How hospitals are using tablets, apps to communicate with patients

Shannon Olson got more sleep than she expected during her daughter Emilia's hospital stay in January. Emilia, 2 1/2, was hospitalized for 10 days at the Geisinger Janet Weis Children's Hospital in Danville, Pennsylvania, to treat an infected cyst on her face. Olson slept in Emilia's room and had planned to wait up for the nurses' last rounds. Instead, she went to sleep before the late rounds, and each morning logged into an app on the tablet Geisinger offers each patient. The app provided access to Emilia's hospital chart.

“It made it so much easier knowing that all of Emilia's updated chart information was available to me on the tablet,” Olson said.

An increasing number of hospitals are offering “interactive patient-care systems” — a tablet with controls and apps patients can use, including one with access to their hospital medical information.

Adult patients can choose to provide access to family members or other caregivers. The apps provide medical information, such as medications and dosage, procedures, daily care schedules, test results and education videos; photos of the patient's physicians and nurses; and an expected date of discharge, often including what factors — for example, no fever — must be met for a patient go to home.

Hospitals decide when to release the information. For example, some release lab results to patients at the same time that they are sent to the health-care team, while others have a delay of several hours to give physicians a chance to review the information before sharing it with the patient. Just about all do not disclose life-changing information, such as a cancer diagnosis, to allow the physician to discuss it in person.

Anna Prochnow, 16, of Markesan, Wisconsin, was born with trisomy 13, a genetic condition. She has been hospitalized several times at University of Wisconsin's American Family Children's Hospital, which has offered families interactive tablets for several years. Anna's mother, Hope Prochnow, said that seeing a projected discharge date in her daughter's chart helped them discuss with the care team “what needed to be accomplished for Anna to go home” and gave them a sense of control.

Cynthia Harrod of New York City relied on information in husband Albert Harrod's chart to update the many family members who called his hospital room after he had surgery at Mount Sinai last year.

Michelle Kelly, a pediatric hospitalist at the American Family Children's Hospital and an associate professor at the University of Wisconsin School of Medicine and Public Health, who helped develop a tool kit for implementing patient bedside portals at children's hospitals, said parents are often the most engaged patient advocates. Parents of children undergoing chemotherapy seek data on daily blood work knowing that if, for example, the white blood cell counts are too low, their child will not be treated that day. Access to charts also prepares all patients and family members for doctors' rounds, allowing them to ask more informed questions, Kelly said.

The systems can also root out medical errors. Kelly said her research has shown that parents who accessed their children's hospital charts sometimes find errors in medication information, including specific drugs and drug doses.

Barry Runyon, an analyst with Gartner, an international information-technology research and consulting firm in Stamford, Connecticut, who studies the field, said 20 percent of hospitals in the United States offer patients access to their medical information on apps on tablets, which frequently also come loaded with entertainment such as TV shows, movies, games, music and meditation videos.

Runyon said he expects to see many more hospitals provide an interactive patient-care system.

“Many hospitals wait to offer patients the system until they renovate or build a new inpatient facility,” Runyon said. That allows the hospitals to enhance WiFi capacity and make other updates.

Both NYU Langone Health in New York City and the Jacobs Medical Center at UC San Diego Health, for example, added interactive patient-care systems in their new buildings. They also set up 75-foot wall-mounted monitors in the rooms in their new buildings. The monitors can display what is on the tablet, including patient entertainment and health education videos. They even offer the possibility of physicians reviewing imaging such as CT and MRI scans during in-room discussions on diagnoses and treatment.

Other interactive features can include meal ordering (after physicians and dietitians have added any restrictions), and controls for lights, blinds, and heat and air conditioning. Some hospitals have also added messaging systems to ask a nurse or floor aide for water or a blanket.

“We heard during focus groups that patients often didn't want to bother a nurse even if they were cold or thirsty,” said James Fitter, chief executive of Oneview Healthcare, based in Australia, which has sold several interactive systems to U.S. hospitals. Fitter said the features “give patients, who have so little control over what's happening to them in the hospital, some control over their environment and comfort.”

Ann Scheck McAlearney, a health services researcher and health management professor at Ohio State University College of Medicine and an author on more than a dozen studies on the interactive systems, said meal ordering, chart access and entertainment are the most commonly used features.

Several factors, including competition, a culture of patient engagement, and a push to reduce hospital readmissions drive hospitals to spend the thousands to millions of dollars needed — depending on the size of the hospital and the sophistication of the technology and software — on the systems.

“We hope patients tell their friends and relatives about the systems and that they are a factor they consider when choosing a hospital,” said Jonathan Austrian, medical director of inpatient clinical informatics at NYU Langone, which competes with several major medical centers within a few miles.

The relative simplicity of the apps belies the years it took hospitals to build in not only patient-friendly features but also secure ones. Every patient gets to set up a password that usually has to be entered each time they use the tablet.

While many patients appreciate the apps, not all of them use a majority of the features. Patients and family members tend to narrow their use to what works best for them. Rachel Glick, 22, who spent about a week at NYU Langone in the fall for stomach pain, hadn't accessed her chart by Day 5 of her hospital stay but did use meal ordering and a pain assessment app that let her track her pain levels.

One study also observed “navigational errors and technical challenges” related to the use of the apps. Problems with understanding how the apps work also has “spurred anxiety and uncertainty” in patients. All of which also has led to more questions from patients.

Some physicians and nurses have been wary of the apps, concerned that it would add to their workload.

In some hospitals, the task of training patients about the interactive patient-care systems has fallen to nurses, a study that surveyed physicians and nurses about the systems found. The study also noted concern over messages, which could often be on top of email, phone calls and in-person visits, and that patients might expect to hear back from their physicians immediately. Some hospitals have shut off that messaging option.

Some hospitals have taken steps to reduce nurse and physician involvement in connection with the interactive systems. For example, at UCSF Medical Center, technology volunteers show patients and family members how the devices work. A study published last year recommended having more printed materials available to explain how the systems work, as well as preparing medical staff members for increased anxiety and questions from some patients who access their charts.

As physicians, nurses and other health-care workers get more accustomed to the apps over several years, they are “feeling better about the systems even though they're not perfect,” McAlearney said. Etiquette for both patients and medical staff members will ultimately shake itself out, she said.

“We will need to provide more guidance and training to both patients and clinicians about the best way to incorporate system use into the care process,” McAlearney said.

Changing attitudes, surveys have found, come from seeing patient satisfaction with the systems and how much patients can do for themselves. Jessica McKee, a nurse and the clinical communications coordinator at the Jacobs Medical Center in San Diego, said patient education videos that can be accessed on the tablets has meant that nurses are being asked questions more specific to the patients' condition and how to manage it once they are home.

Also, messages from patients — such as “I'm in pain” or “I don't understand my condition” — can help improve care by letting medical staff use them to assess the patients' concerns, said Janet Campbell, vice president in charge of MyChart Bedside for Epic, a major provider of these systems.

On balance, experts who study the medical technology landscape said they benefit patient care. Joe Kvedar, vice president of the Center for Connected Health Services, a project of several Harvard-affiliated hospitals, said that “while it's more work to deal with patients who are more engaged, the payoff is that they do better and are more healthy long term, and that's what we should be shooting for.”