Tablet computers in healthcare settings: novelty or necessity?
This article first appeared in the November 2014 issue of Pulse+IT Magazine.
Australian hospitals are increasingly encouraging the use of mobile devices such as tablet computers for clinical purposes beyond laptops and computers on wheels, and evidence suggests this is a popular move. Recent research shows that while tablet computer use at the bedside is not unusual, access to the full range of clinical information systems and how that information is presented on a small device is still a stumbling block to getting the best value out of tablets.
Clinical information in healthcare settings is becoming increasingly digitised. The majority of Australian GPs use clinical software packages for prescribing medications, checking interactions, and recording patient notes. Although the implementation of clinical information systems in hospitals has been slower than in general practice, there are now hospitals that are completely paperless.
With the introduction of clinical information systems, health professionals have had to adapt their work practices to integrate computing devices. GPs have an advantage in that most patient consultations occur in practice rooms within easy reach of a desktop computer or laptop. For doctors, nurses and other health professionals working in hospitals who are constantly moving between patients or wards, the integration of computers into their work is more challenging.
Desktop computers are typically located away from the patient bedside and carrying a laptop or carting around a computer on wheels (COW) is more cumbersome and time consuming than taking a paper record to the bedside. Tablet computers, such as iPads, are often promoted as having the potential to match the mobility of paper records. In theory, tablet computers could be used for quick and convenient entry or retrieval of patient information anywhere and at any time. They could also be used to share information with patients at the bedside, such as showing patients their x-ray images.
In practice, however, the potential benefits of tablet computers can be limited by a hospital’s clinical information systems. Many clinical information systems that are currently in place have been designed to be displayed on larger screens (i.e., laptops, COWs or desktop computers), and as a consequence, the system interface does not translate well onto the screens of smaller devices.
We found this to be the case in a study we conducted comparing doctors and nurses use of desktop computers, COWs and tablet computers . The smaller size of the tablet computers meant that less patient information could be displayed on the screen, requiring users to scroll more to view and obtain information compared to a desktop computer screen. In addition, the on-screen keyboard of the tablet computers obscured the “ok” button of decision support pop-up windows, making it difficult for users to close the window and return to the main user interface.
Issues of interoperability can also affect the functions that can be performed on tablet computers. If the hospital’s clinical information systems are Windows-based, they may not adequately communicate with or be transferable to iOS devices. In a recent study, we provided 10 senior doctors with iPads for use on ward rounds . However, the devices were limited to read-only functionality of the hospital’s Windows-based clinical information systems and could not be used to access the picture archiving and communication system (PACS) to view radiology images.
During ward rounds, doctors were frequently observed looking up test results and medications, and to a lesser extent patient information, images and reports. Of the computing devices available (desktop computers, COWs, iPads and smartphones) the primary device of choice for accessing information on ward rounds was the iPad (56 per cent) followed by the COW (36 per cent). The regularity of iPad use on ward rounds was somewhat surprising given they were not fully integrated with the hospital’s clinical information systems (e.g., PACS could not be used) and they provided read-only access.
While doctors valued the mobility that the iPads afforded, in order to improve usefulness and efficiency, they emphasised the need for tablet computers to allow full access to existing clinical information systems so that all relevant tasks could be performed on the devices.
The ability for doctors to use tablet computers to access clinical information systems at the patient bedside lends itself to the possibility of showing patients relevant information during care interactions. We hypothesised that iPads could be used during ward rounds to show patients their test results and other clinical information leading to improved patient engagement in their care process .
Disappointingly, during 36 hours of observed interactions with 525 patients, we only observed one patient interaction where a doctor used the iPad to show the patient their test result. Nonetheless, 63 per cent of patients, whose doctor had used an iPad, reported feeling very or somewhat engaged in their care process. The patient who was shown their test result via the iPad reported that they thought the device had increased their engagement in the care process. Although doctors believed it is important to engage patients and share information with them to deliver high quality care that fosters confidence and improves patient satisfaction, they preferred to share information with patients verbally.
As it currently stands, tablet computers are more than a novelty but are not as yet a necessity. Tablets are useful for data retrieval during ward rounds but their use as a tool to engage patients in the care process remains limited. Individual health professionals or organisations contemplating the introduction of mHealth are advised to speak to their IT department prior to purchasing tablet computers to understand their local clinical information systems requirements (e.g., operating system compatibility) and any limitations associated with translating the systems to smaller devices. Such considerations are critical if tablet computers are to deliver on their full potential.
- Andersen et al. (2009) Mobile and fixed computer use by doctors and nurses on hospital wards: multi-method study on the relationships between clinician role, clinical task, and device choice. JMIR. 11(3): e32.
- Lehnbom et al. (2014) iPad use during ward rounds: an observational study. Stud Health Technol Inform. 204: 67-73.
- Baysari et al. (2014) iPad use at the bedside: a tool for engaging patients in care processes during ward-rounds? Intern Med J. doi:10.111/imj.12518.
ABOUT THE AUTHORS
Dr Elin Lehnbom BScPharm, MPharmSc, MClinPharm, PhD, FACHI
Dr Mirela Prgomet BAppSc(HIM)(Hons), PhD
Dr Elin Lehnbom and Dr Mirela Prgomet are postdoctoral research fellows with the Centre for Health Systems and Safety Research at the Australian Institute of Health Innovation (AIHI), formerly at the University of NSW and now at Macquarie University. They have published extensively on mobile computing devices and clinical decision support tools in healthcare.
Posted in Australian eHealth