When Henry Feldman wants to give a patient a quick tutorial on her gall bladder or hip joint, or explain the message behind a white blob on her X-ray, he pulls out his iPad and taps the screen to call up electronic records, test results and images, and massive reference resources in an instant. "I'll sit on the side of the bed and show patients their imaging results, and then I'll bring up a perfect drawing of the anatomy, sometimes in 3-D," says Feldman, a hospitalist at Beth Israel Deaconess Medical Center in Boston. "And they really respond. I remember one patient saying, 'Wow. This is the first time I've understood what's going on.' "
Smart phones and tablet computers could potentially redefine healthcare, and at hospitals like Beth Israel, it's already happening. Far more flexible and bedside-friendly than even small laptops, these handheld devices promote safer, better, and faster care by enabling doctors and other caregivers to educate themselves and their patients on the fly.
Busy doctors and nurses at busy hospitals need ready access to computers. In a conventionally equipped hospital, one wing might have only a few laptops or desktop computers on rolling carts; if all are taken, time is wasted waiting for one to come free or hunting up another one. Enter the handheld solution.
At the University of Chicago Medical Center, the interns and residents who provide most care in teaching hospitals were given iPads. After three months, survey results showed an improvement in efficiency—doctors were saving the equivalent of three hours a day, giving them more time to spend with patients, review records, and deal with paperwork. They also made fewer medication errors and other potentially harmful mistakes. "This is a way to access information when we need it while keeping a hand free to attend to patients," says chief resident Bhakti Patel.
Smart phones and tablets put hundreds of clinical references on the screen. A free app from Medscape.com, for example, pipes in crucial facts about more than 7,000 medications, such as drug interactions, and 3,500 diseases, and provides 2,500 images and videos. Other apps decipher medical jargon, pull up diet and nutrition advice for patients, and interpret test results.
"I use an app that gives a 3-D interactive view of the brain," says Iltifat Husain, an emergency medicine resident at Wake Forest Baptist Medical Center and founder of iMedicalApps.com, which posts reviews of hundreds of medical apps. "Instead of pointing at my head or even pulling up a plain picture, I can show patients exactly what's going on." Husain reads the New England Journal of Medicine and other professional publications on his iPhone. Many of his peers, he says, are creating their own apps and toolkits.
The appeal of a quick Web or network connection at a fingertip goes beyond the ability to dig out critical information with a tap or two. The devices have enough power to help doctors forge better relationships with patients. Patients often don't grasp what doctors tell them, and showing them high-quality images and videos can help. Doctors even show YouTube clips at a patient's bedside. Test results have a better chance of making an impact, too. "Talking to a patient about diabetes, sugar control, and kidney function is very abstract," Feldman says. "But when I hand over the iPad, I can say, 'Look at your labs. Remember when you stopped taking your medication? You can see how your kidneys got worse.' That makes it very concrete." It also involves patients more directly in their own care. That gives them more of a sense of empowerment, increasing the likelihood that they'll follow their treatment plan.
Patients can even get faster pain relief from a tablet or smart phone. The usual routine at most hospitals when a patient is hurting is for a doctor to find a computer, log in, and write out an order for pain meds. It takes time, perhaps half an hour or longer, and meanwhile the patient remains in pain. A physician equipped with a smart phone or tablet can shortcut much of the process, tapping in orders whenever and wherever is most convenient. "If someone is unstable, you want to be at his bedside watching him as you put the orders in," Patel says. "You don't want to delay how care is delivered, and you don't want to have to run away from the bedside."
Getting another doctor's opinion harnesses the power of the devices to communicate in more than one way. Feldman once used his iPad to photograph a suspicious growth on a patient's back and E-mailed it to a dermatologist colleague to see what he thought. After finding out, Feldman briefed the on-call dermatologist, who as a result knew to bring a biopsy kit when he saw the patient later. "All of a sudden, location isn't important anymore, and that really changes things," says Feldman.