Cost to health systems
Fewer clinicians are clamoring for the latest and greatest laptops, so these new consumer devices will result in less expensive hardware at the bedside and in the patient care area, Velasco says.
"This small footprint of the device replaces the biomedical equipment interfaces that we see in laboratories, our clinical research benches, and in the critical care units where we have so many monitoring devices," says Mary Alice Annecharico, senior vice president and CIO of Henry Ford Health System, a Detroit-based seven-hospital system with more than 1,900 beds, 2011 revenue of $4.22 billion, net income of $21.5 million, and more than 24,000 employees. "It is becoming a smaller and smaller footprint with greater and greater capacity to be able to help us organize, aggregate, and utilize the kinds of data that are the outputs to make good clinical and business decisions."
"There's tremendous convergence between what our clinicians want and what we'd like to have happen," Perlin says. "From the clinician's perspective, their life is incredibly complex. Healthcare is more complex, the administration of medicine is more complex, and people are working very, very hard. When they say, ‘If I could use my device, it would improve my efficiency and my effectiveness,' that's a pretty compelling statement."
Leadership's goal is safe, effective, efficient, compassionate, informed patient care. "So this is a wonderful meeting of the interests: their desire for efficiency and effectiveness, our desire for efficiency and effectiveness," Perlin says. The tablet trend may be about to kick in to a higher gear, as clinicians clamor for the latest iPad, the lab coat pocket–friendly iPad Mini, which shipped in November.
"It's almost a perfect size for a physician who's doing rounding or somebody who wants to travel with less in their hands, if you will, and just put things in their pockets," says Michael Saad, vice president and chief technology officer at Henry Ford.
Enhanced clinical care
Aside from convenience, smartphones and tablets are also playing an increasingly important clinical role—involving both physicians and patients. At Texas Health Resources, as part of a secure messaging initiative, the system is purchasing iPhones for its employed hospitalists, Velasco says. But messaging is just the start. For physicians with heart patients, Texas Health supports AirStrip, a suite of applications delivering critical patient information, including virtual real-time waveform data, directly from the patient's location to a doctor's mobile device.
"These are actual digital representations of the EKGs, the waveforms, so they can zoom in and do fine evaluations of the waveform on the EKG that would not otherwise be possible on a static, just purely analog representation of EKGs," Velasco says.
Because AirStrip's applications are FDA-approved, Texas Health is assured of the integrity of the data being transmitted wirelessly to phones and iPads, Velasco says. Texas Health obstetricians are using the AirStrip OB application to remotely monitor fetal heart rates with these same devices, he says.
R. Malcolm Stewart, MD, of Neurology Specialists of Dallas, is a leading researcher of motor disorders and interim director at the neuroscience center at Texas Health Presbyterian Hospital Dallas. Stewart developed a number of tests to assess patients for early signs of Parkinson's disease and similar motor disorders. In the future, Texas Health will be porting these applications to the iPad so patients will be able to take these tests on their own tablets without having to travel to Texas Health's laboratories, Velasco says. Clinicians can track these patients' progress and, if necessary, make adjustments to their treatment regimens.
Due to their newness, tablets aren't yet running full implementations of the most popular EHRs. "As the EHR vendors improve their support for tablets with better user interface, additional functionality, and less typing, we will see more use in the hospital and the office," says Mark Laret, CEO of the UCSF Medical Center that has a total of 660 beds, 180 of which are for the UCSF Benioff Children's Hospital. "Once they can support ordering [CPOE] and note writing, they will start to replace some of the workstations.
"We will deploy tablets in creative ways going forward: patient self-registration, MyChart sign-ups, providing educational content in waiting rooms and patient rooms, patient questionnaires, etc.," Laret says. "Still, they are a piece of technology and tactical infrastructure. Our strategy is to use whatever device is most appropriate to provide the most complete, accessible information to our patients and caregivers at the ideal time. I expect that providers will have their own devices, and that we will provide the infrastructure to support them. We may consider a device for trainees when they start here."