Pediatric Asthma History Review By Patients Using iPads : Challenges & Adoption

1. Pediatric Asthma History Review By Patients Using iPads: Challenges & Adoption Allen L. Hsiao MD1,2,4, George Michel3, Grace Vitkauskas PhD4, Alia Bazzy-Asaad MD1, Paula Burns4, Paul Pimentel4, Clara Filice MD1, and Richard N. Shiffman MD, MCIS1,3 Departments of Pediatrics1 and of Emergency Medicine2, Yale School of Medicine Yale Center for Medical Informatics3 & Information Technology Systems4, Yale-New Haven Hospital, New Haven, CT Background: Despite the advantages of electronic medical records (EMR), such as the clinical decision support deployed as part of our project (GLIDES: GuideLines Into DEcision Support), providers may perceive EMRs as time consuming and access them only after patient visits. Novel methods to decrease provider EMR data entry effort, such as touch tablets to empower patients to enter data directly into the EMR, have not yet been well described. Objective: To see whether an iPad (Apple Inc, Cupertino, CA) “app” could be created to collect interval asthma history from patients/families, securely transmit data into Centricity (GE Health, UK) EMR, and be easily adopted by the users. Results: Since iPad pilot initiation 5/12/11, 116 patients have been seen for asthma: 111 (95.7%) patients were willing and successfully used the iPad application (Fig 2) without any formal training or orientation to the device. Five (4.3%) patients declined to try using the device. Server problems resulted in 14 (12.1%) lost transmissions but the issue was permanently corrected 7/11. Overall, 97 (83.6%) patients had successful completion and transmission to EMR of asthma interval history into Centricity (Fig 3) from the iPad application. Fig 3: Centricity EMR Documentation & CDS Fig 2: Actual iPad screenshot of survey app Design/Methods: An iPad app was developed to collect asthma patient history responses. Appointment registry data was fed from the clinic's IDX system (GE Health, UK) to insure accurate patient identification before receipt of the device in the clinic waiting room. A series of multiple choice questions (English or Spanish) are displayed on the iPad and answered by tapping on the desired answer. Upon completion, responses are sent wirelessly over the secure clinic network to the web application server, creating a lab HL7 message with patient responses as observation terms (OBX segments). This information is then sent to the enterprise interface engine (eLink, Allscripts, Chicago, IL) and directed into the Centricity EMR (Fig 1). Conclusions: While there are many technical and security steps to consider, an easily adopted, touchscreen graphical user interface device, such as an iPad can be used to successfully and securely collect transmit data into an EMR. Provider and patient enthusiasm was extremely positive. Fig 1: Architecture for iPad clinical data acquisition system