iPads for Hospitals

To replace hospital charts with iPads is a no brainer, especially when one has watched any episode of any of the Star Trek shows where there's a scene in Sickbay.  The key to using iPads as patient charts is a fully functional, implemented and utilized electronic medical record (EMR), a concept which in the #HealthIT community is easier said than done.

Utilization, among health care personnel especially doctors, has been poor resulting in many EMR projects failing initially.  As the younger crop of doctors are coming in, doctors who grew up with computers, and their allied personal technology, utilization is improving.

One main obstacle to EMR utilization by doctors is the consequent alteration in their respective workflows that the system needs to impose.  Instead of writing on a chart, which you can do standing, sitting, in the patient's room, at the nurse's station, or in the pantry, a traditional EMR required the doctor to sit down on a terminal, usually needing to rewrite what you had written in your tickler, and frequently competing with other doctors, nurses or students who need to use the same terminal.

An iPad that connects to the hospital's WIFI network that accesses the EMR using a web-browser-based interface, gets you as close as possible to complete EMR utilization without altering the doctor's workflow by much.  Being browser-based, this makes it platform independent, allowing the doctor to access the EMR using his smartphone, tablet, or even laptop without any need for customized and installed software or a specific hardware and operating system requirement.

An article showed that one hospital piloted the use of iPads and computed it's return-of-investment (ROI) rate to be 9 days.  These numbers were based on time and motion studies and how clinical workflow impacted labor costs.  In other words, the iPads increased productivity allowing the staff to do more tasks with the same time as compared to their old workflow.

Unfortunately, in this country such a system isn't possible as a Hospital Information and Management System with a full-featured EMR with 100% utilization has not happened and thus an iPad solution won't fly as of yet.

Yes, we can now PUSH Stones with Ultrasound!

During this year's Annual Meeting of the American Urological Association, one rather interesting State-of-the-Art Lecture delivered on May 7, 2013 by Mike Bailey, Senior Principal Engineer of the Center for Industrial and Medical Ultrasound (CIMU) department of the Applied Physics Laboratory in the University of Washington, showed the ability to PUSH urinary stones using focused bursts of ultrasound directed in the opposite end from where you want the stone to move.

He actually showed videos of stones hopping to and fro experimentally in vitro and in vivo in pig kidneys.  

Urologists will have to learn how to image the kidney stone and how to push it with the device.



Stone in the upper calyx before pushing.

Upper calyx stone is jumping to the pelvis due to ultrasound.

The video demonstrations he showed were actually quite compelling since every Urologist knows the frustration of having the ability to pulverise urinary stones with Extracorporeal Shock Wave Lithotripsy (ESWL) but not able to extract the stones, as opposed to Percutaneous Nephrolithotomy (PCNL) or Ureteroscopy with Stone Basket Extraction (SBE). 

My only concern with this technology is the learning curve for this technology.  Unlike in imaging ultrasound, you merely need to hold the probe in a position that allows you to see the stone.  For SonoMotion, which is probably what this technology will eventually be called, you need to position your probe manually at the side of the stone opposite to the direction you want it to go.  Thus, this requires a good knowledge of the detailed anatomy of the kidney, as well as the specific anatomy of a the patient's kidney.  In my view, this is easier said than done.  That being said, this technology should be closely followed by Urologists with an interest in ESWL.

The State-of-the-Art Lecture presented in the AUA can be viewed here.