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    Tuesday, March 08, 2005

    More Adventures in Computerized Medicine: Hospital rounds have been taking more time than usual lately, not only because I've had more patients (the place is bursting at the seams with pneumonia and the like), but because I've been trying out the hospital's new wireless tablet PC's. In an effort to help us make our rounds faster, they hospital is supplying us with wireless tablets that let us tap into the hospital computer system to get patient information. At least, the hope is it will make our jobs easier and more effecient and thereby improve patient care. But, if I, and the sole other partaker of the tablets this weekend were any indication, that may be too much to hope.

    It's not an unreasonable hope. The system brings up patient census lists, lab results, and even x-rays (the actual films, mind you, not just the reports.) Theoretically, doctors should be able to carry carry these little tablets from room to room, with the main page showing a list of the doctor's patients. Then, when he needs the lab or x-ray results, he just clicks the patient's name with the mouse-pen to pull up the latest reports. But someone in the IT department decided to set the tablets to hibernate after just the amount of time it takes to talk to and examine a patient (or to write a progress note), so that when you're ready to turn to the computer for information, it's booted you off the wireless network and you have to sign in all over again. To top it off, they hid the control panel so it's impossible to change the settings. Clever people.

    I also found it physically awkward to juggle the tablet and the patient's chart, which I often had to do this weekend when paged in the middle of writing a progress note. But then, I find the design of the tablet PC in general awkward, and working with these made me glad I chose notebooks over tablets for my office. There's no easy way to enter information (such as user id's and passwords) into these tablets without rotating the screen around to face the keyboard. And then you have to rotate it again to transform it back to an easy-to-carry form. The mouse-pen, which is necessary when the screen is in tablet position, adds to the awkwardness. I found myself continuously switching back and forth between my conventional writing pen for the chart and the mouse-pen for the tablet. Of course, a lot of the awkwardness would be eliminated if the tablet replaced the hospital chart. That day may come, but it doesn't appear to be in the near future.

    Unfortunately, the the tablets don't appear to have caught on with the staff. According to the sign-out sheet, only a handful of doctors have used them since they've been introduced. And in recent days, I've been the only one. This past weekend it was only myself and one of the gastroenterologists. He, too, found it slowed the progress of his rounds, even though he was already familiar with the system.

    Part of the lack of enthusiasm is due to lack of communication. There hasn't been much of an effort to launch or promote the tablets, or to educate us on how to use them. My only tip off was an email a few weeks ago telling me the tablets were available. I never would have known about all the features of the system, or that I could get it installed on my office computer, if it weren't for the friendly gastroenterologist. (Of course, if I attended staff and department meetings with anything approaching regularity, I might know these things.) I suspect, however, that the biggest reason so few have elected to use the tablets is an unwillingness to experience the steep learning curve of learning to use new equipment and of adopting a new routine. It definitely slows you down, and who can afford that in the midst of flu season?

    posted by Sydney on 3/08/2005 10:07:00 PM 0 comments


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