2. The iPhone & iPad
Tools to Improve Point-of-Care Information and
Patient Education
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3. ANDREW J. BOWMAN
Acute Care Nurse Practitioner
Trauma Nurse Specialist
Paramedic
Nerd
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4. A LITTLE ABOUT ME
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5. HOW MY BOSS SEES ME
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7. HOW THE DRUG SEEKERS SEE ME
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9. HOW THE OLD MEN FROM ECF WISH
THEIR NP LOOKED LIKE
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11. WHAT MY MOM THINKS I DO
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13. WHAT I WISH I DID MORE OFTEN
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15. WHAT I FEEL LIKE I DO
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17. WHERE I WORK
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20. MY PDA / SMARTPHONE HISTORY
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23. MY PALM HISTORY
• Palm V
• Palm Vx
• Palm m505 / m515
• Palm Tungsten C
• Palm TX
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24. NOW WHAT I CARRY
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26. NURSING USE OF TECHNOLOGY
• PDA’s (smartphones) are often touted as the “wave of the
future” in health care
• That future may not be close at hand for many nurses
• Nurses often must buy their own devices
• “Nurses Taking Technology Into Their Own Hands”
• NurseZone.com - 2003
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27. NURSING USE OF MOBILE DEVICES
• More nurses using mobile devices
• Smartphones, tablets, e-book readers
• 74.6% nurses own smartphone or tablet
• 41.5% own e-book reader
• Springer Publishing Company 2011

28. HANDHELD COMPUTERS IN CLINICAL
PRACTICE
• Perceived benefits
• Enhanced Productivity
• “saves you aggravation of looking for something”
• “don’t have to leave room to look up reference”
• Enhanced Quality of Patient Care
• “timeliness of information”
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29. HANDHELD COMPUTERS IN CLINICAL
PRACTICE
• Personal Barriers to Device Use
• Physical factors
• Age
• Comfort with technology
• Comfort with device
• Preference for paper
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30. HANDHELD COMPUTERS IN CLINICAL
PRACTICE
• Expectations for Future
• “everyday in medicine (and nursing) there
is more stuff you have to know and things
are more complex”… “electronics are going
to be our savior for our sanity and for
medical errors”
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31. ACCESS TO CHANGING INFORMATION
• Need access to increasing amount of rapidly changing
medical information
• 40,000 MedLine citations added monthly
• 1-2 new drugs each week
• Rapidly increasing diagnostic tests
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32. EVIDENCE BASED MEDICINE/NURSING
• Need to bring evidence based practice to ED bedside
• “EB (practice) is judicious use of current best evidence
in making decisions regarding care of patients” –
Sackett, BMJ, 1996
• 2001 IOM report cites lack of translation of clinical
research findings into bedside practice
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33. PATIENT SAFETY IMPROVEMENTS
• Need to improve safety / reduce errors
• Scope and complexity of clinical Dx and Tx
considerations has led to unacceptable rate of
medical/nursing errors
• Frenetic pace of ED/ICU increases risk of error
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34. BENEFITS TO DEVICES AT BEDSIDE
• At the Point of Care
• Access to extensive information
• Integrated “all in one place” functionality
• Up-to-Date, event breaking, clinical developments
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35. CLINICIAN PERCEPTIONS
• Many users find devices
are invaluable addition to
clinical practice
• “I’d rather be without my
stethoscope than my
“device”
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36. INVOLVING THE PATIENT - INFO
• Anecdotal experience indicates patients accept---AND
VIEW POSITIVELY---the use of handheld devices in
encounter
• Appreciate that provider is being careful and precise
and accessing the “latest information”
• Welcome opportunity to obtain information on the spot
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37. MEDICAL ERROR REDUCTION
• US healthcare infrastructure is plagued by
numerous core problems
• Fragmented care
• Non-standardized procedures
• Soaring costs
• Millions without insurance
• Unacceptably high rate of medical error
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38. MEDICAL ERROR REDUCTION
• Healthcare professionals frustrated
• Healthcare providers expected to practice error free
• Virtual avalanche of new medical information combined with
the stresses of working in the medical environment almost
guarantees that mistakes will occur
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39. MEDICAL ERROR REDUCTION
• Medical Error as “Misinformation”
• Agency for Healthcare Research and Quality
(AHRQ) has noted that insufficient or flawed
point-of-care information is a frequent and
significant cause of medical error
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40. MEDICAL ERROR REDUCTION
• Medical Error as “Misinformation”
• Patient Information Problems
• Improper diagnosis, lab values, allergies, drug
contraindications, pediatric dosing
• Drug Information Problems
• Dosing miscalculations, potentially harmful drug
interactions
• International Pediatrics,18 (2) 2003
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41. PATIENT SAFETY
• Nearly half serious medication errors result of
insufficient information about patient and/or drug
• Another common cause is calculation error
• Implementation of a computerized drug assistance
program resulted in 55% reduction in medication
errors
• New England Journal of Medicine,348(25), June 2003
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42. MOBILITY EMPOWERS EXCELLENCE
• The ‘habit’ of checking for current information is key
to maintaining excellent clinical practice
• Best way to achieve goal is source of information as
mobile as the provider
• Clinical Nurse Specialist, 17(5), September 2003
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43. REDUCE MEDICAL ERRORS
• Skyscape Survey 2004
• 50% medical professionals reported reduction in medical
errors by using a mobile device
• 88% check drug references
• 38% check drug interactions
• 78% use more than one clinical reference

44. CONTINUING EDUCATION
• Highly mobile, “go where you go” continuing
education
• Can act as “a virtual stack of books” or as
streaming media for learners
• www.healthcmi.com 2012

45. HOSPITALS USING iPADS
• Massachusetts General Hospital (MGH)
• Nursing and physicians using iPads to enter and
review patient information
• New York Methodist Hospital
• Mounted with EKG and other Dx machines to
access patient information
• www.padgadget.com 2012

46. CAN iPAD CHANGE EMERGENCY
MEDICINE?
• Operating system & Applications
• Turn on ready to use
• Finger taps and swipes, no pens or styli
• Form factor
• Lightweigt, flat
• Smaller area than paper
• www.epmonthly.com 2010

47. VA USE OF IPADS
• Studying tablet devices and health related apps to
improve and coordinate care between providers,
veterans and families
• 1000 iPads for “Clinic-in-Hand” program
• Pre-loaded with apps to facilitate communication with
provider
• iMedicalApps 2012
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48. TABLET USE FOR CT
• Tablets used for bedside CT interpretation / sharing
• Resolution comparable to desktop
• No significant discrepancies in interpretation
• Emergency Radiology, April 2012
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49. MORE RECENT USAGE STUDY
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50. THE ULTIMATE SMARTPHONE
iPhoneone
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51. EMR VENDORS TARGETING IPAD
• Often difficult to view PC ready electronic medical
records on tablet
• Vendors are looking at making iPad friendly versions
for bedside data collection and charting
• Personal conversation, Gregg Malkary
• Spyglass Consulting
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56. DISTRACTIONS CAN OCCUR
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59. DEVICE ENVY / FRUSTRATION
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61. SO WHAT DO I USE MINE FOR?????
HOW DO I USE MINE?????
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