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Exploring Clinicians' iPad Use in Healthcare Settings

This study conducted at Pennsylvania Hospital explores the impact of clinicians' iPad use on patient care decisions, information access, and patient education. The project, funded by a grant from NIH/NLM, aims to evaluate the effectiveness and benefits of integrating iPads into clinical practice. The study results show that participants found iPads to be helpful and functional, influencing decision-making and improving patient care. However, access to the EMR and security issues were identified as barriers to optimal iPad utilization. Overall, the study highlights the potential of mobile technologies in enhancing healthcare delivery.

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Exploring Clinicians' iPad Use in Healthcare Settings

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  1. May 7, 2013One Health MLA ‘13, Boston“Emerging Roles for Health Librarians and Finding New Information in Novel Places” Mobilizing Knowledge Resources: A Study of Hospital Clinicians’ iPad Use Pennsylvania Hospital Philadelphia, PAUSA

  2. Background • Conducting the study • Study results • Going forward

  3. Pennsylvania Hospital – est. 1751 • Lydia Witman, MLISClinical Librarian • Linda Sinisi, BSEntity Information Officer • Mary McCann, MLIS, MBA, RNDirector of Library, Informatics, and Privacy

  4. Organization UPHS/Penn Medicine • 3 in-patient hospitals & 1 in-patient rehab facility: HUP, PAH, PPMC, GSPP (also: acquiring CCH) • Out-patient, home care, hospice care practices • Annual Operating Revenue: $4.3b • Employees: 21,864 • Adult Admissions: 78,262 • Licensed Beds: 1,632 Entity (PAH) • Employees: 2,780 • Adult Admissions: 23,603 • Licensed Beds: 517 • 4 physician residency programs (IM, OB/GYN, Path, Rad)1 pharmacist residency program

  5. Project Background • Increasing interest in tablets, esp. since 2010 • Early adopters around UPHS/Penn Medicine • PAH Library pilot study of PDAs completed 2009

  6. Image credit: NBC News / AP

  7. Project Objectives Objectives (as listed in grant proposal): • Obtain iPad devices • Recruit 5 clinicians to participate (outreach) • Evaluate clinicians’ use of devices, accessing info for both themselves and for patients / patient education • Develop educational materials related to using iPads • Share results of pilot with other hospital libraries

  8. NIH/NLM Grant from NN/LM MAR RML • “Technology Improvement – Express Award” • received from NN/LM MAR RML (Pittsburgh), Dec 2011 • Purchased 10 iPads(iPad 2, 16 GB, Wi-Fi enabled) • 5 for Library and IT staff, 5 for lending to clinicians

  9. Evolution from pilot to research study • Lack of research to support clinicians’ using iPads • No formal studies identified in the literature • CITI training had been completed previously • Submitted to IRB for approval • IRB requested more info about how we’d protect PHI IRB process required the following documents: • Informed Consent Form • Questionnaire (survey) • Usage Agreement (regarding PHI) • Copy of grant proposal • Sample participant recruitment message

  10. Topics of study • Effect on patient care decisions • Clinical setting and types of clinical question • Characteristics of information delivery • ease of use, speed, frequency, barriers, alternate sources of information • Patient education

  11. Participants recruited • 1 attending (IM, teaching faculty) • 1 resident (IM) • 2 nurses (Onco) • 1 Pharm D, Clinical Pharmacist (anticoagulation specialist)

  12. Study Results

  13. Overall experience of participants • Devices perceived as helpful & functional • All participants reported an influence on decision-making • Resident especially found that it affected patient care, by: • reducing drug errors • avoiding unnecessary tests • changing tx • Used for patient education • Resident and nurse reported daily patient education uses, incl.: • “YouTube was my most popular app. Easy to use, [and] patients were familiar with it. I was able to find many videos covering stem cell reinfusion/blood transfusions and holistic treatments.” -Nurse

  14. Overall experience (cont’d) • Most common negative feedback was needing access to the EMR • Unclear whether access is desired for entering orders & documentation (input) or for viewing only (output), or both • When participants did not use the device, most often (N=3) they used a desktop computer instead; the second-most often (N=2) used was a smaller device – 1 iPod Touch, 1 iPhone • Pharmacist used iPod Touch instead of iPad because iPod could be carried in a pocket during rounds (Lexi-Comp app)

  15. Types of question prompting use of device, by number of participants

  16. Demographics

  17. Demographics (cont’d) Note: Participants with 6-10 years of experience were the BSN nurse and MD attending physician.

  18. Barriers • Delayed start • Delay receiving iPads due to change in payment process, UPHS Accounts Payable • Delay receiving cases due to backorder (corporate supplier used because manufacturer required credit card to order directly) • Delay in IRB approval process due to PAH not having general approver • Lack of tablet-based EMR • No vendor support fortouch-pad OS • Insufficient security Remember our friends, Patience & Fortitude! Photo by: Laura McNamara

  19. Partnership • PAH • Senior attending physician (participant), Chief Resident and other IM residents (recruiting participants), nurse manager (recruitment) • Entity Information Officer, IT Dept • CEO (signed contract for grant agreement) • Penn Medicine • IT analyst • IRB officers/staff at U Penn • U Penn Biomedical Library • U Penn • Penn Computing

  20. Summary of Study Results • Access to PHI (e.g. patient chart, test results) preferable, esp. for physicians • Device and apps generally performed well – all participants stated more likely to use after study • Some trouble with apps – w possible additional unreported • One nurse used it primarily for patient education videos • Varying comfort levels with the technology

  21. Lending launched March 2013 • 5 iPads available for lending • Usage Agreement must be signed • restricts use to protect PHI • UPHS IT - new Apple device MDM • VGA cable allows projection from iPad

  22. Next Steps • PAH iPad lending: • investigate adding read-only apps (Epic Haiku/Canto, MedView Mobile) • more outreach/education about program • UPHS Mobile Apps Taskforce & Survey • App “collection development” • Policy re device use at bedside? • Research into use of tablets: • How to validate the survey instrument? • How to power an adequate study?

  23. Takeaways • PHI access on devices is important, and protection plan is required • Infection prevention plan is required • Librarian familiarity with IRB/research process is valuable • More research needed!

  24. Thank you! And thanks to: NN/LM MAR – RML at Pitt, esp. Renae Barger MLA Hospital Libraries Section, esp. Ene Belleh

  25. For more info: “Lunch with the RML” web presentation, June 27, 2013 Witman L. Hospital clinicians' iPad use: an interim report. Med Ref Serv Q. 2012;31(4):433-8. doi: 10.1080/02763869.2012.724304. PubMed PMID: 23092420.

  26. Questions / Comments?

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