Doctors quick to adopt tablets into practice

When a patient enters an exam room at the Wake Forest Baptist Medical Center’s Downtown Health Plaza, a general internal medicine outpatient clinic in Winston-Salem, N.C., the visit starts out the usual way. A nurse takes the patient’s vitals, reviews the medical record and says the doctor will be in shortly. What happens next was not typical even two years ago and shows the impact that tablet computers have had on practice life in a very short time.

Before the nurse leaves the exam room, she hands the patient an Apple iPad and queues up one of more than 30 video modules, a choice made based on the patient’s condition or health concerns. The patient then passes the time between the nurse’s visit and the doctor’s arrival watching an educational video. James Wofford, MD, an internist and clinic chief at the Downtown Health Plaza, said the introduction of the iPad helps in teaching a poorer, less-educated patient population about health during what otherwise might be wasted time.

Physician adoption of tablet computers has grown rapidly, according to Manhattan Research’s “Taking the Pulse U.S. 2012” survey of 3,015 physicians in 25 specialties. The survey, conducted in the first three months of 2012, found that 62% of physicians owned a tablet computer, up from 27% in 2011, the first full year after the introduction of the iPad set off the newest wave of tablets. Of the 62% who own tablets, half use them at the point of care. By comparison, most surveys put electronic health record use by physicians at around 50%, and that has required federal incentive programs to help get adoption to that mark.

“I believe docs with an iPad ran to the iPad,” said Lewis Hofmann, MD, a family physician in a two-doctor, hospital-owned practice in the Washington area. “Most docs on an EHR right now were probably dragged to it. No one had to pay me to buy my iPad.”

It helps that tablet computers, compared with EHRs, are inherently mobile and inexpensive. A tablet computer usually doesn’t cost more than $800 at the high end, while an EHR could run in the tens or hundreds of thousands of dollars depending on the model. Doctors also can adapt tablets to their use, unlike EHRs, which tend to force physicians to change the way they work. Physicians are among the many app developers, including the American Medical Association, offering products that make tablets more practical for work.

Monique Levy, vice president of research at Manhattan, said the findings on tablet adoption and use show that “we can finally put to rest this whole idea that physicians are Luddites. When it makes sense, it’s usable, and it gives them something, they’re going to do it quickly.”

They proved it with smartphones, which more than 81% of physicians now have, according to Manhattan Research. Eric Goldberg, MD, an internist with the Murray Hill Medical Group in New York, said physician adoption of the smartphone is partially a factor in their enthusiasm for tablets. Tablet operating systems are the same as the ones on their smartphones. Doctors can’t make a phone call with a tablet, but they can do just about anything else they can do on their smartphone, only with a bigger screen.

“It’s not learning a new way of interacting with a device,” Dr. Goldberg said.

Not just bigger smartphones

Frances Dare, senior executive with Accenture Health, a consulting and research firm, said physicians quickly realized that tablets are “so much more than a smaller version of the computer.” Because tablets are portable, multifaceted communication devices, combined with a camera, bar-code reader, video player, research tool and apps for just about anything, physicians value their convenience,

They also find that tablets are more than just oversized smartphones. They see so many benefits that they now engage with patients and one another in ways that didn’t exist before, Dare said.

Dr. Goldberg said it is technically possible to do some things he now does on his tablet with a smartphone, but it isn’t practical due to the limited screen size. With his tablet, he can gain remote access to his EHR and view or enter patient data at the point of care, eliminating the scrap pieces of paper he used to collect in his pockets with information he later entered into the EHR on a computer.

Having that remote access has been especially helpful when he is on call. He can make more informed decisions by having a patient’s information at his fingertips.

The biggest advantage to Dr. Hofmann is the quality of the graphics display. One of the things he often uses on his iPad is a drug reference tool that helps patients identify pills prescribed by other doctors by looking at pictures and descriptors. He also uses the tablet to show patients illustrations of certain body parts to help explain injuries or illnesses.

Those illustrations are a big benefit for Alexander Kutikov, MD, a surgeon and urologic oncologist at Fox Chase Cancer Center in Philadelphia, and his former medical school roommate, Todd Morgan, MD, a urologic oncologist at Vanderbilt University Medical Center in Nashville, Tenn. Before the iPad came out, they used to complain to one another about having to sketch pictures to explain complex surgical procedures to patients. They recognized the potential for the tablet to replace those rudimentary drawings, which many patients wanted to take home. That used to mean ripping a section from the exam table paper and folding it up to fit into the patient’s pocket.

The two doctors created an app, drawMD, that displays anatomical pictures that physicians can draw on top of and layer as needed to help explain hard-to-visualize concepts. Those drawings can by emailed to patients, who can study them or share them as they wish.

Like many physicians, Michael Fisch, MD, MPH, chair of the Dept. of General Oncology at the University of Texas MD Anderson Cancer Center, bought his iPad mostly for personal use, knowing there were many ways he could use it in practice as well.

He said interactions with patients became easier as he could show them things he used to have to sketch. However, Dr. Fisch said he prefers using a smartphone. He finds the iPad cumbersome to carry because it doesn’t fit in his pocket, and he worries about setting it down somewhere and forgetting about it. He also noticed that opportunities for patient education often turned to conversations about the technology itself. Many of the reference tools he used on the tablet he is back to using on his smartphone. And he brings in his iPad for those situations where only a tablet will suffice.

For some physicians, the biggest impediment to using the tablet more frequently is that they can’t use it to access their EHR. While Dr. Goldberg can connect to his EHR, Dr. Hofmann cannot.

“I feel like we’re kind of in this transitional period right now where the benefits of the electronic medical record outweigh the inconveniences of it,” Dr. Hofmann said. “Therefore, we are in a situation where we are using it in a suboptimal way. Hopefully, with the speed and growth of technology, if we can get the advantages of the electronic medical record in your hands as a tablet, that’s when we will have really made a difference.”