I recently commented on a friend’s very interesting photo. It showed a group of doctors around a patient’s bed all holding iPad Mini’s while they digitally document their decisions. The photo caption mentioned how truly amazing this whole experience was for her.
My friend is an Intern doctor at one of the most well known hospitals in our country: Groote Schuur Hospital. Twelve iPad Mini’s were donated by Canada to the Trauma Unit at the hospital. The reason for the donation: Electronic Trauma Health Record (eTHR.) Electronic Trauma Health Record is an innovative, award winning, new app designed by clinicians, data ethnographers and medical software designers. It is based on EHR (Electronic Health Records). eTHR focuses on three key areas: admissions, operations and the discharge summary of each trauma patient. It also has three capabilities: clinical checklists, injury severity scoring and wireless data transfer to an electronic registry.
With a vast majority of medicine directed at the prevention of infectious diseases; a group of Canadian doctors lead by Professor Morad Hameed (a surgeon at the University of British Columbia) understood that trauma was actually the leading cause of death. It accounts for more deaths than HIV, TB and Malaria all combined! Additionally, he suggests trauma can be prevented by analyzing trauma statistics documented at hospitals. Canada chose Groote Schuur Hospital because it is classified as a low-resource, high-volume trauma unit, seeing 10,000 trauma patients per year. It was an ideal place to pilot the app.
Pro’s and Con’s
I spoke to my friend who is doing her Internship at Groote Schuur and she had mixed reviews about the eTHR.
Laura: Is the App easy to use and easily accessible?
Dr: We were given 12 iPad Mini’s which were distributed between Casualty’s and the Trauma Ward. The iPads aren’t allocated to a certain doctor, but rather used by the doctors on call each day. Anyone in the trauma unit has access to it including interns, the registrars and even the final year medical students. And because it is the iPad Mini, it is easy to carry around and put in our jacket pockets.
Laura: Would you say that the infrastructure in Groote Schuur is developed enough to cope with eTHR?
Dr: Because the app is new, we have definitely had problems but we report them and they are fixed by the next day. Some of these problems include when the Wifi network is down or weak. The team of doctors (Canadians and South Africans) respond quickly to any obstacle we have and they have now brought in adapters and signal boosters to improve the Wifi signal. Although most of the other departments such as Radiology and the Pathology lab, are also using online systems; these systems aren’t all synced so we end up retyping a lot of information into each system which is very time consuming. They are also trying to adapt the app so that we can access it from our smart phones.
Laura: Are the doctors keen to use eTHR or was there some resistance?
Dr: Everyone was happy to use it! It’s new technology and we get to use an iPad! But it is very time-consuming because of all the drop-down options that have to be selected and although it makes our history-taking very thorough it also interferes when we have high patient loads.
Laura: Would you say that there is continuity with the management of the trauma patients now that the app is being used?
Dr: No. The app only documents admissions, operations and the discharge summary. When the patient is transferred to a ward, the doctors are then returning to hand-written notes. But this is something that they are hoping to change in the future. The app is still very much in the development phase and I can see that the team of doctors are trying to expand and improve it as much as possible so that the system will become more flawless and efficient in the future.
Laura: What is your overall impression on eTHR?
Dr: It makes our approach to the trauma patients more thorough but it is very time consuming and more lengthy than writing by hand. It is finally giving us the opportunity to quantify trauma cases and to address where injuries can be avoided and better managed for the future. I think it is a fantastic idea and I am happy they have implemented it here but there is still a lot that needs to be developed and improved. Something that truly bothers me is thinking about when the Canadians leave, whether our Government will continue the funding.