1. Beth Israel Deaconess Medical Center Harvard Medical School Beth Israel Deaconess Medical Center Harvard Medical School Tablets in Healthcare: Not Just Pills Anymore Henry Feldman, MD Chief Information Architect Division of Clinical Informatics, BIDMC

2. Beth Israel Deaconess Medical Center Harvard Medical School There are no conflicts of interest in this presentation Funding Sources: Dasman Diabetes Institute HaCIRIC National Institutes of Health Robert Wood Johnson Foundation Clinical Care Advisory Boards (unpaid) Simulconsult Inc, StrictlyPersonal Inc

3. Beth Israel Deaconess Medical Center Harvard Medical School Tablets in Healthcare Promised for decades Supposedly the deus- ex-machina for healthcare providers Never suited the task well

4. Beth Israel Deaconess Medical Center Harvard Medical School Tablets in Healthcare Physicians have wanted a portable patient record they can round with for millennia The devices have come with a bunch of limitations, that have limited utility until now.

5. Beth Israel Deaconess Medical Center Harvard Medical School Early Tablets in Medicine Heavy Poor Battery Life Poor user interface Expensive Essentially desktop OS glommed onto pen interface

6. Beth Israel Deaconess Medical Center Harvard Medical School And Then...

7. Beth Israel Deaconess Medical Center Harvard Medical School Concerns Ruggedness Infection Control (né tablet as fomite) SecurityCost User Interface

8. Beth Israel Deaconess Medical Center Harvard Medical School Ruggedness and Infection Control

9. Beth Israel Deaconess Medical Center Harvard Medical School Use in the OR * Your Milage May Vary....

10. Beth Israel Deaconess Medical Center Harvard Medical School Security iOS more secure in general than a typical desktop (heavily sandboxed) Lack of flash a good thing! Biggest risk is losing the device Don’t have local storage (our EHR is web only) Remote location and Wipe

11. Beth Israel Deaconess Medical Center Harvard Medical School Cost $499 for lowest iPad (which is more than sufficient since heavy local media storage is not a real feature of healthcare) At our medical center the overwhelming majority are self purchased by the physicians Which tells you about the cost-benefit, since we are spending our own money

12. Beth Israel Deaconess Medical Center Harvard Medical School User Interface Since most application development in HIT is web based, the iPad (and other tablets) work very well natively Native apps can add additional utility when needed, but a well designed HTML 5 application is universal (and works on your desktops too) and are much cheaper Need to think about location and size of clickable targets (lots of tiny links are painful on a tablet)

13. Beth Israel Deaconess Medical Center Harvard Medical School The “Killer App”

14. Beth Israel Deaconess Medical Center Harvard Medical School

15. Beth Israel Deaconess Medical Center Harvard Medical School How it Has Changed My Practice The hospitalized patient can be as involved as an office based patient can be

16. Beth Israel Deaconess Medical Center Harvard Medical School So In Summary More rugged than folks think Security needs to be carefully thought about, but is solvable Location services present new opportunities Bringing care to the bedside presents many new opportunities to engage patients Relatively inexpensive