iPads make University of Chicago medical residents more efficient

By Neil Versel

iPad 2Maybe iPads aren't so bad after all acting as Citrix terminals for mobile EHR access.

Unlike in the failed, much-publicized, small-scale trial at Seattle Children's Hospital last year, medical residents and interns in internal medicine at the University of Chicago felt more efficient when carrying iPads around the hospital, according to new research published in the Archives of Internal Medicine.

In a trial of 115 internal medicine residents who were issued iPads to access the hospital's Epic Systems EHR through a Citrix client, 78 percent reported that they felt more efficient when carrying tablets through hospital wards, believing that they saved about an hour per day. More than two-thirds of the residents said that iPads helped them avoid delays in delivering patient care.

Almost 90 percent of the medical residents studied indicated that they used their iPads for performing clinical responsibilities and about 75 percent said that they used their iPads every day while on duty.

Specifically, the University of Chicago researchers found that residents were more likely to enter orders before postcall rounds by attending physicians at 7 a.m. when they carried iPads (38 percent of the time) than they were before they had tablets (33 percent). Likewise, residents with iPads entered orders prior to the scheduled departure of postcall medical teams for 64 percent of inpatient admissions for general medicine, compared to 56 percent before they had iPads. This, according to the research note, helps promote better continuity of care.

"Resident perception of improvement in workflow efficiency seems to be consistent with data demonstrating that orders were placed earlier in a patient's admission. Furthermore, more orders were entered before the postcall team had to leave the hospital. In addition to enhancing efficiency of residents, the iPads may have facilitated greater continuity of patient care since the primary service was able to advance care for the patients they admitted and will follow before they execute a handoff," the researchers, led by Dr. Bhakti Patel, a University of Chicago fellow in pulmonary critical care, wrote.

The research team also found that residents with iPads entered more orders in the first two hours after patient admission, helping to reduce delays in care delivery. Patel and four colleagues in the medical school's Department of Medicine noted that other studies have found EHRs to increase the amount of time in-hospital physicians spend hunting for computers to document cases in order tests. However, they did not track whether residents enter orders on their iPads or at a fixed workstation.

The researchers also cautioned against drawing general conclusions based on this study, which took place at a single institution. "Despite these limitations, it seems that personal mobile computing can help improve perceived and actual resident efficiency in an era of increasing work compression," they wrote.