iPad Use & Value is Related to Hospital’s Infrastructure

The iPad is the new darling of the hospital world.  Depending on who you talk to, it can do almost anything.  Perhaps that is why some groups are jumping into the iPad arena before they are ready.  The adoption of any technology depends heavily on whether an institution has the infrastructure to support it.  Here is an example of one residency program testing the use of an iPad before its hospital had the infrastructure to support it.

The article “Resident Impressions of the Clinical Utility and Educational Value of the iPad” published in the November issue of Journal of Mobile Technology in Medicine tried to determine the value of the iPad during clinical rounds and for education.   The authors from Riverside Methodist Hospital gave 119 residents an iPad to use during the 2011-2012 academic year.  The residents gave their opinions on the clinical utility and educational value of the iPad.  The results were disappointing.  “The iPad received low marks for daily clinical utility (14.7%) and efficiency in documentation (7.8%).  It was most valued for sourcing articles outside the hospital (57.8%) and as a research tool (52%).”  Basically residents did not place a high value on the iPad when used in clinical rounding or as an educational tool.

Yes the residents didn’t find the iPad to be useful during clinical rounding, but that is because the hospital really wasn’t ready for the iPad, or any device, to helpful during rounding.

At the time the article was written, the hospital was still writing orders on a paper based chart.  Moving from paper to the iPad is quite a jump for people and hospital technology.  “All resident groups reported problems with utilization of the iPad for medical documentation/progress notes.” If the hospital is still writing orders on paper based charts perhaps it isn’t the iPad to blame but the fact that the hospital hasn’t adopted writing orders electronically.

In addition to writing orders on a paper based chart, the hospital’s other infrastructure items clearly were not ready for the use of iPads.  Further in the article they discuss connectivity problems and EMR access problems.

Connectivity –  “All resident groups noted problems with iPad login-in and connectivity/WiFi.  During the academic year 98 tickets specific for iPad set-up and connectivity issues were reported to Information Technology services.”  Now the authors do mention that it was 98 tickets out of 182,000 global tickets, but when you only have 119 people using iPad, 98 tickets is not good.  Anybody who has been in a deadzone can relate to the frustration of losing network access. Relying upon a network device for clinical use when you have poor connectivity (or difficult to access WiFi) is like relying on a cell phone service in the mountains after a winter storm.

EMR access – Residents were asked to recommend apps and medical tools for the iPad.  “The single most frequently cited application was Riverside’s electronic medical record.” The method by which they access their EMR makes it cumbersome for somebody with an iPad to access it.  “Our EHR is access via remote desktop, requiring a two-step login process.”  So the device that they wanted them to test its clinical use, does not have easy access to the EMR, a major clinical application.

The authors of this study suggest that residency efficiency “may be less positively impacted by the use of the iPad than previously reported.”  I believe the authors are both right and wrong to make this statement.  The authors clearly listed several hospital wide infrastructure issues creating barriers to online access.  “Though log-in and connectivity issues were noted as a significant problem, technology support was rarely utilized.  Residents often found it faster to use a computer than reporting difficulties.  Additionally, electronic order entry is not available at our hospital.”  Not only do these statements reveal the hospital wasn’t ready for adoption of the iPad or any tablet device, but it reflects their residents’ attitude toward their help desk and the speed at which they need things to work to get information.  I think the authors would have been more accurate if they had stated, residency efficiency may be less positively impacted by the use of the iPad if the hospital is not adequately prepared ahead of time for the use of mobile devices.

To study the use of the iPad in a clinical setting when the clinical setting is clearly not ready, is like testing the use of a car in an area where there are no roads.

I look forward to reading other iPad studies where the hospital is not the barrier and we can better determine whether the iPad (or any other tablet) is of clinical value or not.

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