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EHR on iPads in the Emergency Department

EHR on iPads in the Emergency Department. Chris Taylor, Muhammad Nauman & Jill Raimo. Background. Emergency Department (ED) must provide care to everyone (EMTALA) Emergency care 24/7/365 Patients screened, stabilized, & treated Anti-dumping Law Role of ED is evolving Last resort.

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EHR on iPads in the Emergency Department

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  1. EHR on iPads in the Emergency Department Chris Taylor, Muhammad Nauman & Jill Raimo

  2. Background Emergency Department (ED) must provide care to everyone (EMTALA) Emergency care 24/7/365 Patients screened, stabilized, & treated Anti-dumping Law Role of ED is evolving Last resort

  3. State of the ED 124 million ED visits in 2008 10% of all ambulatory care visits 41 ED visits / 100 Americans 2007 IOM report revealed crowded ED crisis BTW 1995-2008 ED visits 28%

  4. Challenges for ED Docs Overcrowded, stressful environment Quickly assess, treat, educate & discharge patients Instant access to critical health info at the bedside Maximize direct patient care time Reduce response time to treat patients Technology should not be barrier to patient care Solution?

  5. http://www.youtube.com/watch?v=SrKI6IUryQM “The iPad will change the way doctors practice medicine.” (Dr. John Halamka, 3/2/11 Apple iPad2 launch video)

  6. Why Use iPad in the ED? Long battery life (10 hrs.) - no need to recharge during typical ED shift Speed - always on, fast app switching Price ($399 iPad2, $499 iPad3) Rich feature set (audio, HD video, handwriting, retina display) Portable Apple quality unmatched

  7. EHR Clients/Apps for iPad Remote Access EMR Systems • Allscripts • eClinicalWorks • Eclipsys • Epic • GE Centricity Native iPad EMR Applications • drChrono • Nimble • SparrowEDIS http://www.youtube.com/watch?v=DUJ3rojx7HU&noredirect=1

  8. Case Study: EHR on iPads in the ED Who: Executive leadership, ED, IS/IT Dept. What: Implement EHR on iPads Where: In the Emergency Department

  9. Case Study: EHR on iPads in the ED Hospital uses Epic EHR Conduct pilot study using ED docs to test and evaluate Epic EHR client on iPad Results of pilot help to determine potential for organization-wide implementation

  10. Case Study: EHR on iPads in the ED Each physician on shift equipped with iPad Enough iPads purchased for 2 full shifts of ED docs plus a few spares Choose pilot team of docs Provide training Implement Epic client app on iPads Support ED operations Evaluate use of EHR on iPads in ED

  11. Evaluation of Case Study Improved Physician-Patient Interaction Improved ED Workflow Structural Benefits of iPads

  12. Improved Physician-Patient Interaction iPads facilitate face-to-face interaction iPads enhance patient education Improved patient satisfaction

  13. Improved ED Workflow Access to clinical information at point-of-care Reduce redundancy – single login Mobility – physicians need information on the go

  14. Improved ED Workflow Workflow faster with touch screen - easier than point-and-click, scrolling with mouse Future development of EHR for iPad – customize apps to physicians’ workflow EHR on iPad brings physicians closer to an ideal clinical workflow

  15. Structural Benefits of iPads Usability – intuitive Like paper but much smarter Thin & lightweight Easy to clean No fan to spread germs

  16. Impact on the Organization Strategic Operational Cultural Political

  17. Strategic Points of Change Create more user-friendly environment in ED for physicians (familiarity with technology) Leading change - pioneer use of EHR on iPads to facilitate EHR adoption HCO-wide Promoteservice differentiation

  18. Operational Points of Change • Improve ED workflow • Improve patient-physician interaction • Fast information access at point of care • Reduce costs • Streamline technology infrastructure • Less physical space needed • iPad much less expensive than COW

  19. Cultural Points of Change ED using cutting edge technologies to improve quality of care Promotes culture of information sharing in HCO Patient-centric – satisfaction and engagement

  20. Political Points of Change Accelerate adoption of EHR use Meaningful Use HIE Interoperability

  21. Mitigation of Potential Problems • Personnel impact • Physician resistance • Pilot with innovators/early adopters of HIT • Provide adequate training

  22. Mitigation of Potential Problems • Protection of data • Authentication • Encryption • Data Wiping • Find My iPad • Automatic screen lock

  23. Mitigation of Potential Problems Structural Challenges • Portability – iPad too big for lab coat pocket • New lab coat design • iPad mini • Remote access EHR via Citrix on iPad requires 1 login for Citrix & 1 for EHR (cumbersome) • Future app development – biometric identification

  24. Questions

  25. References http://www.acep.org/content.aspx?id=25936 http://hschange.org/CONTENT/1204/1204.pdf http://www.imedicalapps.com/2011/03/ipad-2-doctors-practice-medicine/ http://www.epmonthly.comfeaturescurrent-featureshow-the-ipad-can-change-emergency-medicine AMIA-0756-A2012.R1. Study of the factors that promoted the implementation of Electronic Medical Record on iPads at Two Emergency Departments Akhil Rao; Terrence Adam; Raymond Gensinger; Bonnie Westra AMIA-0807-A2012.R1. EHR on the Move: Resident Physician Perceptions of iPads and the Clinical Workflow. Colin Walsh; Peter Stetson

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