EHR on iPad in ED

Federal law (EMTALA) requires ED to provide care to everyone.

Emergency careAnti-dumping LawScreened, Stabilized, TreatedRole is evolvingLast resort24/7/365

Emergency Department

124 million ED visits in 2008 (NHAMCS).10% of all ambulatory care visits.41 ED visits for every 100 Americans.2007 IOM report showed crowded ED crisis2003 US GAO report showed insufficient

inpatient capacityB/w 1995-2008, ED visits increased 28%.Number of uninsured decrease from 17 to

15%Non urgent health problems

Emergency Department Statistics

No simple definitionUrgency is best determined by level of

immediacy by triage staff. Immediate (4%), Emergent(12%),

Urgent(39%), Semi-urgent(21%), non-urgent(8%), Unknown (16%).

2/3 rd of all ED visits outside normal business hours (8a.m.-5 p.m., M-F).

Non-urgent health problems

Triage status is based on the following classification: Immediate/emergent – Patient should be seen

immediately or within 15 minutesUrgent – Patient should be seen within 15-60 minutesSemi-urgent – Patient should be seen within 61-120

minutesNon-urgent – Patient should be seen between 121

minutes and 24 hoursUnknown – No mention of immediacy in the medical

record; hospital does not perform triage; or the patient was dead on arrival.

Source: CDC/NCHS. National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department

Triage Status

Rapidly assess, treat, educate and discharge patients

Time delays crucial concern to patient careNeed to reduce response time in treating

patientsProviders concerned using EMR slows down

patient care

ED Challenges

Strategy or strategies presented concisely with appropriate relevance

Who: ED physiciansWhat: Implement EMR on iPadWhere: Emergency Department

Who, What, Where

Improved physician-patient interaction Improved workflow with iPadsStructural benefits of iPads

http://www.youtube.com/watch?feature=player_embedded&v=DUJ3rojx7HU

Benefits

Improved physician-patient interaction Physician can maintain effective communication

with patients via face-to-face interaction iPads enhance patient education

physician can show images, videos, X-ray scans, test results, medical references and dictionaries

Improved patient satisfaction Patients see physicians making use of latest

technology for treatment Patients have face-to-face time with physician

Benefits

Improved Workflow with iPads Improve access to patient and clinical

information in patient room iPads reduce redundancy – don’t need to log

in and out, adjust screen position, push cart in and out in each room

Mobility – physicians constantly moving, need access to information on the go

Benefits

Improved Workflow with iPads iPads make the workflow faster – touchscreens,

more efficient for orders entry Future customization of EMR

Customize EHR to physicians’ worflow Future application development Integration with other clinical applications

Closer towards an ideal clinical workflow More efficient Put in orders and meds Get tests results back expeditiously Discharge patients more quickly

Benefits

Structural Benefits of iPads Touch screens enable ease of use

Easier to navigate than using mouse, clicking , scrolling Use is intuitive Ability to hold and manipulate item helps encourage use Removes barriers between user and device

Similarity to paper Lightweight Write on it Carry around like clipboard chart Like using smart paper Tactile experience replicates familiarity of paper interface

iPads improve infection control Screens can be wiped down easily No keyboard so no dust collection, No fan to spread germs

Benefits

Application development – iPad app using Citrix receiver to virtualize EMR

Incorporate phone directory and paging system from device

Documentation review, lab study review, order entry, review of imaging studies

Other Benefits

Application development – iPad app using Citrix receiver to virtualize EMR

Incorporate phone directory and paging system from device

Documentation review, lab study review, order entry, review of imaging studies

Examples

Remote Access EMR Systems Allscripts – client for iPad eClinicalWorks – client iClickDoc Eclipsys – remote access to Sunrise Hospitla EHR Epic – Canto/Haiku GE Centricity – remote access client for iPad

Native iPad EMR Applications Dr. Chrono - advanced medical speech to text function,

paperless medical billing, iPad patient check-in and custom clinical notes.

Nimble - medical art, refill requests, evidence based decision support, patient scheduling, patient data graphing and more.

iPad EHR Clients & Apps

EPIC Haiku

Remote Access EMR Systems Allscripts – client for iPad eClinicalWorks – client iClickDoc Eclipsys – remote access to Sunrise Hospitla EHR Epic – Canto/Haiku GE Centricity – remote access client for iPad

Native iPad EMR Applications Dr. Chrono - advanced medical speech to text function,

paperless medical billing, iPad patient check-in and custom clinical notes.

Nimble - medical art, refill requests, evidence based decision support, patient scheduling, patient data graphing and more.

iPad EHR Clients & Apps

1. The Atlas of Emergency Medicine - iPhone / iPad app by Usatine Mediahttp://www.youtube.com/watch?v=_Ey8HSXsuf4- the app described in the demo has a very

broad and comprehensive outline which can provide physicians with medical advice at their fingertips.

- the app provides both text and images for easier use during research on medical procedures.

2. palmEM http://www.palmer-ww.com/

iPad App Examples

- palmEM app similar to Usatine app in principle.

3. Sparrow EDIS by Montrue Technologieshttp://medcitynews.com/2012/05/ipad-app-uses-voice-technology-to-improve-er-patient-experience/- Utilizes Nuance™ voice recognition- Ground Control feature allows for other

patient health information to be displayed on iPad.

iPad App Examples

OperationalStrategicCulturalPolitical

Impact to Organization

Operational Impact

Strategic Impact

Cultural Impact

Political Impact

Personnel impact Physician resistance

Protection of dataOther ethical concerns

Mitigation of Potential Problems

Personnel impactProtection of dataOther ethical concerns

PortabilityCitrix client – requires multiple logins

Mitigation of Potential Problems

http://www.acep.org/content.aspx?id=25936http://hschange.org/CONTENT/1204/1204.pdf

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