Familiar, user friendly consumer technologies (think: smartphones and iPads) are remaking industries more accustomed to old-fashioned notebooks and pencils. Surprisingly, despite all the high-tech machinery surrounding them in hospitals, patients have suffered from an unnecessary technological gap. Daniel Schwartz, medical director at QxMD, a software company that creates mobile apps for medical professionals, spoke with The SmartVan about why iPads and smartphones in operating room is good news for patients.
What is QxMD, and what is your background?
I’m actually an internist and a nephrologist by training. I still practice medicine, but not full time. QxMD is a way to get better decision-making happening at the point of care. It’s a real challenge to get pertinent research into the hands of actual practitioners and then have them actually apply it. It’s what we call “knowledge translation.” It’s how to take what we know should be done and actually use it in real clinical practice. As a person or a patient, people would hope that practitioners are using things that are new and landmark as soon as they get published, but the reality is that there is a large disconnect there.
What we try to do is advance that cycle, so that when things are released in the medical literature we can convert it to real, applicable tools and get it in the hands of practitioners, so that they can do their jobs better. Traditionally, we’ve used mobile phones — Blackberries, iPhone and Android — and we’re just moving over to tablet. In the medical space, the tablet’s usage is growing tremendously and it’s estimated that about one in four doctors in the United States has an iPad already. And those numbers are growing. We’re finding that moving our application to the tablet form factor is a really outstanding way to access practical information.
Do you have a technology background, in addition to your medical training?
I have really negligible tech training. In undergrad I took a computer science class. I like to try to code, and I’ve tried to pick up a few languages here and there that I’m not particularly good at, but I do think that in medicine there is a growing need for people who have an understanding of technological capabilities and an understanding of the application, which I think can be said for almost any industry. People who know an industry from the inside are probably best equipped to actually translate that knowledge into tools that help doing whatever you’re trying to get done more efficiently.
So these apps are geared toward doctors and others in the medical profession?
They’re not just doctors, but really anyone who is seeing patients. In fact, a huge number of our users are nurses, EMTs and other medical therapist or technologists, so only about 55 percent of our user base is physicians. The rest are other people in the medical field. The reality is that with multi-disciplinary care becoming much more important, the doctor is not the most important person on the team anymore. The contributions from the entire team are incredibly important, so putting the right tools in those peoples’ hands is obviously critically important.
How many users do you have?
Our user base is creeping up to 500,000, which isn’t a huge number compared with other commercial products, but when you think that in the U.S. there are only about 700,000 doctors in the whole country, it’s a reasonable number.
A large portion of our users is in the United States. Canada’s big, and we’re seeing increasing growth in Western Europe, Australia and Japan. Other parts of the world are slower to pick up, but as the smartphone trend increases in other parts of the world, I think those numbers will increase, as well.
How does this allow doctors and nurses to do their jobs better?
Let me give you a great example: The WHO (World Health Organization) has something called a surgical safety checklist, and this is a process that actual came from the aviation industry. In aviation, they found that if you don’t do a checklist pre-flight, planes tend to crash. It took medicine a long time to catch up with these very simple ideas. What was created was a simple checklist that’s done around the time of surgery, before the patient gets anesthetized, before any incisions are made into the patient and before the patient is wheeled out of the operating room. There was a clinical trial that found by going through a simple checklist, complications and operative mortality were reduced.
We have actually implemented the checklist into a full-featured tool so that people can actually run through the checklist and track it electronically as they are in the operating room. Again, this is a really practical example about how we hope people will use these tools at the point of care to improve patient outcomes. The whole idea of having it on tablet device or a smartphone device is that the number of these tools is increasing exponentially.
So what was happening before? Were doctors and nurses checking off steps on a piece of paper?
The reality is that this research was only published a few years ago, so prior to that people were not doing these simple checklists. I would guess that the vast majority of centers using this checklist are still paper-based. If you look at our usage numbers, this area’s in its infancy. We’re seeing 15 to 20 percent growth in usage per month. Clearly, people are latching onto this idea. What I think we’ll also see is integration with other clinical systems. For example, if you did do a surgical safety checklist in the operating room, ideally you would want to take the checklist and import it into the patient’s chart. Right now, that’s not something that’s done, but it’s something I expect to see moving forward.
The vast majority of error in medicine is human error; its not technological. It’s very rare that the piece of equipment will break down or malfunction. That happens, but it’s not common. The real errors are in communication, follow-through and documentation. Our hope is if we can at least help people make better decisions, and not have to make calculation errors or forget steps, that’s at least one part of the equation.
How are doctors and nurses reacting to this technology? Are they embracing iPads and other technologies in the operating room, or are they resisting the change?
The interest and excitement is palpable. The real barrier right now is the support. It’s the chicken-and-egg problem with all smartphone and tablet devices: If you don’t have the apps, people don’t want the hardware; and if you don’t have the hardware, you can’t have the apps. Right now, most systems don’t necessarily integrate with these types of tools, so you are seeing a lot of early adaptors trying to find ways to make it work. Some examples are AirStrip Technologies. They’re not actually on a tablet yet (they’re on smartphones), but it allows a doctor or nurse to actually look remotely at patients’ critical vital signs who might be in intensive care unit, or fetal heart tracing of a woman who’s in labor.
As these tools become more available, I think we’re going to see the desire to have these point-of-care tools increase more significantly. Right now, we’re finding that the tablets are not being seen on the same level of adoption at the patient bedside. That’s probably because of the form factor of the tablet. It’s physically larger, a little harder to get around. Smartphone penetration at the point of care has taken off. In the past 24 months, the increase has been incredible. And I think that’s partly because it’s very easy for someone to take even a personal device, not necessarily a device provided by an institution, and use it at point of care. But to get these tablets into actual clinical practice, it does require some infrastructure: recharging, storage, security, cleaning, and then also integration with the backend systems. But we’re seeing that change.
So consumer technology is entering into markets where, in the past, there may have been a lack of these technologies?
It’s going to be a really good thing for patients. Traditionally, healthcare software has not been user friendly. It’s been very expensive. And what the whole Apple-type development culture is doing is focusing on user interface, simple design, outstanding functionality and the ability to build it once and launch it everywhere. So what we’re seeing is outstanding tools — I’m not talking just about ours — but there are lots of things being built that are going to get wide adoption because of how good the hardware is and the environment it’s developed in. And what that’s going to mean is more people using better tools for better patient care. The future is very, very bright.