[digoxin]

I have been thinking a bit since the launch of the iPad about how it could be a breakthrough product in areas where a good robust portable device fill an unmet need.

I work in the medical field and have previously worked in large hospitals. A lot of how hospitals work is to do with gathering and sharing information among a team and different teams as well as with the patient. I can see how the iPad could be an ideal portable device where a laptop or palm pilot device had major deficiencies. I know that that there are other medical related people on mactalk and interested to hear your thoughts and ideas.

It is likely that in the future digital patient notes will make way for traditional paper files. The iPad may with further refinement be the perfect portable device in this environment. Currently if you are admitted into hospital you are allocated a paper file which follows you around hospital. Lets say you are in the ward it stays in the ward office and is accessed and written onto by the various people in the team that look after you.(Eg Doctors, nurses, physiotherapist etc). Each person will need to physically find the file and write in it. The hassle is when the file is misplaced or you want access it and someone else is using it. Often the latest information(eg blood result/x-ray reports) is not filed in there because it takes time for the ward clark to print out that stuff and file it.

So instead of having one physical patient folder why not have a 'virtual' digital patient folder which is in the cloud/hospital central network. Anyone with the appropriate clearance can access it from any of the computer terminals. The iPad would be the perfect portable device for staff to carry around to access any of your patients digital file from anywhere in the hospital.

The screen is large enough to read and enter notes. You can view ECGs, x-rays or other radiology fillms on it. You can order test on the run. You can read through old history notes without having to look for the physical history folder. You can update the drug chart digitally where information about drug interactions /dosage can be obtained easily. The latest journal articles and clinical guidelines are there on your fingertips. Wifi / 3G should allow onsite as well offsite use.

It is also large enough to use as a patient education tool with multimedia content. Eg. Mr Smith is having a knee joint replacement. In the bedside the doctor can show Mr Smith his knee x-rays and talk through what the operation is involved with diagrams and pictures on the iPad. Often information is conveyed from doctor to patient in a verbal manner which is often misunderstood because of the jargons and medical terms use. It is much easier for the patient to understand information when visual information is also used.

The other problem with information in hospital is making it up to date and readily available. For example the medical team might see a patient and decide he needs an x-ray , a visit from the physio and changing his diet to diabetic diet. Usually to carry this out the junior doctor will ring up radiology and fill in a paper form to organise the x-ray, ring up the physio to organise a time. The nurse will then change the bed card to diabetic diet card and ring up catering to inform them of the change. If you have got 20 patients in the team that is a lot of time running around ringing people to book and change things. This could all be done on iPad in an instant. You might figure out that Radiology is fully booked this afternoon so we will organise the physiotherapist to come in the afternoon and have the x-ray in the morning. Catering would alerted immediately about the change of dietary plans.

There are obviously a few obstacles that need to be considered. How do we keep the network secured and running 24/7 with sufficient redundancy? Legally handwritten copies are required for medication charts/scripts/consent forms... Is it too ambitious to go paperless?

[DagrtheSnide]

One thing countering all this "cloud" is that it is difficult to ensure patient's privacy.

And viewing/diagnosing x-rays on this device is not ideal.

[johnq]

I think you are right digoxin, and I have also been exercising the grey matter similarly.

The key I think is view the device as a READER primarily, and a content creation device secondarily. If the need is to have access to gobs of stuff to read or view, and note taking a smaller part of the overall need then I think its a real winner. I can easily see how reading books/magazines/newspapers/web pages can be extended to other reference material and medical note are an obvious choice. Notebooks and netbooks simply wont cut the mustard in that world because of form factor and ease of use issues (the need for a mouse or track pad or whatever).

Interestingly, in that environment lack of camera/usb/gps etc is largely irrelevant.

[lavo]

Will be interesting to hear Rasta's and DrChoy's comments on this subject, especially Dr Choy's as he used to specialise in PDA's for doctors while studying to be one!

[Cybix]

I'm a Systems Analyst for the W.A. Health Dept, I pretty much support applications state-wide.

We have literally only just purchased and set up a couple of new iMac's and iPhones to start developing on. We've also now pre-ordered twenty iPad's. We certainly see the value in the medicine/health area.

We've got a lot of ideas and uses, a lot of the ideas are to extend functionality we already have in existing applications. Catering, bed-side, ED triage, lab results, pharmacy, warehouse (linen stock), dietetics, radiology, consultancy, etc.

[docjolly]

I'm a medico who works in health informatics. My immediate thought when I saw this was that it's one step closer to a portable solution for bedside e-health in hospitals.

I agree it will be a great platform for reviewing notes, ECGs, radiology etc., and for performing point and click tasks such as ordering tests. I think it will be the first lightweight portable device with the UI, screen real estate, connectivity and battery life combo to really make this practical.

The real test however is input. Part of the reason e-health has penetrated the GP world so fully is that GPs sit at a desk in front of a keyboard. Hospital doctors take notes on the fly (have you ever noticed the poor intern scribbling in a patient chart by the hospital bedside?). I'm don't know that typing on a virtual keyboard on the iPad is a practical solution. It will take some clever software development (that leverages off the iPad touch based UI) if the iPad is going to solve the 'note taking' problem.

[motef]

Originally Posted by DagrtheSnide

And viewing/diagnosing x-rays on this device is not ideal.

Why?

[will]

I will be looking very closely at one for my work - education.

From what I have read it could make an outstanding e-clipboard with iwork spreadsheets.......gosh!

[digoxin]

Originally Posted by Cybix

I'm a Systems Analyst for the W.A. Health Dept, I pretty much support applications state-wide.

We have literally only just purchased and set up a couple of new iMac's and iPhones to start developing on. We've also now pre-ordered twenty iPad's. We certainly see the value in the medicine/health area.

We've got a lot of ideas and uses, a lot of the ideas are to extend functionality we already have in existing applications. Catering, bed-side, ED triage, lab results, pharmacy, warehouse (linen stock), dietetics, radiology, consultancy, etc.

This sounds great and do keep us up to date. Might be a great way to get more macs into the system.

Spent most of my hospital years at RPH and it must be those come in on Sunday night and look for missing x-rays to display for Monday 7 AM X-ray meetings that has got me thinking.

[digoxin]

Originally Posted by docjolly

The real test however is input. Part of the reason e-health has penetrated the GP world so fully is that GPs sit at a desk in front of a keyboard. Hospital doctors take notes on the fly (have you ever noticed the poor intern scribbling in a patient chart by the hospital bedside?). I'm don't know that typing on a virtual keyboard on the iPad is a practical solution. It will take some clever software development (that leverages off the iPad touch based UI) if the iPad is going to solve the 'note taking' problem.

Very good points. Still early days but it looks promising. Handwriting or speech recognition might facilitate this. Although it would have to be a very good handwriting to learn the bad handwriting doctors are known for.

I work as a GP and we have been trialling successfully using laptops to go for home visits and nursing home visits. Currently using a Macbook Air and 3G dongle to connect back to Windows based setup with Hamachi. The 3G iPad would have been an even more compact setup except that it doesn't run Mac OSX.

[decryption]

Originally Posted by digoxin

Very good points. Still early days but it looks promising. Handwriting or speech recognition might facilitate this. Although it would have to be a very good handwriting to learn the bad handwriting doctors are known for.

I work as a GP and we have been trialling successfully using laptops to go for home visits and nursing home visits. Currently using a Macbook Air and 3G dongle to connect back to Windows based setup with Hamachi. The 3G iPad would have been an even more compact setup except that it doesn't run Mac OSX.

Hamachi is by LogMeIn, who have a good iPhone app (that no doubt will be ported to the iPad, or at the very least, will work on the iPad unmodified), so you might be in luck

[digoxin]

Originally Posted by decryption

Hamachi is by LogMeIn, who have a good iPhone app (that no doubt will be ported to the iPad, or at the very least, will work on the iPad unmodified), so you might be in luck

Will have to check this out. Thanks. I could have used the iPhone all along instead a laptop although the screen is way too small.

[tom5955]

I think with a really good application that can handle all the information in a cloud way would really work, especially if it was to go along with a program on the computers.

It would have to incorporate handwriting recognition because i think note taking would take too long without it.

Forms could be pre made and come with the app, or presets could be made and distributed for different sections of the hospital.

[motef]

Originally Posted by decryption

Hamachi is by LogMeIn, who have a good iPhone app (that no doubt will be ported to the iPad, or at the very least, will work on the iPad unmodified), so you might be in luck

I use the Logmein iphone and love it.

Couldnt live without it

[motef]

Originally Posted by digoxin

Spent most of my hospital years at RPH and it must be those come in on Sunday night and look for missing x-rays to display for Monday 7 AM X-ray meetings that has got me thinking.

You needed a PACS!

[stab]

This is a great read for those of us with no knowledge of medical itc systems etc.
Can't wait to hear more when those iPads arrive Cybix!

[docjolly]

Originally Posted by digoxin

Handwriting or speech recognition might facilitate this.

I'm not sure these will be the way forward. I think it's more likely to be along the lines of sophisticated templates that use a lexicon like OpenEHR, which will reduce the vast majority of bedside note taking to a point/touch/click affair.

[Cybix]

Originally Posted by motef

You needed a PACS!

we do have PACS

regarding xray's on the iPad.... It just doesn't have the horsepower. You need at least gigabit ethernet to successfully view x-rays on the device, not to mention the current system in place uses -very- expensive greyscale display panels to properly display the x-rays (I do not know the tech details). Probably something to do with the resolution, contrast, etc, etc.

[docjolly]

Originally Posted by Cybix

we do have PACS

regarding xray's on the iPad.... It just doesn't have the horsepower. You need at least gigabit ethernet to successfully view x-rays on the device, not to mention the current system in place uses -very- expensive greyscale display panels to properly display the x-rays (I do not know the tech details). Probably something to do with the resolution, contrast, etc, etc.

Depends what you are trying to do. True that a radiologist reporting films needs a full res DICOM image on CXR sized expensive grayscale LCDs - and perhaps there should be one set of these on every ward (like viewing boxes of old on the wall). But a good quality jpeg of a couple of hundred kB on something like an iPad would produce surprisingly good results and would no doubt be fine for bedside use.

[Lutze]

I've got a co-worker who's wife is a GP in the Perth area. Her practice use Mac's entirely.

I've not had a chance to talk to her about any of this yet, but the IT guy they have there is pretty clued up it seems.