Clinicians Prototyping iPad Apps to Solve Niche Problems

The nation’s top health information technology officer recently said that new iPad apps are part of a bold but incremental movement toward improved care and patient engagement.

Speaking at a Nov. 17 conference in Washington, D.C., Farzad Mostashari, M.D., who leads the Office of the National Coordinator for Health Information Technology in the Department of Health & Human Services, said federal incentives have helped unleash “an explosion of innovation,” including cloud-based apps and iPad apps. “Products and choices are better, cheaper and faster than they were just a little while ago,” he said. “They do different things.”

Indeed, clinicians at major research universities are prototyping iPad apps to solve specific niche problems in healthcare. I had a chance to see some of these in poster sessions at the Fall Symposium of the American Medical Informatics Association. For instance, one app I saw targets nursing hand-offs in medical/surgical units. I had a chance to do follow-up interviews with a few of the authors working on iPad interventions.

Researchers at the Indiana University School of Medicine in Indianapolis have been developing a tablet-based application that allows physicians to take a patient’s medical history.

“Physicians hate writing notes, in part because the process interferes with the interaction and listening to the patient,” explained William E. Bennett Jr., M.D., assistant professor in the department of pediatrics. The prototype application doesn’t require the physician to do any typing. It uses a diagram of the human body that the physician can touch on the iPad to show where there is pain, and the app translates that into text. The patient can touch a scale of 1 to 10 to indicate how bad the pain is. Once the app has enough information, it can generate a paragraph that is the “history of present illness” that doctors regularly generate, and that is also used for billing purposes, Bennett said.

But the researchers are hoping to streamline the process even more by adding a voice recognition element, not for the physician’s comments, but for the patient’s. So if a patient says, “I have a stomachache,” the voice recognition system would identify that comment and record it. “It has the goal of helping to ensure that a complaint isn’t missed,” Bennett explained.

Some electronic health record vendors are working with speech technology such as Nuance’s Dragon on physicians’ dictated notes, he said, but listening to the patient is a more complex problem because you have so many different voices, accents, etc. “But we are just looking to train it to recognize about 20 sentences or so,” Bennett said. “If it hears anything like those 20, it makes a note. Of course, we get some degree of false positives. And the physician has to weed those out.”

Bennett said he chose the iPad over other tablets because of design elements. “For Apple the Holy Grail is the human-computer interface and I thought that for the problem I am trying to solve I wanted to go with the best in human-computer interface, and the iPad has that over other tablets on the market now,” Bennett said. “Also, the clinicians are much more familiar with it than with other tablets.”

Bennett is currently working on ramping up to a larger pilot with clinicians. He is also keeping it as an academic open source project for now. “Once it is robust enough,” he added, “there may be the possibility of licensing it.”

iPads for Patient Engagement
Researchers at Columbia University Medical Center, a large urban academic medical center that is part of New York-Presbyterian Hospital, have created a prototype app that gave a small group of cardiology patients an iPad and access to their medication history and detailed information about medications.

I recently interviewed David Vawdrey, Ph.D., assistant professor in the Department of Biomedical Informatics at Columbia University, for a new tablet-specific publication called TabTimes. He described how the research team developed an app that accesses clinical data from the hospital’s electronic health record. For example, when a physician modified a medication order or a nurse recorded the administration of a medication, the tablet application displayed the new information almost instantaneously. Although the iPad demonstration project involved only five patients in one cardiac unit, researchers were encouraged by their response, he added. The patients had very little experience with tablet computers, yet all perceived the tablet app as a useful tool for providing information and increasing their engagement in their care.

All of these apps are in the early stages of development, and it’s likely that many will not result in transformative products. But as Mostashari said, we may be seeing a cultural shift in the healthcare sector’s relationship to information technology and innovation.