Mobilizing Knowledge Resources:

A Study of Hospital Clinicians’ iPad Use

May 7, 2013One Health MLA ‘13, Boston“Emerging Roles for Health Librarians and Finding New Information in Novel Places”

Pennsylvania Hospital Philadelphia, PAUSA

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BackgroundConducting the studyStudy resultsGoing forward

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Pennsylvania Hospital – est. 1751

Lydia Witman, MLISClinical Librarian

Linda Sinisi, BSEntity Information Officer

Mary McCann, MLIS, MBA, RNDirector of Library, Informatics, and Privacy

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Organization

UPHS/Penn Medicine3 in-patient hospitals & 1 in-patient rehab facility: HUP, PAH, PPMC, GSPP (also: acquiring CCH)Out-patient, home care, hospice care practicesAnnual Operating Revenue: $4.3bEmployees: 21,864Adult Admissions: 78,262Licensed Beds: 1,632

Entity (PAH)Employees: 2,780Adult Admissions: 23,603Licensed Beds: 5174 physician residency programs (IM, OB/GYN, Path, Rad)1 pharmacist residency program

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Project Background

Increasing interest in tablets, esp. since 2010 Early adopters around UPHS/Penn Medicine PAH Library pilot study of PDAs completed 2009

6Image credit: NBC News / AP

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Project Objectives

Objectives (as listed in grant proposal):

1)Obtain iPad devices

2)Recruit 5 clinicians to participate (outreach)

3)Evaluate clinicians’ use of devices, accessing info for both themselves and for patients / patient education

4)Develop educational materials related to using iPads

5)Share results of pilot with other hospital libraries

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NIH/NLM Grant from NN/LM MAR RML

“Technology Improvement – Express Award” • received from NN/LM MAR RML (Pittsburgh), Dec 2011

Purchased 10 iPads (iPad 2, 16 GB, Wi-Fi enabled) • 5 for Library and IT staff, 5 for lending to clinicians

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Evolution from pilot to research study

Lack of research to support clinicians’ using iPads• No formal studies identified in the literature

CITI training had been completed previously Submitted to IRB for approval

• IRB requested more info about how we’d protect PHI

IRB process required the following documents:

1)Informed Consent Form

2)Questionnaire (survey)

3)Usage Agreement (regarding PHI)

4)Copy of grant proposal

5)Sample participant recruitment message

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Topics of study

Effect on patient care decisions Clinical setting and types of clinical question Characteristics of information delivery

• ease of use, speed, frequency, barriers, alternate sources of information

Patient education

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Participants recruited

1 attending (IM, teaching faculty) 1 resident (IM) 2 nurses (Onco) 1 Pharm D, Clinical Pharmacist (anticoagulation specialist)

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Study Results

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Overall experience of participants

Devices perceived as helpful & functional• All participants reported an influence on decision-making• Resident especially found that it affected patient care, by:

– reducing drug errors– avoiding unnecessary tests– changing tx

Used for patient education• Resident and nurse reported daily patient education uses, incl.:

– “YouTube was my most popular app. Easy to use, [and] patients were familiar with it. I was able to find many videos covering stem cell reinfusion/blood transfusions and holistic treatments.” -Nurse

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Overall experience (cont’d)

Most common negative feedback was needing access to the EMR• Unclear whether access is desired for entering orders &

documentation (input) or for viewing only (output), or both

When participants did not use the device, most often (N=3) they used a desktop computer instead; the second-most often (N=2) used was a smaller device – 1 iPod Touch, 1 iPhone

Pharmacist used iPod Touch instead of iPad because iPod could be carried in a pocket during rounds (Lexi-Comp app)

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Types of question prompting use of device, by number of participants

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Demographics

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Demographics (cont’d)

Note: Participants with 6-10 years of experience were the BSN nurse and MD attending physician.

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Barriers

Delayed start• Delay receiving iPads due to change in payment process, UPHS

Accounts Payable• Delay receiving cases due to backorder (corporate supplier used

because manufacturer required credit card to order directly)• Delay in IRB approval process due to PAH not having general

approver

Lack of tablet-based EMR • No vendor support for

touch-pad OS • Insufficient security

Remember our friends, Patience & Fortitude!

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Partnership

PAH • Senior attending physician (participant), Chief Resident and other IM

residents (recruiting participants), nurse manager (recruitment)• Entity Information Officer, IT Dept• CEO (signed contract for grant agreement)

Penn Medicine• IT analyst• IRB officers/staff at U Penn• U Penn Biomedical Library

U Penn• Penn Computing

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Summary of Study Results

Access to PHI (e.g. patient chart, test results) preferable, esp. for physicians

Device and apps generally performed well – all participants stated more likely to use after study

Some trouble with apps – w possible additional unreported One nurse used it primarily for patient education videos Varying comfort levels with the technology

Supplied on devices Used (as reported)

Medical: DynaMed, FirstConsultNursing: Nursing Reference Center

Medical:Dynamed, UpToDate, PubMedNursing:YouTube, “Oncology Resources”Pharm: Lexi-Comp

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Lending launched March 2013

5 iPads available for lending Usage Agreement must be signed

• restricts use to protect PHI

UPHS IT - new Apple device MDM VGA cable allows projection from iPad

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Next Steps

PAH iPad lending: • investigate adding read-only apps (Epic

Haiku/Canto, MedView Mobile)• more outreach/education about program

UPHS Mobile Apps Taskforce & SurveyApp “collection development”Policy re device use at bedside?Research into use of tablets:

• How to validate the survey instrument? • How to power an adequate study?

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Takeaways

PHI access on devices is important, and protection plan is required

Infection prevention plan is required

Librarian familiarity with IRB/research process is valuable

More research needed!

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Thank you!

And thanks to:

NN/LM MAR – RML at Pitt, esp. Renae Barger

MLA Hospital Libraries Section, esp. Ene Belleh

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For more info:

“Lunch with the RML” web presentation, June 27, 2013

Witman L. Hospital clinicians' iPad use: an interim report. Med Ref Serv Q. 2012;31(4):433-8. doi: 10.1080/02763869.2012.724304. PubMed PMID: 23092420.

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Questions / Comments?