Ipads and Tablets in Hospitals

pclancy

Hi All,

I work in the IT dept of a Hospital in New Zealand and was just wondering have ipads and other tablet devices crept into Irish hospitals yet? Anyone using them at Emergency Departments or for ward rounds, bedside xray display etc?

I'm trying out having PACS and some Cathlab imaging software on an Android tablet, some of our docs have their own ipads that they can show and view Xrays, patient bloods, notes etc but we're only in the very early stages of seeing what we can do.

Cheers

El_Dangeroso

Some speech and language therapists are using them in GUH, but I think that's about the limit.

Most hospitals in Ireland don't have electronic charts yet, but there's no reason they couldn't be used for PACS, dunno about PAS, though I'd say it's probably possible to create a terminal emulator.

In any case due to budget constraints I wouldn't see that happening in the near future unless it saved a lot of money.

jumpguy

When on work experience last summer, I was shadowing a consultant that was using his iPad quite a bit, although I'm not sure what exactly he was doing with it. It was said in the Emergency Room of this hospital dependence on their own devices (such as iPads) were a must, as the hospital computer system was terrible.

opinion guy

OP must Irish hospitals barely have computer systems at all and the one they do are generally from the 1980s.

PACS is only just now being rolled out many places

El_Dangeroso

opinion guy wrote: »

OP must Irish hospitals barely have computer systems at all and the one they do are generally from the 1980s.

PACS is only just now being rolled out many places

Yep instead they employ about 30 people to run around pulling paper charts per hospital. I have no idea how they justify that as cheaper than a good computer system long term.

opinion guy

El_Dangeroso wrote: »

Yep instead they employ about 30 people to run around pulling paper charts per hospital. I have no idea how they justify that as cheaper than a good computer system long term.

When computers break down they stop working and you have to do something. When interns break down they pretend they are ok and management can ignore it

El_Dangeroso

opinion guy wrote: »

When computers break down they stop working and you have to do something. When interns break down they pretend they are ok and management can ignore it

Interns don't do it, they are admin employees, that is their only job all day. If they are conservatively paid €20,000 p/a which would be ~25k including PRSI, nevermind only working a small percentage of the time, that is 750k per year ongoing cost per large hospital. Just cannot imagine an EHR system costing that much over a period of 10 years. Though the logistical nightmare that is converting paper to electronic might be an issue.

To think we don't even have a unique national hospital number is just farcical to be honest, though you can thank the data protection commissioner for that one.

Thoie

Wouldn't cross contamination be an issue?

opinion guy

El_Dangeroso wrote: »

Interns don't do it, they are admin employees, that is their only job all day. If they are conservatively paid €20,000 p/a which would be ~25k including PRSI, nevermind only working a small percentage of the time, that is 750k per year ongoing cost per large hospital. Just cannot imagine an EHR system costing that much over a period of 10 years. Though the logistical nightmare that is converting paper to electronic might be an issue.

To think we don't even have a unique national hospital number is just farcical to be honest, though you can thank the data protection commissioner for that one.

Interns also do it

El_Dangeroso

opinion guy wrote: »

Interns also do it

Depends how you define 'fetching' the chart, at least in GUH the interns would not have the full idea of the filing system. They may go down and request the chart and then physically bring it to a consultant etc. but if the permanant chart pullers are not there the chart cannot be pulled afaik.

Anyway semantics! It's an even bigger wastage of resources if interns are doing it!

pclancy

opinion guy wrote: »

OP must Irish hospitals barely have computer systems at all and the one they do are generally from the 1980s.

PACS is only just now being rolled out many places

OMG are you serious? so Xrays are still on film and cant be sent between hospitals/GPs etc?

ciara84

pclancy wrote: »

OMG are you serious? so Xrays are still on film and cant be sent between hospitals/GPs etc?

for the most part, yes.

opinion guy

pclancy wrote: »

OMG are you serious? so Xrays are still on film and cant be sent between hospitals/GPs etc?

Lol seriously man you've no idea. If you plan to come back here to work in hospital IT I suggest brush up on your vax/vms, cobol and find a supplier for floppy disks.

I'm not even kidding

opinion guy

El_Dangeroso wrote: »

Depends how you define 'fetching' the chart, at least in GUH the interns would not have the full idea of the filing system. They may go down and request the chart and then physically bring it to a consultant etc. but if the permanant chart pullers are not there the chart cannot be pulled afaik.

Anyway semantics! It's an even bigger wastage of resources if interns are doing it!

Oh Galway. You have PACs. Spoiled rotten you are. In hosptials without PACs interns function as an extension of the admin staff.

lonestargirl

NIMIS went in in my hospital last week - only a year late!

pclancy

Wow I really did think that Ireland would at least have some kind of digital imaging stuff.

How about MRI, CATT, PET, TOE, Cathlab doesnt all that get viewed by some kind of electronic system? Surely you couldnt look at Cathlab imagery on film :O

pclancy

opinion guy wrote: »

Lol seriously man you've no idea. If you plan to come back here to work in hospital IT I suggest brush up on your vax/vms, cobol and find a supplier for floppy disks.

I'm not even kidding

:eek::eek::eek:

That is very worrying. Most people I know that learnt their trade in vax/vms are long retired or way to high in management to get their hands dirty.

How about patient records EHR type stuff? is that all paper based too?

So Ireland got motorways, airports, trains, huge shopping complexes/hotels during the boom years but nobody thought to spend a few euros on the poor hospital information systems? Disgrace.

lonestargirl

pclancy wrote: »

Wow I really did think that Ireland would at least have some kind of digital imaging stuff.

How about MRI, CATT, PET, TOE, Cathlab doesnt all that get viewed by some kind of electronic system? Surely you couldnt look at Cathlab imagery on film :O

Clearly MRI/CT etc are viewed electronically. A number of hospitals have internal PACS but NIMIS (a national PACS) is only being rolled out currently. Where I am is fully digital, we have a link to Beaumont MRI but have to get disks couriered to us from other centres.

ciara84

pclancy wrote: »

:eek::eek::eek:
So Ireland got motorways, airports, trains, huge shopping complexes/hotels during the boom years but nobody thought to spend a few euros on the poor hospital information systems? Disgrace.

I dont actually know what Ireland you're talking about. Ireland only recently got a full motorway from cork to dublin.... trains? where to/from? alot of the major towns/cities arent connected by trains even though they both towns have major train stations, I.e. waterford and cork, waterford/galway

huge shopping complexes? the smallest "mall" I seen in Boston where I lived is probably 10 times as big as any in dublin, including dundrum/blanch, 10 times may be an understatement more than an exaggeration. Hotels?, we dont have any 3 michelin star rated resturants in Ireland (last I checked), we're pretty much still a 3rd world country.

pclancy

I mean the EU infrastructure funds built lots of things like motorways and helped purchase new trains or busses for CIE etc. Lots of developers built large (for Ireland) building developments. I know they're mostly gone bust now but I thought

NZ is a country with similar population size and public sector funding so I guess I just assumed after working here in health for four years that Ireland would at least have a decent PACs system for its clinicians It must be a serious pain to manually pull film images and impact on patient care in some way.

ciara84

pclancy wrote: »

I mean the EU infrastructure funds built lots of things like motorways and helped purchase new trains or busses for CIE etc. Lots of developers built large (for Ireland) building developments. I know they're mostly gone bust now but I thought

NZ is a country with similar population size and public sector funding so I guess I just assumed after working here in health for four years that Ireland would at least have a decent PACs system for its clinicians It must be a serious pain to manually pull film images and impact on patient care in some way.

its not really about how much money you spend on something, it has more to do with efficiency, Ireland has alot of bureaucracy, money never really goes where its needed, they're trying to build a new childrens hospital, and I actually dont see the need for it, especially not anywhere around Dublin, we only have one level 1 trauma centre in all of Ireland (CUH), why not spend money that way? we already have 2 childrens hospitals in dublin, and zero level one trauma centres (last time I checked). AFAIK healthcare in NZ is fully run by their government (like NHS), so its not really fair to compare Ireland and NZ, Ireland has far better healthcare than any country if you're willing to spend private $$ you'll get the care you need and then some, the HSE system is just broke and not at all worth talking about really.

opinion guy

ciara84 wrote: »

Ireland has far better healthcare than any country if you're willing to spend private $$ you'll get the care you need

I disagree - here is why:

and then some

Just becuase you have private health care and get lot sof stuff done does mean you need it all and does not mean it is good.

Full body screen scans for example. Yeah everynow and then you might pick something up. But you expose people to huge amounts of radiation most of whom didn't need a scan in the first place

lonestargirl

Interestingly we find it much more difficult to get access to PETs for private patients that for public ones. If you are private it has to be justified to the insurance company before they will authorise it and they will search for reasons to decline. If you are public it just requires a consultant's signature.

I know my field (radiation oncology) is probably the exception rather than the rule but the most advanced technology in Ireland exists in the public system not the private.

ciara84

opinion guy wrote: »

I disagree - here is why:


Just becuase you have private health care and get lot sof stuff done does mean you need it all and does not mean it is good.

Full body screen scans for example. Yeah everynow and then you might pick something up. But you expose people to huge amounts of radiation most of whom didn't need a scan in the first place

insurance isnt the only way to pay privately and not all imgaging techniques use radiation.

drzhivago

pclancy wrote: »

Wow I really did think that Ireland would at least have some kind of digital imaging stuff.

How about MRI, CATT, PET, TOE, Cathlab doesnt all that get viewed by some kind of electronic system? Surely you couldnt look at Cathlab imagery on film :O

Interesting questions

In Mnay hospitals there is no information system that links stored digital data

Radiology departments have a lot of digital data, in last 10 years or so plain films have been digital in most but these are stored locally for 30 days and then on to archive storage

CT/PET/MRI are stored on tapes or discs and archived ina library system NOT a digital library as such

Cathlab similar to above but generally not available outside cardiology departments

TOE available on the machine for around 30 days also and then on tape storage with no central storage either.

JuliusCaesar

El_Dangeroso wrote: »

Yep instead they employ about 30 people to run around pulling paper charts per hospital. I have no idea how they justify that as cheaper than a good computer system long term.

Well, because the computer system will cost a lot upfront, whereas the same ol' employees are figured into the existing budget.

Same goes for the buildings we're working in. Everything is patched till it falls apart. Then we stay working there for 30 years while they spend a fortune on architects and consultants' fees. Then they pluck an existing plan and decide to build that. Never mind that a geriatric day hospital plan won't really do for use as a dialysis unit. But never ask the staff! Or if you do, shred their answers...

Nothing in the HSE really makes sense. And I fully expect to be saying that in 20 years time, when I retire.

Breezer

pclancy wrote: »

It must be a serious pain to manually pull film images and impact on patient care in some way.

It takes forever and what's more, when they inevitably go missing, the interns have to spend their time running around the hospital looking for them so that they can put them all together or else future scans won't be done. Why? So the secretary doesn't have to spend their time running round the hospital doing the same thing. Meanwhile, the patient sits there waiting for their scan.

I've also had patients not discussed at radiology conferences because the scans weren't available. Why? Because they have to come via CD from a private hospital, and the private hospital doesn't want to waste resources sending out more that one copy when the original CD falls out of the paper chart it's been kept in over in the public.

Then there's paper charts not being available for OPD because they're misfiled somewhere or have been pulled by another team that also treats that patient and not returned, wasting loads of clinic time while the doctor takes a full history all over again. The same thing happens on ward rounds. Especially fun when the patient is confused.

So no, we're a long way from iPads. Personally I'd happily take a computer with a working screen, working USB port and an operating system newer than Windows NT on every ward, it'd be a start.