1.Is the medical handheld device fairytale coming true?
he Physician & the iPad

2. Once upon a time
Doctors longed for a way to quickly and easily access patient information and perform a variety of other functions in a highly mobile way
Laptops were thought to be the answer
Various issues blocked broad adoption
3. Then appeared the iPad!
4. Why all the fuss about the iPad?
Size
Portability
Capability
Availability of apps
Custom designed 1GHz Apple A4 processor= fast connection
Price
5. Why all the fuss about the iPad?
Ability to access full websites (option to go to on some mobile sites; or, download another browser)
1-second turn-on time
Maintains wireless connection while sleeping
Ease of use
Green
6. Why all the fuss about the iPad?
The new Patient Protection and Affordable Care Act created an urgency to make providing and managing health care more affordable, with the White House pointing to Congressional Budget Office predictions that 25 percent of our gross domestic product would go toward health care in 2025 if the status quo persisted. Digitization and interconnectivity between medical facilities is widely viewed as one major way to generate those efficiencies. (White)
7. Popular Uses
Preparing for rounds
Note-taking while on rounds
Accessing medical literature
E-mail
Point-of-care lookup & teaching
Patient education
8. Popular Uses
Patient forms
Viewing x-rays with patients
Updating patient records
Writing prescriptions
d/c plans (though must complete on computer with printer)
9. Real-life examples
Dr. Henry Feldman, Chief Information Architect for the Harvard Medical Faculty Physicians
For any provider who is highly mobile this blows the doors off of the COWs
Running a trigger with the iPad at the bedside was amazing. Not having to leave the bedside and having OMR and POE right there was awesome
On average a full 13 hour stretch with heavy use burned 28% of the battery over the week, best 20% worst 35%.
In general it was incredibly useful and given that all of our clinical apps are web based it basically all worked perfectly.
10. Real-life Examples
Dr Harry Hemley, Australian Medical Association, Victoria, President
Re: an iPad pilot program for graduate doctors, iPads in hospitals will begin to solve computer access problems and allow doctors transportable access to clinical journals, online information and email. It will give doctors the tools they need to fulfil their clinical responsibilities and provide quality care to patients. (AMW staff)
11. Real-life examples
VineetArora, MD, MPP; Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago
I used UpToDateto review the ARA criteria for lupus and rheumatoid arthritis for patients with these conditions.
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.
12. Real-life examples
D. K. Simmons, DDS
Over the past several weeks I have incorporated the use of my iPad into my daily patient interactions. From reviewing medical histories using WebMD and Epocrates, to designing slideshow presentations to present cosmetic and implant cases to patients, the ability of this device to perform has been outstanding.
Within seconds, I am able to check for potential harmful drug interactions or better plan treatment based on new found medical conditions that affect my patients. The fact that they can hold the iPad seems to engage them and involve them in their treatment.
13. Real-life examples
Iltifat Husain, 4th year MD/MPH student at Wake Forest University School of Medicine; receiving his Masters in Public Health from the University of North Carolina School of Public Health; Editor in Chief of iMedicalApps.com
battery life is stunning
Seeing radiology images is going to be a breeze on this device.
Health care point of care use requires the ability to pull up key information quickly, or the physician patient experience suffers. I really cant emphasize how fast the iPad is.
14. Real-life Examples
Dr. Ali Sadrieh
Patient forms (intake, history, etc)
Magazine subscriptions
Surgical consent videos
Displaying x-rays
Collect and input data during surgery
first medical practice in the country to have fully integrated this remarkable device into our day to day operations.
15. Imagine-ifs
Joseph Kim, MD; MPH.; blogger Mobile Health Computing
Imagine if every patient went to a doctor's visit with an iPad. The doctor could help the patient record some notes, access important patient education materials, and could also provide the patient with some digital media that could be used to help that patient manage his/her disease when he/she returns home.
16. Popular Mobile Resources
Epocrates
iAnnotate
UpToDate
MedCalc
PubMed
Airstrip (OB, Cardiology, etc)
17. Does the iPad fairytale have a dark side?
18. Does the iPad fairytale have a dark side?
Of course!
As with any mobile device, there exists the possibility of:
Compromised security (HIPAA)
there is a trade-off between security and usability, but such problems are far from solved in the desktop environment, with security often being complicated by avoidable usability issues (Reinhardt)
Biometric recognition suggested (Reinhardt; White)
19. Does the iPad fairytale have a dark side?
Spread of infection- no evidence that the iPad has been tested for an Ingress Protection rating (IP52 or higher) (Brady)
Less accuracy in data collection in a clinical setting (Haller)
No printer
Relatively fragile
Lack of iPad customized apps
No ability for multiple windows
Limited projection capability- works for certain apps, but not Safari
20. The iPad at UVa
Are they being used here?
Yes, but by individuals. No whole-HS adoption.
Epic has developed Haiku, an EMR app for the iPhone.
Epic is developing Canto, a native iPad app.
21. The iPad at UVa
Does HS/CS provide support for the iPad?
Yes, for both wireless email and the hscs-pda network
The iPad is fully supported for wireless email access. We are researchingcompatibility with ourinfrastructure for possible additional functionality and will post updates as they become available. http://bit.ly/ddXARR
What about security?
Due to the potential for ePHI or other highly-sensitive data contained within email, hand-helds used for this purpose must be protected according to the criteria detailed by UVa Policy IRM-015.The iPad meets this criteria: http://bit.ly/95dktK
Can you get your hands on one?
Yes. Check one out from the CMHSL!
22. The iPad may not mean happily ever after
But it may be the closest thing we have now
John D. Halamka, MD, MS; Chief Information Officer of Beth Israel Deaconess Medical Center; Chief Information Officer at Harvard Medical School; Chairman of the New England Healthcare Exchange Network (NEHEN); Chair of the US Healthcare Information Technology Standards Panel (HITSP)/Co-Chair of the HIT Standards Committee; practicing Emergency Physician; blogger.
My general impression is that it is not perfect for healthcare, but it is closer than other devices I've tried. It will definitely be worth a pilot.
23. Resources
Please view the resources for this presentation at my delicious account:
http://www.delicious.com/riverspirit/ipad
*All images courtesy of SurLaLune Fairytaleshttp://www.surlalunefairytales.com/
The End