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May 7, 2013 One Health MLA ‘13, Boston “Emerging Roles for Health Librarians and Finding New Information in Novel Places”. Mobilizing Knowledge Resources:. A Study of Hospital Clinicians’ iPad Use. Pennsylvania Hospital Philadelphia, PA USA. Background Conducting the study Study results - PowerPoint PPT Presentation

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  • Mobilizing Knowledge Resources:

    A Study of Hospital Clinicians iPad UseMay 7, 2013 One Health MLA 13, Boston Emerging Roles for Health Librarians and Finding New Information in Novel PlacesPennsylvania Hospital Philadelphia, PA USA

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    BackgroundConducting the studyStudy resultsGoing forward

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    Pennsylvania Hospital est. 1751Lydia Witman, MLIS Clinical Librarian

    Linda Sinisi, BS Entity Information Officer

    Mary McCann, MLIS, MBA, RN Director of Library, Informatics, and Privacy

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    OrganizationUPHS/Penn Medicine3 in-patient hospitals & 1 in-patient rehab facility: HUP, PAH, PPMC, GSPP (also: acquiring CCH)Out-patient, home care, hospice care practicesAnnual Operating Revenue: $4.3bEmployees: 21,864Adult Admissions: 78,262Licensed Beds: 1,632

    Entity (PAH)Employees: 2,780Adult Admissions: 23,603Licensed Beds: 5174 physician residency programs (IM, OB/GYN, Path, Rad) 1 pharmacist residency program

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    Project BackgroundIncreasing interest in tablets, esp. since 2010Early adopters around UPHS/Penn Medicine PAH Library pilot study of PDAs completed 2009

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    Image credit: NBC News / AP

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    Project ObjectivesObjectives (as listed in grant proposal):Obtain iPad devicesRecruit 5 clinicians to participate (outreach)Evaluate clinicians use of devices, accessing info for both themselves and for patients / patient educationDevelop educational materials related to using iPads Share results of pilot with other hospital libraries

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    NIH/NLM Grant from NN/LM MAR RMLTechnology Improvement Express Award received from NN/LM MAR RML (Pittsburgh), Dec 2011 Purchased 10 iPads (iPad 2, 16 GB, Wi-Fi enabled) 5 for Library and IT staff, 5 for lending to clinicians

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    Evolution from pilot to research study Lack of research to support clinicians using iPadsNo formal studies identified in the literatureCITI training had been completed previouslySubmitted to IRB for approvalIRB requested more info about how wed protect PHI IRB process required the following documents:Informed Consent FormQuestionnaire (survey) Usage Agreement (regarding PHI)Copy of grant proposalSample participant recruitment message

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    Topics of studyEffect on patient care decisionsClinical setting and types of clinical questionCharacteristics of information delivery ease of use, speed, frequency, barriers, alternate sources of informationPatient education

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    Participants recruited1 attending (IM, teaching faculty)1 resident (IM)2 nurses (Onco)1 Pharm D, Clinical Pharmacist (anticoagulation specialist)

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    Study Results

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    Overall experience of participantsDevices perceived as helpful & functionalAll participants reported an influence on decision-makingResident especially found that it affected patient care, by:reducing drug errorsavoiding unnecessary testschanging txUsed for patient educationResident and nurse reported daily patient education uses, incl.:YouTube was my most popular app. Easy to use, [and] patients were familiar with it. I was able to find many videos covering stem cell reinfusion/blood transfusions and holistic treatments. -Nurse

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    Overall experience (contd)Most common negative feedback was needing access to the EMRUnclear whether access is desired for entering orders & documentation (input) or for viewing only (output), or both

    When participants did not use the device, most often (N=3) they used a desktop computer instead; the second-most often (N=2) used was a smaller device 1 iPod Touch, 1 iPhone

    Pharmacist used iPod Touch instead of iPad because iPod could be carried in a pocket during rounds (Lexi-Comp app)

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    Types of question prompting use of device, by number of participants

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    Demographics

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    Demographics (contd)Note: Participants with 6-10 years of experience were the BSN nurse and MD attending physician.

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    BarriersDelayed startDelay receiving iPads due to change in payment process, UPHS Accounts PayableDelay receiving cases due to backorder (corporate supplier used because manufacturer required credit card to order directly)Delay in IRB approval process due to PAH not having general approverLack of tablet-based EMR No vendor support for touch-pad OS Insufficient security

    Remember our friends, Patience & Fortitude!Photo by: Laura McNamara

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    PartnershipPAH Senior attending physician (participant), Chief Resident and other IM residents (recruiting participants), nurse manager (recruitment)Entity Information Officer, IT DeptCEO (signed contract for grant agreement)

    Penn MedicineIT analystIRB officers/staff at U PennU Penn Biomedical Library

    U PennPenn Computing

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    Summary of Study ResultsAccess to PHI (e.g. patient chart, test results) preferable, esp. for physiciansDevice and apps generally performed well all participants stated more likely to use after studySome trouble with apps w possible additional unreportedOne nurse used it primarily for patient education videosVarying comfort levels with the technology

    Supplied on devicesUsed (as reported)Medical: DynaMed, FirstConsult Nursing: Nursing Reference Center Medical: Dynamed, UpToDate, PubMedNursing: YouTube, Oncology ResourcesPharm: Lexi-Comp

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    Lending launched March 20135 iPads available for lendingUsage Agreement must be signedrestricts use to protect PHIUPHS IT - new Apple device MDM VGA cable allows projection from iPad

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    Next StepsPAH iPad lending: investigate adding read-only apps (Epic Haiku/Canto, MedView Mobile)more outreach/education about programUPHS Mobile Apps Taskforce & SurveyApp collection developmentPolicy re device use at bedside?Research into use of tablets:How to validate the survey instrument? How to power an adequate study?

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    TakeawaysPHI access on devices is important, and protection plan is required

    Infection prevention plan is required

    Librarian familiarity with IRB/research process is valuable

    More research needed!

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    Thank you!

    And thanks to: NN/LM MAR RML at Pitt, esp. Renae Barger MLA Hospital Libraries Section, esp. Ene Belleh

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    For more info:

    Lunch with the RML web presentation, June 27, 2013

    Witman L. Hospital clinicians' iPad use: an interim report. Med Ref Serv Q. 2012;31(4):433-8. doi: 10.1080/02763869.2012.724304. PubMed PMID: 23092420.

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    Questions / Comments?

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