Ottawa Hospital's CIO explains his iPad program

(Editor’s Note: A recent survey conducted on mHIMSS.org asked whether hospitals should dictate which mobile devices their doctors use or allow physicians to bring in their own devices and design a platform accordingly. Of the 70 responses received, 54 percent said hospitals should limit the devices and the other 46 percent said doctors should be able to use their own devices. Dale Potter, CIO at The Ottawa Hospital, explains how he launched a program to provide his staff with iPads).

In December of 2009, 16 months into my CIO posting at The Ottawa Hospital, I was wrestling with a key decision: Should I stay or should I go?

In August 2008 I started in my role as senior vice president and chief information officer. I had had no prior experience in the healthcare industry, aside from having been a patient from time to time. I had been a CIO for the eight years prior at two large, global manufacturing companies and was approached for the position at The Ottawa Hospital in the summer of 2008. My soon-to-be-boss, CEO Jack Kitts, wanted someone to “challenge traditional thinking in healthcare.”

My deliberations around the holidays were that I was about to commit the organization to delivering Computerized Physician Order Entry (CPOE). I had done enough research and talked to enough other organizations that it was clear that CPOE implementations rarely succeeded. The reasons for these failures were quite fundamental adoption issues. There was no practical way to make CPOE fast and easy for physicians. Even if you had a PC at every bedside, it was not practical to imagine a doctor would take the time to log in, open the electronic health record, find the patient, find the form and place the order. The order is scribbled in a notebook and dealt with somehow later.

I was on the verge of telling our CEO that I didn’t want to be another failure story and that he should find someone else to lead this. I decided to get through the holidays and I would take a decision in the New Year. By luck, some weeks into 2010, people started talking about a new device from Apple called an iPad. Could this be a way out, I thought?

I frantically sought out any information about this new technology. After the U.S. release at the beginning of April, I had an engagement in Las Vegas for work and spent most of my day and a half there scouring the city and surrounding areas to find iPads to take back to Canada. They may say ‘What happens in Vegas stays in Vegas,’ but I managed to bring home four of the devices. I gave two to my technical architect and two to physicians for feedback. The response from the docs was “We MUST have these devices for our clinical work,” and my technical team felt the iPad was “technically sound” and that clinical information from the EHR could be viewed in a mobile capacity.

So off I went. I made my implementation of CPOE conditional on use of the iPads for orders by physicians. Without knowing it at the time, this sparked a number of decision points and directions which, on reflection, other CIOs will have to face to some degree as they embrace mobility:

• The rate at which we implement CPOE was now tightly coupled with our rate of deployment of the iPads.
• Therefore, if we wanted to roll orders out quickly, we would have to deploy the mobile devices quickly.
• Therefore a “bring your own device” approach would not be predictable or rapid enough.
• Therefore, TOH would purchase large numbers of the iPads as tools for the future clinical populations placing orders.
• Well then, the next question was when would our EHR vendor have a mobile iPad solution for us. We were told 18 to 24 months, as they could not take a 90-degree turn on their development roadmap.
• Therefore, we would have to build or acquire skills to develop the mobile viewer and order screens ourselves.

This was agreed to by senior management, medical leadership and our board in July 2010, and off we went. I set a target for the fall to have a first-release solution in place.

The first clinical mobile application viewer went live in November 2010 to around 300 physicians. It displayed all of a patient’s relevant clinical information on the iPad with two exceptions: medical Images and PDFs or other documents. This was overcome at the beginning of 2011. Mobile orders (CPOE) for diagnostic imaging and laboratory were completed in the late fall of 2011 and are being deployed on the iPads from the beginning of 2012. Next are medications and other orders like consults and other health professions such as social work, physio and so on. We are also in early stages of a pilot for medication management, reconciliation, administration and closed loop delivery.

That is a brief ‘fly-by’ of our journey over the past 18 to 20 months. We have nearly covered our target iPad population of just over 3,000 docs, residents, pharmacists and other clinicians. We have also deployed a few hundred iPhones and iTouch devices but will be deploying these iOS devices more aggressively through 2012-13 to nursing, portering and housekeeping, among others.

On reflection, it is clear to me that the new wave of mobile devices will become globally pervasive in healthcare. Twenty-five years ago the health information of a patient in a hospital setting was in a colorfully coded manila folder in a slot at the end of each bed. As technology was embraced in healthcare, the information became much more complex and farther from the bedside. Attempts were made to address this through the mobile computer on wheels (COW), but these platforms were extremely heavy and cumbersome. Earlier tablet technology was just a bit too large as a form factor and, more importantly, the boot time was too long and the battery life was too short to last a work shift. The iPad came out of the gate having conquered all three of these challenges.

It is quite amazing to watch how the physicians have gone back into the natural workflow of 25 years ago, where care is delivered at the bedside, but with the ability to share clinical results in real time with patients or family members or show images to explain a medical condition, the level of engagement of the physicians and the patients has taken a tremendous leap forward.

For those of us who some years ago said personal computers will never take off, the cell phone is a toy and will never be pervasive, World Wide ‘What’?... go back to sleep for a while. When you wake up the world will be in a place you could only dream about a couple of short years ago.

Dale Potter is senior vice president and CIO at The Ottawa Hospital.