The ever-growing use of electronic health records (EHRs) and information needs of patients have increased time away from the bedside and the need to use computer workstations whenever they become available. Some medical centers have adopted tablet computers because they can process information much quicker and are less cumbersome than when they first came on the market. With more hospitals adding wireless internet access, physicians can use these mobile devices to access an increasing number of utilities and functions, including EHR systems.
Putting Tablets to the Test
In a study published in Archives of Internal Medicine, my colleagues and I sought to implement and evaluate the deployment of personal mobile tablet computers (Apple iPads) on resident workflow efficiency and patient care.
Nine out of 10 residents reported using the mobile tablet for clinical responsibilities at work, and nearly 75% reported using it every day. The number of orders per admission didn’t change after tablet deployment, but the timing of orders with respect to time of patient admission did. During the post-deployment period, 5% more orders were placed prior to post-call attending rounds. Also, 8% more orders were placed prior to the time at which post-call teams were scheduled to leave the hospital. More orders were placed within the first 2 hours of patient admission following tablet deployment.
The majority of residents (78%) reported being more efficient on the wards when using their tablets, stating that they saved about an hour per day. More than half (56%) reported being able to attend more conferences by using their tablet computers. Of all house staff, 66% reported that patient care delays were improved with tablet use. Interestingly, 89% of interns reported that the tablet improved their efficiency on the wards, compared with 71% of residents.
Tablet computers can process information much quicker and are less cumbersome than when they first came on the market.
Maintaining a Good Doctor-Patient Relationship
It’s important for any physician using mobile devices to be aware that they could get distracted or be perceived as doing something non-medical. We can’t replace a good doctor–patient relationship with technology and efficiency enhancements. The cost-effectiveness of a tablet computer program should also be considered. The costs include the devices themselves as well as administrative time for training. These costs can be expensive in a large residency program, but small hospitalist groups could likely see a quick return on their investment through greater efficiency.
Currently, we’re exploring the characteristics of early adopters in order to determine who would likely be the most appropriate champions of tablet computer use. With more and more physicians adopting these devices in the workplace, effective champions and leaders are paramount to facilitate implementation and greatly improve efficiency.
Readings & Resources (click to view)
Patel B, Chapman C, Luo N, et al. Impact of mobile tablet computers on internal medicine resident efficiency. Arch Intern Med. 2012;172:436-438.
Arora V, Georgitis E, Siddique J, et al. Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities. JAMA. 2008;300:1146-1153.
Zeng Q, Cimino J, Zou K. Providing concept-oriented views for clinical data using a knowledge-based system: an evaluation. J Am Med Inform Assoc. 2002;9:294-305.
Verghese A. Culture shock: patient as icon, icon as patient. N Engl J Med. 2008;359:2748-2751.
Horng S, Goss F, Chen R, Nathanson L. Prospective pilot study of a tablet computer in an emergency department. Int J Med Inform. 2012;81:314-319.
Vawdrey D, Wilcox L, Collins S, et al. A tablet computer application for patients to participate in their hospital care. AMIAA Annu Symp Proc. 2011;2011:1428-1435.