A neurology patient at a Texas hospital may soon find doctors handing him an iPad with game-like apps on it to test his motor skills. Nurses will be able to roam bedsides while remotely checking electrocardiograms, or EKGs, on their iPads. Doctors are already sharing medical records on iPads with their peers, in order to discuss patient care.
At Texas Health Resources, a healthcare provider with 24 hospitals, these are just a few ways the iPad will allow clinicians to spend more time with patients. It's a significant break from the traditional hospital setting: Wander around most hospitals in the country and you'll likely see clinicians sitting in chairs at nursing stations staring into computers.
"When we made them start using [desktop] computers and spend hours in front of a screen, we took them away from that context of interacting with other people," says Ferdinand Velasco, M.D., chief medical information officer at Texas Health. "Devices like the iPad and smartphone help get them mobile again."
Technology critics point to cubicle-filled offices around the country that compel workers into self-imposed solitary confinement. At hospitals, though, the impact of little human contact takes an even darker turn. Consider a patient holed up in a strange room, suffering from severe illness or injury and craving a visit from an assuring nurse or doctor.
At Texas Health, the iPad promises more frequent visits.
Last year, Texas Health launched a formal mobile health strategy, called mHealth, to corral the growing number of mobile devices and apps coming to market. Doctors and nurses at Texas Health, for instance, jumped on the smartphone and tablet bandwagon. A recent Texas Health survey showed two-thirds of doctors have personal smartphones, mostly iPhones. Velasco, who leads the mHealth strategy, estimates up to 40 percent of doctors have an iPad or other tablet.
Other hospitals bear witness to the iPad craze. "We had physicians coming to us as soon as the first iPad came into the Apple Store wanting to connect everything," John McLendon, senior vice president and CIO of AHS Information Services, the IT division of Adventist Health System (AHS), a not-for-profit Protestant healthcare provider with 44 hospitals across 10 states,
A Mobile Health Strategy
One of Velasco's goals this year is to make it compelling for doctors to use their tablets regularly at work. This means finding useful apps on the App Store, jointly developing apps with contractors and vendors, and even building apps in-house.
The evolution of iPad apps in the App Store has been rapid resulting in some standout iPad apps, including popular medical apps such as VisualDX (free), ICD9 Consult 2011 ($15), and Mediquations Medical Calculator ($5). There are more than 300,000 iPhone apps and 65,000 iPad apps in the App Store.
For an organization with many personal iPhones and iPads in the field, vetting apps can be a monumental task. Texas Health's solution: an enterprise social network similar to Twitter. Doctors and nurses can talk about the pros and cons of certain apps, find out what apps their peers are using, and learn what apps to avoid.
Other apps will play a central role at Texas Health. A dozen doctors in a pilot group are testing an app that accesses electronic healthcare records. "We're going to roll it out to one of our hospitals," Velasco says. "By the end of the year, we expect to have it out to all of our physicians who have tablets."
This month, Texas Health will deploy an app that lets clinicians view EKGs from both smartphones and tablets rather than on computers in nursing stations. Medical equipment vendors embracing the iPad have made this app possible. GE Healthcare teamed with AirStrip Technologies earlier this year to allow EKG data to appear on iPhones and iPads. Texas Health and Cedars-Sinai Medical Center will be using the AirStrip technology.
On the in-house app development front, Texas Health is working with a neurosurgeon to develop an app that taps into the iPad's three-axis gyroscope. The gyroscope has helped the iPad become a serious gaming platform; it gives gamers the ability to control virtual cars and planes. Texas Health is using this platform to create an app that will allow patients to perform certain specific motor skills that a neurosurgeon can evaluate, possibly making an early diagnosis of a disorder.
Priority One: Patients
Texas Health has half-a-dozen smartphone and tablet apps in the works, running on iOS and Android. Velasco is considering support for Hewlett-Packard tablets, too. "We don't want to lock ourselves into one platform," he says.
An equal number of apps are aimed at patients with smartphones and tablets. Last month, Texas Health released a smartphone app for patients to access their health records. The app also sends out alerts.
One of the conundrums in developing mobile apps for clinicians and patients is where to start, smartphones or tablets. The tablet has a larger screen so there's much more you can do with an app, Velasco says. It's also easier to downsize an iPad app to the iPhone.
On the other hand, most people carry smartphones, not tablets. Even if a doctor or nurse owns both, chances are they'll have their iPhone with them but not necessarily their iPad. This means, in most cases, Texas Health will develop an app for the smartphone first.
But clinicians carrying iPads are becoming a more familiar sight, so Texas Health has to continue delivering solutions on this platform. After all, mobile apps need to be on the devices that go wherever a doctor or nurse goes.
"Physicians need to get around, want to be with patients, want to be with other doctors, nurses and healthcare providers," Velasco says. "Locking us down to be in front of a computer is just not the way to go."