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

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%

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?

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)

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

Why Use iPad in the ED?

Remote Access EMR Systems Allscripts eClinicalWorks Eclipsys Epic GE Centricity

Native iPad EMR Applications drChrono Nimble SparrowEDIShttp://www.youtube.com/watch?v=DUJ3rojx7HU&noredirect=1

EHR Clients/Apps for iPad

Who: Executive leadership, ED, IS/IT Dept.

What: Implement EHR on iPads

Where: In the Emergency Department

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

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

Case Study: EHR on iPads in the ED

1. Improved Physician-Patient Interaction

2. Improved ED Workflow3. Structural Benefits of iPads

Evaluation of Case Study

iPads facilitate face-to-face interactioniPads enhance patient educationImproved patient satisfaction

Improved Physician-Patient Interaction

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

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

Improved ED Workflow

Usability – intuitive Like paper but much smarter Thin & lightweight Easy to clean No fan to spread germs

Structural Benefits of iPads

StrategicOperationalCulturalPolitical

Impact on the Organization

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

Promote service differentiation

Strategic Points of Change

Improve ED workflowImprove patient-physician interactionFast information access at point of careReduce costs

Streamline technology infrastructureLess physical space needediPad much less expensive than COW

Operational 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

Cultural Points of Change

Accelerate adoption of EHR use Meaningful Use HIE Interoperability

Political Points of Change

Personnel impact Physician resistance

o Pilot with innovators/early adopters of HITo Provide adequate training

Mitigation of Potential Problems

Protection of data Authentication Encryption Data Wiping Find My iPad Automatic screen lock

Mitigation of Potential Problems

Structural Challenges Portability – iPad too big for lab coat pocket

o New lab coat designo iPad mini

Remote access EHR via Citrix on iPad requires 1 login for Citrix & 1 for EHR (cumbersome)o Future app development – biometric

identification

Mitigation of Potential Problems

Questions

Referenceshttp://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