
23
NOW WHAT I CARRY

24
25
NURSING USE OF TECHNOLOGY
• PDA’s (smartphones) are often touted as the “wave of the
future” in health care
• That future ...
NURSING USE OF MOBILE DEVICES
• More nurses using mobile devices
• Smartphones, tablets, e-book readers
• 74.6% nurses own...
HANDHELD COMPUTERS IN CLINICAL
PRACTICE
• Perceived benefits
• Enhanced Productivity
• “saves you aggravation of looking f...
HANDHELD COMPUTERS IN CLINICAL
PRACTICE
• Personal Barriers to Device Use
• Physical factors
• Age
• Comfort with technolo...
HANDHELD COMPUTERS IN CLINICAL
PRACTICE
• Expectations for Future
• “everyday in medicine (and nursing) there
is more stuf...
ACCESS TO CHANGING INFORMATION
• Need access to increasing amount of rapidly changing
medical information
• 40,000 MedLine...
EVIDENCE BASED MEDICINE/NURSING
• Need to bring evidence based practice to ED bedside
• “EB (practice) is judicious use of...
PATIENT SAFETY IMPROVEMENTS
• Need to improve safety / reduce errors
• Scope and complexity of clinical Dx and Tx
consider...
BENEFITS TO DEVICES AT BEDSIDE
• At the Point of Care
• Access to extensive information
• Integrated “all in one place” fu...
CLINICIAN PERCEPTIONS
• Many users find devices
are invaluable addition to
clinical practice
• “I’d rather be without my
s...
INVOLVING THE PATIENT - INFO
• Anecdotal experience indicates patients accept---AND
VIEW POSITIVELY---the use of handheld ...
MEDICAL ERROR REDUCTION
• US healthcare infrastructure is plagued by
numerous core problems
• Fragmented care
• Non-standa...
MEDICAL ERROR REDUCTION
• Healthcare professionals frustrated
• Healthcare providers expected to practice error free
• Vir...
MEDICAL ERROR REDUCTION
• Medical Error as “Misinformation”
• Agency for Healthcare Research and Quality
(AHRQ) has noted ...
MEDICAL ERROR REDUCTION
• Medical Error as “Misinformation”
• Patient Information Problems
• Improper diagnosis, lab value...
PATIENT SAFETY
• Nearly half serious medication errors result of
insufficient information about patient and/or drug
• Anot...
MOBILITY EMPOWERS EXCELLENCE
• The ‘habit’ of checking for current information is key
to maintaining excellent clinical pr...
REDUCE MEDICAL ERRORS
• Skyscape Survey 2004
• 50% medical professionals reported reduction in medical
errors by using a m...
CONTINUING EDUCATION
• Highly mobile, “go where you go” continuing
education
• Can act as “a virtual stack of books” or as...
HOSPITALS USING iPADS
• Massachusetts General Hospital (MGH)
• Nursing and physicians using iPads to enter and
review pati...
CAN iPAD CHANGE EMERGENCY
MEDICINE?
• Operating system & Applications
• Turn on ready to use
• Finger taps and swipes, no ...
VA USE OF IPADS
• Studying tablet devices and health related apps to
improve and coordinate care between providers,
vetera...
TABLET USE FOR CT
• Tablets used for bedside CT interpretation / sharing
• Resolution comparable to desktop
• No significa...
MORE RECENT USAGE STUDY

49
THE ULTIMATE SMARTPHONE

iPhoneone

50
EMR VENDORS TARGETING IPAD
• Often difficult to view PC ready electronic medical
records on tablet
• Vendors are looking a...
52
53
 
             

                                                                        
DISTRACTIONS CAN OCCUR

56
DEVICE ENVY / FRUSTRATION

59
SO WHAT DO I USE MINE FOR?????
HOW DO I USE MINE?????

61
Indiana ENA 2012 iPad & iPhone in ER
Indiana ENA 2012 iPad & iPhone in ER
Indiana ENA 2012 iPad & iPhone in ER
Indiana ENA 2012 iPad & iPhone in ER
Indiana ENA 2012 iPad & iPhone in ER
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Indiana ENA 2012 iPad & iPhone in ER

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Indiana ENA 2012 iPad & iPhone in ER

  1. 1. The iPhone & iPad Tools to Improve Point-of-Care Information and Patient Education 2
  2. 2. ANDREW J. BOWMAN Acute Care Nurse Practitioner Trauma Nurse Specialist Paramedic Nerd 3
  3. 3. A LITTLE ABOUT ME 4
  4. 4. HOW MY BOSS SEES ME 5
  5. 5. 6
  6. 6. HOW THE DRUG SEEKERS SEE ME 7
  7. 7. 8
  8. 8. HOW THE OLD MEN FROM ECF WISH THEIR NP LOOKED LIKE 9
  9. 9. 10
  10. 10. WHAT MY MOM THINKS I DO 11
  11. 11. 12
  12. 12. WHAT I WISH I DID MORE OFTEN 13
  13. 13. 14
  14. 14. WHAT I FEEL LIKE I DO 15
  15. 15. 16
  16. 16. WHERE I WORK 17
  17. 17. 18
  18. 18. 19
  19. 19. MY PDA / SMARTPHONE HISTORY 20
  20. 20. 21
  21. 21. 22
  22. 22. MY PALM HISTORY • Palm V • Palm Vx • Palm m505 / m515 • Palm Tungsten C • Palm TX 23
  23. 23. NOW WHAT I CARRY 24
  24. 24. 25
  25. 25. NURSING USE OF TECHNOLOGY • 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 26
  26. 26. 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
  27. 27. HANDHELD COMPUTERS IN CLINICAL PRACTICE • 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” 28
  28. 28. HANDHELD COMPUTERS IN CLINICAL PRACTICE • Personal Barriers to Device Use • Physical factors • Age • Comfort with technology • Comfort with device • Preference for paper 29
  29. 29. HANDHELD COMPUTERS IN CLINICAL PRACTICE • 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” 30
  30. 30. 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 31
  31. 31. 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 32
  32. 32. 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 33
  33. 33. 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 34
  34. 34. CLINICIAN PERCEPTIONS • Many users find devices are invaluable addition to clinical practice • “I’d rather be without my stethoscope than my “device” 35
  35. 35. 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 36
  36. 36. MEDICAL ERROR REDUCTION • 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 37
  37. 37. MEDICAL ERROR REDUCTION • 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 38
  38. 38. MEDICAL ERROR REDUCTION • 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 39
  39. 39. MEDICAL ERROR REDUCTION • 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 40
  40. 40. PATIENT SAFETY • 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 41
  41. 41. MOBILITY EMPOWERS EXCELLENCE • 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 42
  42. 42. 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
  43. 43. 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
  44. 44. 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
  45. 45. 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
  46. 46. 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 47
  47. 47. TABLET USE FOR CT • Tablets used for bedside CT interpretation / sharing • Resolution comparable to desktop • No significant discrepancies in interpretation • Emergency Radiology, April 2012 48
  48. 48. MORE RECENT USAGE STUDY 49
  49. 49. THE ULTIMATE SMARTPHONE iPhoneone 50
  50. 50. 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 51
  51. 51. 52
  52. 52. 53
  53. 53.                                                                                         
  54. 54. DISTRACTIONS CAN OCCUR 56
  55. 55. DEVICE ENVY / FRUSTRATION 59
  56. 56. SO WHAT DO I USE MINE FOR????? HOW DO I USE MINE????? 61

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