Tablet showing detailed heart anatomy app next to open medical textbook and handwritten notes

Will the Apple iPad Transform Medical School Education?

The new class of medical students is being weaned away from pencil and paper to digital learning BY TRACIE WHITE First-year medical students Jonathan Dunlap, Lizzy George and Stacie Vilendrer learn how to use their new iPads for lectures and studying, as part of a training for the new class that the School of Medicine provided on Aug. 20. Steven Sloan pointed to his laptop screen, which displayed a tiny diagram of a molecular structure that he needed to memorize for his molecular foundations of medicine class. He was hanging out in the student lounge along with several other Stanford medical students a few weeks after the start of the new school year. “You can’t even see that,” said Sloan, a University of Miami graduate, who squinted at the image on his computer screen. “But on the iPad, you can just touch the screen to enlarge it.” Then he reached into his backpack to pull out his new iPad, eager to show off its amazing imaging technology. Sloan is one of the 91 medical and master’s of medicine students who began class Aug. 23 with school-provided iPads for the first time. In addition to getting used to the intensive first-year course load — diving into applied biochemistry and disease mechanisms, genetics and anatomy — the students are experimenting with their iPads trying to figure out how to best use the mobile devices to enhance learning. Stanford’s medical school joins a small but growing group of educational institutions across the nation experimenting with iPads as a way to lighten the load of textbook-toting students, and to learn how best to teach an extremely tech-savvy generation of students who’ve grown up in a wired world. RELATED NEWS “So far so good,” said Brian Tobin, the school’s instructional technology manager who helped hand out the iPads on Aug. 19 during orientation week, adding that it’s still a work in progress. “Everyone is doing their own thing,” said Tobin “Some students are learning on it really well. Others have decided that laptops are still the best option. Some still use paper. And others use some mix of all three.” Tobin had earlier addressed the students at an Aug. 20 tutorial on how to use their iPads  and had pointed to a 2-foot pile of binders. “This is the material for one course,” he said. “We want to get you started going paperless. There’s a lot less for you to carry around. … We want you to use the iPad when working with your cadavers in anatomy, or viewing slides in pathology.” But because this is breaking new ground, he added that the faculty want to see how the students decide to use the iPads themselves. “No one has to use the iPad exclusively, or even at all,” Tobin told the students. Jamie Tsui/Stanford EdTech Staff help students Aug. 19 to set up the iPads they just received. An early head count shows 68 students are using the iPad exclusively for note taking; eight are using laptops exclusively; about eight more are using the paper version of the course syllabus; and the rest some variation thereof. School officials will conduct regular surveys to gauge how the students choose to use the devices as the semester progresses. Sloan and two friends who were in the student lounge the second week of school talked about how everyone uses the iPad a bit differently, each adapting the device’s strengths to their own preferences for how best to study and learn. There’s a lot of excitement about the devices, mixed in with a twinge of skepticism and an appreciation for the school’s willingness to try something new. Christine Nguyen, a Yale University grad, said she uses the iPad about 20 percent of the time, and uses her laptop the remainder for studying and in lectures. But she loves it for anatomy. In anatomy class, students have traditionally used colored pencils to shade in the various body parts in an anatomy manual. “Look at this,” Nguyen said, pointing to the rainbow of colors in an iPad program used for annotating documents. Simply touching a different color changes the highlighting. “It’s so useful for drawing in anatomy class. It’s a lot of fun. You customize it the way you want to use it.” Norbert von der Groeben Second-year student Stesha Doku, who offers iPad lessons, stands next to one course’s syllabus, which can now be stored on the device instead of carried in a knapsack. The iPads are equipped with iAnnotate, a note-taking software program that enables students to write directly onto text, to sketch diagrams, to copy text and add highlights or underline with the drag of a finger. Some of the students’ textbooks are available digitally, and school officials hope more electronic texts will be in the future to further lighten the load of the students’ backpacks and save on paper. Henry Lowe, MD, senior associate dean for information resources and technology, said he uses an iPad himself as a physician and found the device extremely helpful. “It’s quite popular with physicians,” he said. “Physicians are mobile. They move around from clinic to clinic, from patient to patient. It’s a nice, lightweight, portable device.” First-year medical student Abdullah Feroze of New Mexico, who described himself as a “paper-and-pencil” kind of guy, appreciated that learning how to use an iPad now could be beneficial for his future as a doctor, given the move toward electronic health records for patients. “It will be an interesting experiment,” he said.

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Nurse holding tablet displaying electronic ER patient chart with medical icons

Could the iPad Really Change Emergency Medicine Practice?

by Nicholas Genes, MD, PhD on May 12, 2010 A few of you might be reading this on your new or old  iPads. The rest of you are probably sick of the speculation and hype that Apple’s new tablet will transform the publishing world, just as the iPhone changed mobile phones and the iPod revolutionized the music industry. But a more relevant question for us is: “Can the iPad change the way we work in the emergency department?” I sure hope so. Because the nature of emergency medicine – the speed at which we have to work, the interruptions, the need for information, has forced some unfortunate compromises. Many departments are stuck with 20th century paper charting, depriving physicians of easy access to patient data and decision support in the name of efficiency. Other EDs have made the leap to electronic information systems, recasting doctors as glorified clerks, parked in front of computers, engaged in protracted data entry sessions, while the confused patients look on and wonder what could possibly be so important on that screen. Another option – docs with scribes in tow – is an expensive and awkward band-aid for this fundamental problem of workflow. The iPad offers a solution. Maybe it won’t happen with this specific iPad release. Maybe it won’t happen this year or next. But I expect emergency physicians will someday be able to wander through their department, moving patient to patient, with a tablet like the iPad tucked under their arms. During encounters, we’ll use iPads to tap on elements of the history or exam in, and enter orders – all very quickly at the bedside. These tablets will help us go over images and lab results with patients, and let us review diagnoses and instructions. In short, I think the iPad can liberate doctors from the desk-based tyranny of ED information systems and the shortcomings of the paper chart. Here’s why. The Operating System You might be wondering– isn’t the iPad just a bigger iPhone with fewer capabilities? After all, it can’t make calls or take photos. Well, you’re missing something: the iPhone, even without a camera or phone, is already a pretty amazing product (Apple markets it as the iPod Touch, and they’ve sold about 30 million of them). Putting this intuitive operating system behind a more powerful processor, bigger battery, and a much larger 9.7 inch screen (which translates to about 8 times the viewable area on an iPhone or iPod Touch), opens up a lot of possibilities. But let’s focus on the platform, first. Already Apple’s mobile operating system has apps that help physicians at work – the healthcare section of the app store is popular, and there’s dozens  of apps specifically for emergency medicine (a few favorites include EMRA’s antibiotic guide and WikEM, a physician-edited repository of EM pearls and formulas). Even with the small screen of iPhones and iPod Touches, this operating system has attracted interest from a variety of ED information systems (EDIS) vendors. Why is this operating system so compelling? For one, these devices just turn on and are ready to use (although you’d expect that with a smartphone; it’s still not standard among computers). With the iPad’s interface, unlike netbooks or laptops, there’s never any searching for files or folders, or wrestling with uninstalls and malware. Navigating and launching apps is easy, and getting new ones through the App store is, too. While Palms and handheld Windows devices have offered programs like notepads, calculators and ePocrates for a decade or more, it’s only when Apple entered the handheld market that these apps became fast and slick enough to completely abandon handbooks and scraps of paper. But just as importantly, Apple has put forth some elegant design precepts for their apps, and forces developers to stick to them. Instead of multi-tiered menus, apps should have intelligently laid out buttons and easily navigable screens. Selections are optimized for fingers, instead of mice or styli. You move through screens by swiping, instead of clicking tiny scrollbars. You choose options by flicking through a slot-machine-like wheel, instead of drop-down lists. You zoom in and out by pinching with your fingers. We’ve never seen an EMR based on this elegant interface, though certainly people think it’s desirable (Mandl, Gamble refs). Current ED information systems have evolved haphazardly – the rush to add features and maintain interoperability has left them bloated, slow, and difficult to navigate. In the past decade, hospital experiments with tablet PCs haven’t taken off, despite obvious benefits of portability (Cockerham ref). The problem was these Windows-based tablets were running similar EMR software as found on desktop PCs, only with a stylus instead of a mouse. These portable systems brought all the frustrations of desktop charting and order entry into a miniaturized (but still heavy, and unnaturally warm) tablet. Bringing cumbersome screens full of menus and checkboxes to the bedside isn’t the solution; the EDIS needs to be reimagined for tablets. And while the cost of this software is very much an open question, the hardware cost – $500 for a basic iPad – ought to be pretty attractive for administrators. This is not only cheaper than most desktops PCs with monitors, but should be easier to support and maintain. The Form Factor The iPad weighs about a pound and a half. It’s half an inch thick, and couldn’t cover up a standard sheet of paper. So, while its big glossy screen has understandably rejuvenated the prospects of the publishing world, it shouldn’t be too cumbersome to carry around. Maybe moving with the iPad can’t be as straightforward as shoving an iPhone in your pocket, but it ought to be preferable to walking back and forth between patients and desktop EMRs, or toting a clipboard with a T-sheet. And already, a host of accessories has sprung up to augment the iPad, just as with the iPod and iPhone before it.  There are already shock-resistant cases and grip sleeves with shoulder slings. There are even waterproof cases (some that look suspiciously like zip-loc bags). I don’t doubt there’ll soon be cases with extra battery power, giving a boost to the iPad’s non-swappable battery (said to last 10 hours while displaying video, perhaps less if constantly accessing a network). As part of a group that thinks nothing of wearing stethoscopes around our necks, I think docs will find a way to comfortably carry an iPad. Next Steps I doubt we’ll see a fully integrated and comprehensive ED information system spring forth on the iPad this year. Instead, I think administrators warm up to the device’s potential with already existent apps that provide different aspects of a comprehensive system. First, perhaps, the department will buy some iPads for patient education apps which, given the device’s screen and multimedia capabilities, can make efficient teaching tools. Then, maybe, an investment in a radiology app that interfaces with your hospital’s PACS, or an app with discharge instruction templates and prescription writers that, through Bluetooth or network connections, prints to your nearest location. ED-specific apps might be implemented next, like a tracking board to monitor patients’ bed status or vitals. I expect Dragon and other voice transcription software to enter the marketplace, either with a standalone app that can export transcriptions to charts, or with integration in a vendor’s system. Eventually, I expect a vendor will release an app that does it all, seamlessly interfacing with the enterprise, offering charting, computerized order entry, bed tracking, results review, and admission and discharge pathways.  It won’t look like any system we’ve seen for desktop PCs. That’s why I think it’ll change the way we work. Trailblazers: a few health care Apps that are already leading the way Epic’s Haiku For hospitals and clinics with the latest version of Epic and a Haiku license, Haiku lets authorized clinical users on iPhone and iPod Touch (and now, iPad) securely access hospital patient lists, test results, notes and schedules. Airstrip A suite of apps (including the only FDA-approved iPhone and iPod touch medical app) that provide HIPAA-compliant access to lab results and streaming data, including vitals, telemetry waveforms, fetal rhythms for OB, patient census and more. The app is free but hospitals have to buy Airstrip equipment and use compatible monitoring devices. eDr. Rx A standalone browser-based e-prescribing solution, already available on smartphones and now on the iPad. Departments sign up for a subscription to send new prescriptions to local pharmacies. Features include the option of integrating prescription data with the medical record. coActiv EXAM-PACS for iPad Enables secure DICOM querying of a hospital’s PACS, bringing a patient’s radiology images to the touch-screen iPad where they can be reviewed or mailed as JPGs. Allscripts Remote Optimized for iPhone or iPod Touch, this app can log into compatible electronic health records remotely, checking vitals, patient summaries, contact info, and enabling e-prescribing.

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Tablet on a stand beneath a desk lamp on a wooden desk

Apple’s iPad 2 Keynote on Changing How Doctors Practice

on 03/03/11
At the beginning of the iPad 2 event yesterday, Apple played a video that showed the various ways the iPad had been utilized in 2010 –  from the classroom to sales teams.  The video also spent time featuring how the iPad has been used in medicine. Dr. John Halamka, Chief Information Officer of Beth Israel Deaconess Medical Center, who we have mentioned numerous times in the past, was featured in the “2010, the year of the iPad” video.  He talked about how the iPad is being used in the physician workflow, and how physicians are able to spend more time with patients because of the iPad. Apple’s video showed physicians interacting with their iPads in a few different manners: *A physician was shown displaying a patient’s EKG results to them. *A physician was shown displaying gastrointestinal pathology to a patient, focusing on the gallbladder, and most likely explaining to a patient the mechanism of cholecystitis, or prepping them for a cholecystectomy. *A physician is shown using a DICOM viewer that enables them to go through a patient’s radiology images with them at bedside. But the ultimate quote of the Apple video, by Dr. Halamka, who truly is  one of the unique innovators in not only medicine but technology as a whole (we encourage you to read his blog):
The iPad will change the way doctors practice medicine
This bold statement, and Apple featuring the iPad in medicine, could be signs Apple is going to take the mobile healthcare field more seriously. At the very least, it shows Apple is aware of the significant impact the iPad is having on medicine, and the potential it holds. Steve Jobs himself said during the keynote speech, when referencing the plethora of apps available for the iPad: Steve Jobs:
…a lot of apps for business, and vertical markets, like medical
Other key uses shown in the video — How the iPad has changed the lives of kids with autism. This is something we have featured multiple times before, and it was nice to see Apple acknowledge the developers who have created transformational apps enabling children with autism to communicate better. Source: Apple Keynote Video (11:40 minute mark)

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.