May 7, 2013One Health MLA ‘13, Boston“Emerging Roles for Health Librarians and Finding New Information in Novel Places” Mobilizing Knowledge Resources: A Study of Hospital Clinicians’ iPad Use Pennsylvania Hospital Philadelphia, PAUSA
Background • Conducting the study • Study results • Going forward
Pennsylvania Hospital – est. 1751 • Lydia Witman, MLISClinical Librarian • Linda Sinisi, BSEntity Information Officer • Mary McCann, MLIS, MBA, RNDirector of Library, Informatics, and Privacy
Organization UPHS/Penn Medicine • 3 in-patient hospitals & 1 in-patient rehab facility: HUP, PAH, PPMC, GSPP (also: acquiring CCH) • Out-patient, home care, hospice care practices • Annual Operating Revenue: $4.3b • Employees: 21,864 • Adult Admissions: 78,262 • Licensed Beds: 1,632 Entity (PAH) • Employees: 2,780 • Adult Admissions: 23,603 • Licensed Beds: 517 • 4 physician residency programs (IM, OB/GYN, Path, Rad)1 pharmacist residency program
Project Background • Increasing interest in tablets, esp. since 2010 • Early adopters around UPHS/Penn Medicine • PAH Library pilot study of PDAs completed 2009
Project Objectives Objectives (as listed in grant proposal): • Obtain iPad devices • Recruit 5 clinicians to participate (outreach) • Evaluate clinicians’ use of devices, accessing info for both themselves and for patients / patient education • Develop educational materials related to using iPads • Share results of pilot with other hospital libraries
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
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: • Informed Consent Form • Questionnaire (survey) • Usage Agreement (regarding PHI) • Copy of grant proposal • Sample participant recruitment message
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
Participants recruited • 1 attending (IM, teaching faculty) • 1 resident (IM) • 2 nurses (Onco) • 1 Pharm D, Clinical Pharmacist (anticoagulation specialist)
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
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)
Demographics (cont’d) Note: Participants with 6-10 years of experience were the BSN nurse and MD attending physician.
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 fortouch-pad OS • Insufficient security Remember our friends, Patience & Fortitude! Photo by: Laura McNamara
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
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
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
Next Steps • PAH iPad lending: • investigate adding read-only apps (Epic Haiku/Canto, MedView Mobile) • more outreach/education about program • UPHS Mobile Apps Taskforce & Survey • App “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?
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!
Thank you! And thanks to: NN/LM MAR – RML at Pitt, esp. Renae Barger MLA Hospital Libraries Section, esp. Ene Belleh
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.