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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. - PowerPoint PPT Presentation
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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