Dale Potter didn’t have much experience in the healthcare field when he was named chief information officer at the Ottawa Hospital in Ontario, Canada, in 2008. He had previously worked in IT for manufacturing operations in Canada and Europe. So one of the first things he did was to shadow the clinicians on their rounds to better understand how they interact with computing resources.
He was dismayed by what he found. “The work flow was broken,” he recalls. Physicians were printing stacks of patient charts before making their daily rounds with their clipboards. Or they would leave the point of care to gather or enter data and then return.
Ottawa Hospital, which has four campuses and 1,300 beds, had made some efforts at mobile computing. It also had experience with COWs (computers on wheels), but they proved cumbersome and cluttered hospital hallways, Potter says.
The hospital also tried several tablet PC solutions, but none of them pleased physicians. “Two main issues with the previous generation of tablets were boot times and battery life,” Potter says. Physicians were not going to wait around for the tablets to boot up. “Until a year and a half ago, there wasn’t a solution practical and elegant enough to support their mobile work flow,” Potter says.
Las Vegas game changer
But all that changed in the spring of 2010. Potter returned from a speaking engagement in Las Vegas with four brand new iPads, excited about their potential as a mobility solution. He gave two to his technology team and one each to a surgeon and general internal medicine physician to get their assessment of the iPads’ potential value to the staff.
“Their response was, ‘How quickly can we get these?’” Potter recalls. He decided to take a huge plunge in purchasing over 1,000 iPads initially and developing a native iPad version of the electronic health record (EHR) software in use at the hospital.
The Ottawa Hospital, which has close to 12,000 employees, now owns 3,000 iPads and may buy a few thousand more in next year.
“My own gut feeling on this was so strong,” Potter says, even as he recognized he was taking a significant career risk. “There were arguments being made that these were just toys. There was media scrutiny here in Canada on all types of government spending looking for waste. That was a risk.
"I told our CEO he should fire me if this doesn't work.”
Building a solution
One of the first steps he took was to try to get Telus Health Solutions, the developer of the Oacis EHR software, to partner on an iPad version, but the company chose not to. “To be fair to them,” Potter says, “they have a three-year roadmap of product development they are working on with all their clients. They couldn’t just drop that and turn on a dime.”
So instead Potter set up his own software development team of approximately 70 people made up of internal employees and contractors. They built a clinical mobile application that pulls information from the data source but takes advantage of the native functionality of the iPad.
Launched in January 2011, it initially allowed physicians and nurses view-only access to clinical data that resides in the EHR. Now they are working on adding features that allow physicians to order digital imaging, medications and lab work.
Potter recognizes that at some point he will have to shrink his internal software team. “I know we shouldn’t be in the software design business, but there is such an appetite for it, I can’t cut back on it yet.”
Instead he has challenged the team to create one app a month. “Clinicians provide suggestions and then we try to create what they are asking for,” he explains.
For instance, using a new pain management app, a nurse hands the iPad to a patient and asks them to look at a human body atlas and touch on the screen where they are experiencing the highest level of pain. Then they choose from a color grid the intensity, with crimson red being the highest. That information is fed into a database immediately and if the clinical parameters are high, the most responsible physician or anesthesiologist is notified immediately.
Limitations are still apparent
Although the iPad deployment has exceeded his expectations so far, Potter says the hospital is still grappling with a few of the devices’ limitations.
The iPad was created as a consumer device, he notes, and Apple didn’t envision so much uptake by healthcare, mobile sales and other business users. “Because of that, the administrative rights features aren’t strong enough,” he adds. “We need images we can remotely control.” The hospital uses a mobile device management solution called MobileIron, but Potter was grateful when he heard that Apple is working on its own sophisticated solution.
The other challenge is input capability. Physicians are not going to carry mobile keyboards. Because of this, the hospital is piloting real-time speech-enabled documentation using Dragon Mobile Medical Recorder from Nuance Healthcare.
Potter believes his iPad gamble has paid off, but he is also excited about the future. “What will be interesting is to see where this goes in the next 18 to 24 months,” he says. “We have introduced a disruptive technology. We proved it could work. But now the innovation is coming from the grass roots level, from the physicians themselves.
“I have attending physicians who say they feel more engaged than they have in the 25 years they have been practicing.”