This article appears in the May 2012 issue of Medicine on the 'Net
Clipboards are used by healthcare organizations to collect patient information; however, the push to abandon paper processes has made them an obvious target in need of a high-tech solution. Some healthcare professionals are opting to replace their clipboards with mobile computing devices like the Apple iPad® in an effort to increase efficiency and reduce the headaches associated with paper and pencil–based data collection methods.
According to one recent survey by the SpyglassConsulting Group, 98% of physicians interviewed reported using mobile computing devices to support their personal and professional work flows. However, a common barrier to adoption included hospitals' resistance to support mobile devices on a corporate network due to security, reliability, and cost concerns.
This month, Medicine on the 'Net looks at two ways you can implement the iPad to solve the clipboard conundrum.
Company looks to cure patient registration fatigue
Tonic Health of MenloPark, Calif., is attempting to dramatically change medical data collection by replacing the dreaded patient registration clipboard with its own iPad application, which strives to make the data collection process fun for patients. That's right, we said it—fun.
"Anecdotally, we're finding that patients are willing to fill out 30% more questions with our tool because it is game-like, simple, fun, and intuitive," says Sterling Lanier, TonicHealth's CEO.
Lanier describes Tonic as a data collection platform that works for all kinds of data. It replaces conventional tools used to register patients, assess risk, and measure patient satisfaction.
When used in lieu of a patient registration form, Tonic can ask typical registration questions; it can also ask questions related to why the patient is there by posing queries about pain. Physicians can include their own custom questions using the Tonic online survey builder, which is a self-service platform. Additionally, practices can pick from a variety of different premade surveys, tweaking them to suit their own needs, or create and deploy their own survey.
"Doctors have eight to 10 minutes with a patient," says Lanier. "They really only have time to address the one thing the patient is there for. Tonic allows for additional questions to beasked and harvested for the physician before the appointment." When used in lieu of conventional risk assessment methods, Tonic's software engine can calculate a patient's risk for a diseaseor condition. It can even provide patients with a specific percentage representing their risk, although some providers don't activate this feature.
As an example of Tonic's customizability, according to Lanier, a cardiovascular physician has Tonic ask questions about patient sleep patterns, because he feels there is a link between heart health and sleep disorders.
Additionally, a cardiovascular group using Tonic is calculating Framingham risk score profiles based on data provided by patients. The group's office gives patients their scores to educate them about their risk of getting heart disease. Identifying those at risk also helps physicians create disease or condition groups that require specific interventions. Lanier notes that becauseTonic can help identify at-risk patients earlier, the software can result in cost reductions.
At the end of a healthcare transaction, Tonic can collect feedback and assess patients' satisfaction regarding their experiences.
"Hospital reimbursement is now tied to patient satisfaction and quality of care outcomes," says Lanier. "We're the perfect tool to do that because we've created this patient engagement." Tonic can also help healthcare professionals use data in ways that they never could when it was being collected on paper. In addition to screening, tracking, and segmenting populations, some physicians are beginning to use the data for research purposes.
In fact, according to Lanier, he developed the idea for Tonic when he was working for a market research firm called Chatter that had a large number of healthcare clients. At the time, the University of California was attempting to link all its breast health clinics as part of a data mining exercise to combine clinical care with research. The physician in charge of the project wanted to create a huge data set to research breast cancer. When Lanier asked the physician how she would collect the data, she responded by showing him a stack of questionnaires as thick as a phone book. He began wondering what the questionnaires would look like on a tablet,and the idea behind Tonic was born.
Although the product launched recently, Lanier says Tonic has garnered interest from practices of all sizes and specialties. "It seems like this is an acute problem across all of healthcare and that it is applicable in many types of situations," he says.
The company charges customers using an annual license cost that is based on broad tiers of survey volume. In the future, Tonic Health plans to allow patients to save their information. That way, when they go to other Tonic enabled practices, they won't have to reenter the data.
Tonic's HIPAA-compliant system is cloud-based, meaning that the data that is collected does not live on the iPad. Every time a patient clicks Submit, the data is sent to an electronic health record, or database, where it is saved. Additionally, each iPad is password protected. Tonic is currently implementing a physician version of the product. After patients complete their intake form using Tonic, the information will be sent to an iPad with a physician version of the software.
"Before a physician walks into the room, he is able to review all the completed information from the patient's screening form," says Lanier. "The doctor pad will highlight the answers that have potential abnormalities." Reducing the impact of resident regulations.
Every morning, residents at teaching hospitals begin their day with patient rounds. As they work with patients, they must compete with one another for use of a limited number of computers that are needed to order tests and medications, get results, and input data. In addition to their limited availability, the computers are often physically located away from patients.
"There's this tension between wanting to be with your patients and needing to use the computer to implement the plans for the day," says Bhakti Patel, pulmonary critical care fellow at the University of Chicago Medicine. "If you have your own way of accessing the record, you're going to be more efficient."
In November 2010, the University of Chicago Medicine deployed 115 iPad devices to internal medicine residents to help increase their efficiency. The devices are showing promise by helping residents make the most of their time in the wake of newly implemented regulations that limit their shift hours.
"Because their exposure to work is being limited in terms of their hours, we have to come up with novel ways of imparting education," says Patel, who helped conduct astudy that looked at the benefits of the devices to residents. She is the study's first author.
The study examined whether the ordering patterns of residents changed after the implementation of mobile computing.
To do this, it compared a three-month time period when residents did not have iPad access to a three month time period when they did.
The study found that, armed with the devices, residents placed more orders and did so earlier in the admission process, thus reducing delays in patient care. "It signaled that patient care was becoming more real-time as opposed to fragmented by the availability of computers or the availability of the data needed to make decisions," says Patel. On average, residents were saving about an hour per day using the devices.
Each iPad is loaded with a number of useful tools, including a remote desktop application called Citrix®, links to the hospital paging directory, PubMed®, and medical calculators. Residents also use their devices during twice-daily conference sessions to review internal medicine board questions. Instead of one person raising his or her hand to answer a question, the question is posed on the iPad and everyone can respond using an audience response app. "It was a way for us to make our conferences a lot more interactive," says Patel.
The hospital invests about $650 for each iPad, which includes insurance, a protective cover, straps, and software. Funding for the study and the devices came from the university's Department of Medicine. The results of the study can be found in a research letter published in the March 12 issue of the Archives of Internal Medicine.
This article appears in the May 2012 issue of Medicine on the 'Net