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Having started PatientKeeper (http://www.patientkeeper.com http://www.patientkeeper.com), I feel like I have an informed opinion here. 1. Tablets have been ar

by sanj 17y ago

Having started PatientKeeper (http://www.patientkeeper.com http://www.patientkeeper.com), I feel like I have an informed opinion here. 1. Tablets have been around for a while. They didn't take off. I'm not sure why an iTablet would do any better. 2. The integration costs of healthcare are crazy. Tablets won't help. 3. Older physicians have zero interest in using tablets. The dominate the decision-making and the teaching hospitals. 4. If it doesn't fit in a coat pocket, it is hard to get in front of physicians. 5. Battery life and connectivity are crazy important -- if devices don't last a shift, you're screwed. If radiology equipment messes up wireless, you're lost. 6. Entrenched workflows, especially those with legalities around paperwork, are very hard to extract. Finally, I have to say that the "wishlist" in this article is laughable. 1. Vital signs can be measured automatically. It turns out to be a large set of data that a professional needs to interpret to find useful. Realtime makes a great demo, but no one cares in practice. 2. Shift changes are huge, but tables are a tiny fraction of making them work. Shifting the responsibility between provider has never been a technology problem -- it's a communication problem. 3-5. Really? Videos for the patient are a critical element of workflow? How about something real: checklists and best practice management. That makes a real difference. Perhaps the author ignored it because paper works just fine.

dpcan 17y ago
Thank you for a great post and your insight. I don't know this, maybe you do, but isn't most health care directed software written for Windows / PC as well? Would having an iTablet limit the software options available to physicians as well?
- sanj 17y ago
  Most systems have some sort of web interface these days.
carbocation 17y ago
MSIV here. Sanj's post is rather insightful, and here's why: If it doesn't fit into my coat pocket, then it will end up being something that probably doesn't become 'mine'. Instead of having one per doc, there will be a few for each floor. Since individual providers don't then have a personal relationship with any particular tablet, they all have less incentive to care for them (charge them, make sure they get put back in the right place, not treat them like coasters). No, the nurses will not do this for us. This brings us to the point where we have a floor with several tablets that, if not stolen or covered in "someone else's" coffee, have no battery. If there is a backup battery system, all of those backup batteries are also drained. So far, so bad. But it gets worse: when the next set of docs rotate onto service, they see a totally dysfunctional heap of tablets and won't go near them. I say this from experience with the current iteration of this idea: 'cows' (desktops mounted on rolling platforms with a battery). In my opinion, the best way to succeed is to make a product that each individual provider will develop a relationship with. You will succeed if you can make me treat my tablet like my iPhone because it (a) is 'mine' - not communal; (b) is portable - fits into my fairly giant white coat pockets, or is otherwise easily transportable; (c) gives me something that I want - not what some non-medical person thinks doctors might want. Regarding point (c), sanj's statement about realtime vitals shows that he has discovered something that AirStrip hasn't: realtime vitals in most cases are for nurses, not doctors. I'm not going to be actively monitoring someone's heart rate unless I'm at the bedside. They are promoting the wrong feature, IMHO. Sanj, it sounds like you have good insight into what doctors actually want. Please keep it up!
- roc 17y ago
  Nothing pocketable will be more useful than the paper it aims to replace. At a minimum, you'll need larger pockets. And even then, the reality of weight, battery life and connectivity are at odds with a per-physician solution.
siculars 17y ago
I actually work as a director of medical informatics at a large, well known, medical institution that field tested and uses patientkeeper. Sanj's assertions are spot on. I won't adress all of them individually, but they all speak to real problems in the "digitization" of healthcare. For those of you who think any singular device will be the electronic panacea people are waiting for in healthcare you are out of your minds and have no clue about the current state of medical informatics. Getting medical records systems into the healthcare environment with entrenched users is probably harder than getting the us legal system to use them. As I have said in other forums, it is not any singular device or platform that will make this work. The current landscape is that of a patchwork of systems silos, none of whom talk to one another. There is practically zero integration at a platform level and any integration that is done is ad-hoc and custom. If I were advising Obama, et al, I would Incentivise (with a capital I) data interchange over any specific data format or platform. Do not pick winners and losers, in my opinion it is kind of un-American. Let everyone have a fair shake in the market but encourage them to open their systems to integration from third parties through open read/write (bidirectional) api's. This would go a long way to getting new innovative systems into institutions with entrenched legacy systems. Speaking to integration costs, point 2, I could not agree more. Working at any institution other than a small sized private practice requires an untold amount of training, education and ongoing maintenance to get the users to use any system of even minimal complexity. "Wishlist" 1, again spot on. Doctors do not monitor vitals in real time. They just do not have the time, nor is it pertinent to quality of care. What doctors do want are intelligent alerts. But how do you get an intelligent, dynamic, real-time monitoring system that needs access to raw data? See my point above re open api's.
- absconditus 17y ago
  "The current landscape is that of a patchwork of systems silos, none of whom talk to one another. There is practically zero integration at a platform level and any integration that is done is ad-hoc and custom." I don't understand this part of your comment. I'm not aware of any hospital information system which doesn't support HL7 to some extent.
  - siculars 17y ago
roc 17y ago
1. the iPod touch is already a far better tablet than any iteration of, say, Windows tablets. If the iTablet shares the iPod's ease of use, reliability, durability, battery life and toolchain, there's no reason to expect those old lessons apply. 2. agreed. but they promise to be far more effective and far less costly than putting PCs all over a hospital. 3. they didn't care for computers, email or smart phones either. 4. Any effective device is either going to be nurse- or bed-/room-centric. Frankly, even great interfaces aren't so fast that it's worth the time for most doctors to navigate the UI to bring up a patient's file himself. Nurses move, but doctors move more, their waste is more expensive and their frustration/errors more dangerous. 5. battery and connectivity issues are less a problem in nurse-centric scenarios and a non-issue for place-centric. 6. think of it as a replacement for the ever-present clipboards and physical files. Instead of handing off a file, the nurse hands over her tablet. The legal aspects will have to be updated for a digital solution of one type or another. That ship is set to sail with or without tablets. Also: checklists and best practice management would be far easier to capture, manage and report on, if it was being digitally captured. Paper works fine for the physician because she can fudge it after the fact. Were it captured at time of service and the lists themselves generated dynamically based on the particular case at hand, more errors would be caught, sooner. (I've worked on several smaller projects in the healthcare industry and spent more than my share of time in hospitals, ERs and doctor's offices.)

by sanj 17y ago

dpcan 17y ago

Thank you for a great post and your insight. I don't know this, maybe you do, but isn't most health care directed software written for Windows / PC as well? Would having an iTablet limit the software options available to physicians as well?

sanj 17y ago
Most systems have some sort of web interface these days.

carbocation 17y ago

MSIV here. Sanj's post is rather insightful, and here's why: If it doesn't fit into my coat pocket, then it will end up being something that probably doesn't become 'mine'. Instead of having one per doc, there will be a few for each floor. Since individual providers don't then have a personal relationship with any particular tablet, they all have less incentive to care for them (charge them, make sure they get put back in the right place, not treat them like coasters). No, the nurses will not do this for us. This brings us to the point where we have a floor with several tablets that, if not stolen or covered in "someone else's" coffee, have no battery. If there is a backup battery system, all of those backup batteries are also drained. So far, so bad. But it gets worse: when the next set of docs rotate onto service, they see a totally dysfunctional heap of tablets and won't go near them. I say this from experience with the current iteration of this idea: 'cows' (desktops mounted on rolling platforms with a battery). In my opinion, the best way to succeed is to make a product that each individual provider will develop a relationship with. You will succeed if you can make me treat my tablet like my iPhone because it (a) is 'mine' - not communal; (b) is portable - fits into my fairly giant white coat pockets, or is otherwise easily transportable; (c) gives me something that I want - not what some non-medical person thinks doctors might want. Regarding point (c), sanj's statement about realtime vitals shows that he has discovered something that AirStrip hasn't: realtime vitals in most cases are for nurses, not doctors. I'm not going to be actively monitoring someone's heart rate unless I'm at the bedside. They are promoting the wrong feature, IMHO. Sanj, it sounds like you have good insight into what doctors actually want. Please keep it up!

roc 17y ago
Nothing pocketable will be more useful than the paper it aims to replace. At a minimum, you'll need larger pockets. And even then, the reality of weight, battery life and connectivity are at odds with a per-physician solution.

siculars 17y ago

I actually work as a director of medical informatics at a large, well known, medical institution that field tested and uses patientkeeper. Sanj's assertions are spot on. I won't adress all of them individually, but they all speak to real problems in the "digitization" of healthcare. For those of you who think any singular device will be the electronic panacea people are waiting for in healthcare you are out of your minds and have no clue about the current state of medical informatics. Getting medical records systems into the healthcare environment with entrenched users is probably harder than getting the us legal system to use them. As I have said in other forums, it is not any singular device or platform that will make this work. The current landscape is that of a patchwork of systems silos, none of whom talk to one another. There is practically zero integration at a platform level and any integration that is done is ad-hoc and custom. If I were advising Obama, et al, I would Incentivise (with a capital I) data interchange over any specific data format or platform. Do not pick winners and losers, in my opinion it is kind of un-American. Let everyone have a fair shake in the market but encourage them to open their systems to integration from third parties through open read/write (bidirectional) api's. This would go a long way to getting new innovative systems into institutions with entrenched legacy systems. Speaking to integration costs, point 2, I could not agree more. Working at any institution other than a small sized private practice requires an untold amount of training, education and ongoing maintenance to get the users to use any system of even minimal complexity. "Wishlist" 1, again spot on. Doctors do not monitor vitals in real time. They just do not have the time, nor is it pertinent to quality of care. What doctors do want are intelligent alerts. But how do you get an intelligent, dynamic, real-time monitoring system that needs access to raw data? See my point above re open api's.

absconditus 17y ago
"The current landscape is that of a patchwork of systems silos, none of whom talk to one another. There is practically zero integration at a platform level and any integration that is done is ad-hoc and custom." I don't understand this part of your comment. I'm not aware of any hospital information system which doesn't support HL7 to some extent.
- siculars 17y ago

roc 17y ago

1. the iPod touch is already a far better tablet than any iteration of, say, Windows tablets. If the iTablet shares the iPod's ease of use, reliability, durability, battery life and toolchain, there's no reason to expect those old lessons apply. 2. agreed. but they promise to be far more effective and far less costly than putting PCs all over a hospital. 3. they didn't care for computers, email or smart phones either. 4. Any effective device is either going to be nurse- or bed-/room-centric. Frankly, even great interfaces aren't so fast that it's worth the time for most doctors to navigate the UI to bring up a patient's file himself. Nurses move, but doctors move more, their waste is more expensive and their frustration/errors more dangerous. 5. battery and connectivity issues are less a problem in nurse-centric scenarios and a non-issue for place-centric. 6. think of it as a replacement for the ever-present clipboards and physical files. Instead of handing off a file, the nurse hands over her tablet. The legal aspects will have to be updated for a digital solution of one type or another. That ship is set to sail with or without tablets. Also: checklists and best practice management would be far easier to capture, manage and report on, if it was being digitally captured. Paper works fine for the physician because she can fudge it after the fact. Were it captured at time of service and the lists themselves generated dynamically based on the particular case at hand, more errors would be caught, sooner. (I've worked on several smaller projects in the healthcare industry and spent more than my share of time in hospitals, ERs and doctor's offices.)