Michele L. Hales University of Alberta Edmonton, AB CANADA Chennai, India January 22, 2004 Tablet PCs: Are they the right medicine for you?

Tablets Many systems out there Many systems out there Compaq Computer Compaq Computer Acer Acer Tatung Tatung Fujitsu Fujitsu NEC NEC Toshiba Toshiba Slate-like vs. convertible tablets Slate-like vs. convertible tablets A PC that is virtually limitless A PC that is virtually limitless Will find its place as the most popular form of PC Will find its place as the most popular form of PC

Advantages of Tablets Portability Portability Can be used by large numbers of people who cannot type Can be used by large numbers of people who cannot type Lightweight (size of a legal file folder) Lightweight (size of a legal file folder) Large enough to show charts, graphs, and even radiological images Large enough to show charts, graphs, and even radiological images It's faster, and more mobile a laptop It's faster, and more mobile a laptop Some tablets can run hours on a single charge Some tablets can run hours on a single charge Real-time mobility Real-time mobility

Three Means of Data Input 1) You can write notes that are automatically converted to typewritten text or saved as handwriting 2) You can dictate into the tablet, and your speech is converted into text 3) If you want to type, fold back the tablet screen to reveal a keyboard

“Rich Digital Ink” Rich digital ink can be: Edited Edited Searched Searched Sent as Sent as Manipulated the same way as word processed text Manipulated the same way as word processed text

Where is it going? Increase use by doctors and healthcare workers, either as stand-alone tools or as an integrated EPR/EMR system. Increase use by doctors and healthcare workers, either as stand-alone tools or as an integrated EPR/EMR system. Evidence Based Medicine (EBM) Evidence Based Medicine (EBM) Will become an integral part of one’s practice. Will become an integral part of one’s practice. Tablets will accelerate physician adoption of EMRs Tablets will accelerate physician adoption of EMRs

Applications/Software Electronic Medical Records (EMR) Electronic Medical Records (EMR)

EMR, Tablets & Mobility Office Physicians, PAs, nurses and office staff have easy access to add, edit or update patient records Physicians, PAs, nurses and office staff have easy access to add, edit or update patient recordsHome Freedom to view patient charts and search for information without going to the office Freedom to view patient charts and search for information without going to the officeHospital Take your patient records with you to the hospital using your Tablet and update patient charts while at the hospital. Take your patient records with you to the hospital using your Tablet and update patient charts while at the hospital.

EMR Abilities Taking notes Taking notes Creating referral letter Creating referral letter Printing medical prescriptions Printing medical prescriptions Generating patient reports Generating patient reports Ordering lab tests Ordering lab tests Viewing results Viewing results

Benefits of EMR More efficient communication More efficient communication Download appointment schedules Download appointment schedules Transmit and access critical patient information Transmit and access critical patient information Facilitates more rapid response to clinical deterioration Facilitates more rapid response to clinical deterioration Prevention of errors and adverse events Prevention of errors and adverse events Refill prescriptions and reduce errors due to illegible handwriting Refill prescriptions and reduce errors due to illegible handwriting Monitors dangerous drug contraindications Monitors dangerous drug contraindications Capture photos of patient's condition and transmit them to colleague for second opinion Capture photos of patient's condition and transmit them to colleague for second opinion Access to information when visiting housebound patients Access to information when visiting housebound patients Tracks billing data and charge captures Tracks billing data and charge captures Tracks adverse events Tracks adverse events

Applications/Software Electronic Medical Records (EMR) Electronic Medical Records (EMR) Billing Interface Software Billing Interface Software

Applications/Software Electronic Medical Records (EMR) Electronic Medical Records (EMR) Billing Interface Software Billing Interface Software Schedulers Schedulers

Scheduling Software Manage your patient schedules. Keep track of: Check-in time Check-in time Time of visit Time of visit Check-out times Check-out times Exam rooms Exam rooms Patient cancellations Patient cancellations Patient rescheduling Patient rescheduling

Applications/Software Electronic Medical Records (EMR) Electronic Medical Records (EMR) Billing Interface Software Billing Interface Software Schedulers Schedulers Guidelines & Protocols Guidelines & Protocols

Applications/Software Electronic Medical Records (EMR) Electronic Medical Records (EMR) Billing Interface Software Billing Interface Software Schedulers Schedulers Guidelines & Protocols Guidelines & Protocols Drug Databases Drug Databases

Applications/Software Electronic Medical Records (EMR) Electronic Medical Records (EMR) Billing Interface Software Billing Interface Software Schedulers Schedulers Guidelines & Protocols Guidelines & Protocols Drug Databases Drug Databases Medical Dictionaries Medical Dictionaries

Applications/Software Electronic Medical Records (EMR) Electronic Medical Records (EMR) Billing Interface Software Billing Interface Software Schedulers Schedulers Guidelines & Protocols Guidelines & Protocols Drug Databases Drug Databases Medical Dictionaries Medical Dictionaries Medical Calculators Medical Calculators

Applications/Software Electronic Medical Records (EMR) Electronic Medical Records (EMR) Billing Interface Software Billing Interface Software Schedulers Schedulers Guidelines & Protocols Guidelines & Protocols Drug Databases Drug Databases Medical Dictionaries Medical Dictionaries Medical Calculators Medical Calculators Access your library database Access your library database

58% of respondents said Tablet PCs worked best at the bedside 29% said PDAs are a better mobile hardware choice for clinicians at the point of care November 2003 Mobile Opinions survey by Mobile Health Data Tablet PCs are the best mobile hardware for clinicians at the point of care - Survey: Tablet PCs Favoured at Bedside January 2, 2004

Not just for Physicians Hospitals’ nursing staff - Nurses have started using Tablet PCs loaded with medication management software to ensure proper dispensing of medications to patients Nurses have started using Tablet PCs loaded with medication management software to ensure proper dispensing of medications to patients Within the hospital setting, errors have been caught in the dispensing of medication Within the hospital setting, errors have been caught in the dispensing of medication

Tablet PC's at RSNA Educational Exhibits and Presentations include: Tablet PC for Wireless-Acute, Bedside-Acute Clinical Image Distribution Pen-based Interaction for Workflow Optimization in a High Throughput Imaging Environment Mobile Access to PACS through Secure Wireless Tablet PC Wireless Tablets and PDAs as a Vehicle for Radiology, Multimedia Report Information to Clinicians Anytime, Anywhere At the Radiological Society of North America (RSNA) 89 th Scientific Assembly and Annual Meeting in Chicago held last December, Tablet PCs played a significant role with multiple educational exhibits and presentations.

Research Environment Rapidly collect information for clinical trials Rapidly collect information for clinical trials Ease of access to your research databases Ease of access to your research databases Versatility, flexibility and mobility offered to investigators Versatility, flexibility and mobility offered to investigators

Resources for the Healthcare Professional Doctors Gadgets – Doctors Gadgets – Health·IT World - itworld/ Health·IT World - itworld/ itworld/ itworld/ Mobile Healthcare The Handheld Healthcare Authority - Mobile Healthcare The Handheld Healthcare Authority Windows XP Tablet PC Edition Healthcare Case Studies - ation/healthcarecs.asp Windows XP Tablet PC Edition Healthcare Case Studies - ation/healthcarecs.asp ation/healthcarecs.asp ation/healthcarecs.asp

Benefits Pen input Allows for the annotation of patient information Allows for the annotation of patient information Speech input Increases text input speed and frees hands Increases text input speed and frees hands Wireless networking Provides access to information throughout the hospital or clinic Provides access to information throughout the hospital or clinic Digital camera Allows for immediate documentation Allows for immediate documentation Digital document readers Keeps all reading materials in one place Keeps all reading materials in one placeCalendar/Scheduler Keeps life organized Keeps life organized

Merck – Tablet PC Source:

Summary Provides Flexible, Versatile, Natural Ways to Work Provides Flexible, Versatile, Natural Ways to Work Maximizes Productivity Maximizes Productivity Improves Collaboration Improves Collaboration Improves One-on-One Communication Improves One-on-One Communication Eliminates Expensive Hard Wiring of Computer Workstations throughout your Hospital Eliminates Expensive Hard Wiring of Computer Workstations throughout your Hospital

The NEW ENGLAND JOURNAL of MEDICINE Special Article Patient Safety Improving Safety with Information Technology David W. Bates, M.D. and Atul A. Gawande, M.D., M.P.H. N Engl J Med 2003;348: