Incubator for change?

by Christina on April 23, 2012

I am officially done with being an intern on our inpatient wards! We do four months of it our intern year, and yesterday was my last day.

One of the most interesting things about this last month was our iPad pilot project. Our hospital has always run on paper notes, paper charts, paper orders, paper sign-out, and paper to-do lists. Everything is still paper, except now we each have an iPad, we have an iPad sign-out system, and iPad to-do lists.

I liked it the first two weeks. I carried it around everywhere and used it to keep track of my to-do list, to look up lab results on patients, and do quick searches on medical questions.

Then, our service got busy, my keyboard broke, it became heavy, and I didn’t have the time to log-in every time I needed to look something up. By week 3, I had reverted back to my old paper to-do list system.

I can pull out paper & pen in a quick second when a nurse calls with a vital sign or a consultant calls with recommendations, whereas the iPad is clumsy and slow. We all know it has potential, but on a busy inpatient service there is no time to be slowed down!

Below is a running list of some more pros/cons/potentials… please add more if you have any!

iPad pros:

  • Immediate access to patient’s electronic charts (less time wasted hunting around for a computer)
  • Immediate access to the internet/UpToDate/Wikipedia/Medical apps and calculators/email
  • Instant access to educational videos (i.e. I could watch this NEJM procedure video on how to do a lumbar punctures before actually doing it on a patient)
  • Electronic sign-out system (organized, but not yet more time-efficient)
  • Less risk of HIPAA violations by leaving patient papers around the hospital
  • Less paper-wasting

iPad cons:

  • The log-on process is time consuming
  • Difficult to quickly jot down quick notes on the iPad
  • Cannot yet import vital signs, see radiology films, or print from our iPads
  • There’s still a separate system for daily paper progress notes
  • iPads are too wide to to fit into our white coat pockets

iPad potentials:

  • Using the iPad for patient education (such as showing Khan academy video like this talk on HgA1C for diabetics)
  • Instantly pulling up radiologic imaging
  • Electronic orders that can be input directly from the iPad
  • Vital signs directly imported to the notes (which we write and print on the iPad)
  • Making me more time efficient so that I have more time to be with patients face-to-face
  • Small enough to slip in my pocket so that my hands can be free
  • Quick biometric login (i.e. fingerprint or face recognition)?
  • Something like Siri on the iPad (to open programs, put in orders, write to-do’s, etc)
  • Immediate speech to text function for dictating quick notes or reminders
  • What else???

Like many places, our hospital has some major bureaucratic hurdles to get through before this can be a useful functional tool. But it will happen! A beautiful public hospital right next to Silicon Valley in such need of such help and innovation — it’s an incubator for change waiting to happen.

{ 6 comments… read them below or add one }

Anar Mikailov April 23, 2012 at 7:34 pm

Cool project!!

Out of curiosity, what type of keyboard system did you use with the iPad?



Christina April 24, 2012 at 10:40 pm

Hey Anar,

We used keyboard sort of like this one:

I liked the keyboard because it made it much easier to type things in quickly, but then wonder if a small laptop would have been more effective — we didn’t seem to be taking advantage of all the iPad functionality.


anar April 30, 2012 at 1:57 pm


And is the app avail in the app store yet?



elise April 25, 2012 at 6:30 pm

this is so interesting to me…nice to hear your thoughts about it and compare initial vs later reactions. it seems good in theory, but i agree, theres times when it could be more of a hassle.
seems the to-do list for handoff would be a nice feature. also, for night floats that are covering multiple teams’ patients, is there a way to access the patients trend over the hospitalization? sometimes its hard to summarize everything over the phone or in a text page when i need a verbal order for a patient (and i know the MD doesnt know the full history and is just covering). not sure how big your hospital is, but sometimes the float MDs on night shift are covering up to 5 different teams – thats a ton of patients! so if the RN isnt really good at communicating the essentials, there can be a lot of back and forth before the patient actually gets what he/she needs.
anyway, i am constantly brainstorming ways to streamline the communication between RN and MDs (and RN to RN). its cool that you have this opportunity to trial this program.


john May 1, 2012 at 9:11 pm

I wonder how much hospital medicine decision making is drawn from published learning, versus long term on-the-job knowledge, versus shorter term knowledge observed in local patient population dynamics. Wouldn’t these data collection methods naturally drive developing statistically derived conditional probabilities that are hospital, and community based? The presentation of the mix is always a challenge but seems like there is room for value added assisted judgements. The hardware and firmware evolutions always seems to run far ahead of the real insight software. Best!


Frank May 4, 2012 at 2:17 pm


As my job largely involves the integration of (new) technology, this was interesting. But all of your Cons have obvious solutions, so it’s only a matter of time before they are implemented:

1. The log-on process is time consuming
Need fingerprint recognition to log on with just a swipe. This is on my ThinkPad at work. If the health-care industry demands this on a iPad or similar device, it will come to be.
2. Difficult to quickly jot down quick notes on the iPad
This should be easily doable with a stylus. Handwritten notes need to integrate with typed notes, though, for when there’s no time to deal with a keyboard. My experience with styluses is that the accuracy needs to be improved a bit, but they are close.
3. Cannot yet import vital signs, see radiology films, or print from our iPads
I’m sure this is being worked on. I would think that printing should just require the printers to be set up on the wireless network.
4. There’s still a separate system for daily paper progress notes
This has to be on its way out. As the technology (e.g., iPads) gets better, this won’t be necessary anymore (and will be considered too-high a HIPAA risk).
5. iPads are too wide to to fit into our white coat pockets
As use of these types of devices becomes standard, so will wider pockets in those coats! Call your purchasing department and tell them to give the coat company your feedback!


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