In 2009, Apple popularized the phrase, "There's an app for that."
Today, it's more true than ever, particularly in healthcare. Several studies estimate roughly 75 percent of nurses currently use a smartphone or tablet in their day-to-day work. The number of physicians who use the popular technology is thought to be even higher. And patients are also getting in the mix, with tablets replacing paper forms and being utilized in children's hospitals as a distraction tool during stressful treatments.
The technology does have its drawbacks. Nurses accustomed to more traditional methods of communication may balk at the learning curve inherent in smartphone or tablet adoption. Still others complain about the screen size. But with numbers of smartphone and tablet users growing (nearly one in two Americans owns a smartphone, according to Google, and tablet use could grow by 50 percent this year, says Forbes magazine), there's no doubt these products are here to stay.
How 'Smart' Is the Smartphone?
According to Nielson, a provider of TV ratings and other media measurements, about 50 percent of cellphone users now own a smartphone, a 38 percent increase over last year.
And that's just personal use. While some hospitals do employ a BYOD (bring your own device) approach to smartphones, others are recognizing the vital role of smartphones by investing in them.
Smartphones can provide in-house-only access for voice and texting, plus receive patient alarms. Staff also can access tools such as drug dictionaries with continuously updated drug information.
"I can't imagine going back to being without it," said Danielle Reed, BSN, RN-BC, staff nurse on the medical/respiratory ICU at Sarasota Memorial Health Care System in southwest Florida, where a clinician smartphone system is in use. "It was just such a brilliant simple thing that made such a big, huge difference in our everyday routine."
With little to no learning curve ("A lot of us were familiar with texting with our own personal phones," Reed said), nurses were able to quickly adapt to the device. Instead of intrusive overhead pages for every patient alarm or location of a certain nurse, staff could simply receive messages on their individual phones. Mass texting capabilities put an end to running up and down halls to find staff and share important information, and staff could quickly confirm they received the message.
The system had an unintended benefit for patient satisfaction. "We rely on our patient satisfaction scores tremendously, and more and more, it seems, every day," Reed said. "And such a big satisfier or dissatisfier in some cases is the noise." During the system's 60-day pilot, the hospital found that overhead pages were cut by 78 percent. And now that it has been fully adopted, pages are down to near zero, continuing to have a broad impact on patient satisfaction, according to Reed.
Texas Children's Hospital in Houston uses the same smartphone system. Now offered throughout its Women's Pavilion and its west campus, staff say the phones are a big improvement over their previous phones, which only had voice capability.
"I'm using it right now to talk to you," said Benjamin Price, RN, a neonatal response nurse/staff nurse. "And if someone needs me or needs information, I can look at the message and never interrupt our call."
During high-risk cases, the technology helps nurses like Price work more efficiently and effectively. If he's caring for a baby in a quiet area but needs immediate physician feedback, a quiet text message replaces a ringing phone. Staff also can monitor room alarms with a smartphone.
"It's really nice," Price said. "It will tell you the room, the number the alarm's going off on, it will tell you what the alarm is. So you can look at that phone and know, 'Hey, this is something that needs my immediate attention,' or maybe this is just my baby moving around or being active."
The hospital plans to expand smartphone usage throughout the health system in the near future. It also is working with the vendor to add new capabilities, including interfacing with employees' personal smartphones off campus and the hospital's electronic medical record.
Is the Tablet Next?
Tablets are popular among physicians. In fact, a survey of doctors by the Physicians Consulting Network found 27 percent of primary care and specialty physicians use a tablet device, a rate five times higher than the general population. The University of California Irvine Medical Center even distributes tablets to each incoming class of 100 medical students, and has begun providing them to its 18 emergency department residents too.
Patients also are on board. At Duke University Health System, cancer patients use tablets to fill out medical history questionnaires that link directly to their records, which have resulted in more detailed and accurate histories, allowing staff to initiate key conversations and provide better care. And child life specialists at the University of Chicago Hospitals use the tablets to help lower kids' stress levels in the ED through educational games that help them better understand diseases, video chat with family members, and social media (including taking and sharing photos of stitches with friends!).
But what about nurses? There are anecdotes, but very little data on the actual number of nurses using tablets. Blogger The Nerdy Nurse says, "I still swoon over my [tablet]," citing seven reasons why nurses and nursing students need a tablet, including staying connected, getting rid of the clutter of multiple reference manuals and easy access to key information. And home health and other nursing agencies like Tennessee's Lee Medical Inc. like tablets for their portability and ease in completing forms and tracking patient care.
Interim LSU Public Hospital in New Orleans recently flipped the switch to transition to a paperless medical record that is accessible via healthcare staff's personal smartphones and tablets. Ory Mire, RN, manager of the trauma/surgical ICU, has found the technology most helpful when he is off site, allowing him to quickly access information when contacted by staff with questions.
But most often, he and other nurses access the EMR via in-house workstations on wheels and other workstations widely available throughout the hospital. Further access is available through handheld personal digital assistants (PDAs) that are able to access parts of the EMR such as labs and new orders, as well as medication administration.
But one important benefit of the smartphone/tablet EMR access is during disasters like the hurricanes that frequently batter southern Louisiana. "That was a big loss what happened during Katrina with people's medical records," he said. "Here, our servers are in Baton Rouge, so the chance of them being damaged by a storm is a lot less than it was when it was medical records on paper, which at one time were stored in the basement."
Otherwise, for nurses accustomed to viewing medical records on a 19-inch screen, transitioning to a 4.5-by-2.5-inch smartphone or even a 9.5-by-7.3-inch tablet is somewhat difficult. "I think doctors will be using [smartphones] and [tablets] more to communicate with the nurses via the nurses' access, which would be computer monitors and workstations on wheels," Mire said. "I think the [tablets] are more of a benefit for other disciplines that come into the department [like pharmacy] . who come in and visit and leave."
Texas Children's will be testing that theory in the near future as they move toward providing physicians' and nurses' personal iOS, Windows and Android tablets with access to the EMR. "In the next 12 to 18 months, our strategy is to identify additional options that will increase capabilities with tablet devices and how they securely connect to our network," said John K. Henderson, director of enterprise systems.
Admittedly, it's more likely that physicians will take advantage of EMR access via their smartphones and tablets at this point in time. But that could change in the future as nursing schools place more of an emphasis on high-tech tools in the school setting and as new nurses enter the workforce with these devices being status quo.
Temple University, Philadelphia, recently began requiring nursing students to have smartphones with software to access drug information.
"What's happening now in healthcare is that it's really rapid cycling," said Michael Clark, DrNP, CRNP, CNL, assistant professor in the Department of Nursing, College of Health Professions and Social Work at Temple. Instead of researching medications in a hard copy dictionary that could quickly go out of date, "what they really need is at their fingertips," he said. "With electronic resources, they can very quickly research medications and proper dosages, and any special kind of patient education."
There can be some resistance. According to Clark, students have mentioned some nurses having the attitude of "I memorized this information and you should too." Still others think the students are goofing off and checking Facebook on their smartphones. "But the experience I've had is that more and more, nurse managers are people who need to roam, and all carry cellphones now," he said. "Even staff nurses more and more are doing cellphones."
In the final outcome, while both the smartphone and tablet offer a major cool factor, what's most important is if these tools work for the individual nurse. Every hospital may be different, but what it comes down to is this: Do these tools help nurses provide safer, more efficient and better care? As more health systems continue to work out the kinks with access, ease of use and infection control with these devices, the answer appears to be a resounding yes.
Danielle Wong Moores is a frequent contributor to ADVANCE.