EyeNet Magazine

Practice Perfect: Information Technology
Tablet Computers in Practice: Tips From iPad-Using Eye M.D.s
By Linda Roach, Contributing Writer
Interviewing John W. Kitchens, MD, Raj K. Maturi, MD, and Robert F. Melendez, MD, MBA
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Two years ago, Apple introduced what was to become the first successful tablet computer. First impressions of the iPad were that, in many ways, it is more like a smartphone than a laptop. This suggested to some observers that the device was aimed at the general consumer market. But it turns out that mouseless, touchscreen iPads and other tablet computers may prove to be just what the doctor ordered. Indeed, by mid-2011, 32 percent of U.S. physicians were using a tablet computer—mostly iPads—compared with just 5 percent of all consumers.1 Why the enthusiasm? Three Eye M.D.s explain how iPads are making their life easier.

Information at Your Fingertips

Ophthalmologists must achieve a balance between engaging with patients and meeting the time constraints of a busy practice. When the doctor leaves the room to look up drug interactions or to find an illustration, this limits time with the patient. A tablet computer can make the information readily available through downloaded books, articles, and apps such as the widely known Epocrates drug reference.

An eye library in your hand. Wherever he goes, John W. Kitchens, MD, carries more than a dozen ophthalmic reference books. “I’ve got probably 50 pounds of ophthalmology textbooks in my hand. I can pull them up on a plane or in a clinic. It’s great,” said Dr. Kitchens, a retina subspecialist in Lexington, Ky. His mobile resources—on both smartphone and iPad—include the Academy’s Basic and Clinical Science Course; an ophthalmic atlas; the Wills Eye Manual; and an Amazon Kindle app with several ophthalmology textbooks loaded into it. By swiping his fingers across the screen, he finds information to guide treatment, prescribe drugs, and answer patients’ questions.

Dr. Kitchens has been using the BCSC iBook, which is limited to Apple devices. This has recently been replaced by the BCSC eBook, which can be used on nearly any desktop computer, tablet computer, or smartphone.

Keep up with the journals. Dr. Kitchens relies on his tablet and smartphone to stay on top of the literature, using free Internet-based sorting tools, and apps he downloaded to both devices. His do-it-yourself system is based on:

  • Automatic notifications (called RSS feeds) listing titles of new articles in his favorite journals. He skims these and downloads any articles of interest.
  • Topical RSS feeds from the PubMed database. These list new articles about subjects that he wants to follow closely.
  • Dropbox, an Internet-based tool for storing, managing, and syncing files across several devices.

“The Google RSS reader gathers the feeds for me,” said Dr. Kitchens. “Then it pushes those feeds, as they come up, to the RSS reader apps on my iPhone, iPad, desktop, and laptop. If I read a feed with that app on any of my devices, the reader deletes it on everything. It’s really unified,” he said. Similarly, the Dropbox app allows him to create and revise a slide presentation or research paper on one device and have access to the latest draft version everywhere else. When he wants to save something that is only available in hard copy, he snaps pictures of the pages with his iPad’s 5-megapixel camera and stores the images in Dropbox for later use.


Accessing Charts on the Run

“I can access our electronic medical records from anywhere on the face of the Earth, literally,” said comprehensive ophthalmologist Robert F. Melendez, MD, MBA, of Albuquerque, N.M. “On weekends, if I’m out somewhere with my family and I get a call from a patient or from the emergency department, I can actually call that patient’s records up and access all the information I need to handle the call.”

Built-in privacy protection. At the end of the call, the information that Dr. Melendez viewed disappears from his device. This is because, unlike a laptop, a tablet computer is designed to view information but not to store it. Some critics have cited this feature as a drawback of tablet computers, but it can be an advantage for physicians because it protects patient privacy by default.


Viewing High-Resolution Images

Except for extremely low-end devices, tablet computers typically have high-resolution screens. When the Samsung Galaxy Tab 10.1 was released last year, it featured a screen resolution of 1280 x 800 pixels, compared with 1024 x 768 on the iPad2. The third generation of iPad raised the bar again, to 2048 x 1536 pixels. Linked wirelessly to the office’s EHR system, a tablet device can immediately retrieve and display retinal photos, OCT scans, and other clinical images. These retain their crispness even when the clinician zooms in, which is done by touching the screen, said Raj K. Maturi, MD, a retina subspecialist in Indianapolis. “The resolution is so high that we can actually look at our images of the retina better on the iPad than we can on a computer monitor in the office.”

Share images with patients. With the help of a tablet computer, the ophthalmologist can show patients how their eyes are doing—and can do this quickly.

Evaluate multiple images more efficiently. The iPad increases the efficiency of evaluating sequential retinal photos during a patient’s visit, said Dr. Maturi, who is planning exam rooms with two desktop monitors, with his iPad as a third viewing screen. “For retina specialists, screen room is the problem. In the past you could print everything out and easily view the retina’s condition over time. Now, if you just have two screens you have to scroll through many separate views. So we plan to use the iPad to make the process faster,” said Dr. Maturi.

Dr. Melendez prefers to view images with an app called Sonomed Escalon Axis, which communicates with his practice’s EHR system and is downloadable from the Apple app store. By swiping his fingers over the screen, he can move quickly through multiple visual fields or ocular images. “We’re accustomed to Windows systems where you point and click and point and click, and then wait and wait,” he said. “With this, you literally just tap, tap, tap with your fingers. No pointing. No clicking. No waiting.”


iPads in the Waiting Room

Even technophobes find tablet computers to be user-friendly, said Dr. Melendez. In his office, patients use iPads to watch professionally made 3D video animations explaining their eye diseases, plus videos and adapted slide shows of research results that he presented at medical meetings. “They can check out an iPad with their driver’s license and then learn about their eye disease while they wait to see me.”

Dr. Kitchens uses iPads to show patients videos of the procedure they are to undergo, and Dr. Maturi’s practice has two iPads that waiting patients use to watch videos about diabetic retinopathy and age-related macular degeneration.


Typing on a Tablet? Not So Fast

Don’t plan on ditching your desktop or laptop computer in the near future. The three ophthalmologists agreed that the iPad’s virtual keyboard is too slow and awkward to use for extended typing tasks, including the creation of chart notes. “It’s not efficient to use the iPad for typing new information into the EHR system,” said Dr. Melendez. “iPads are meant to be more for consuming of visual information, rather than producing information.”

But wireless or docked keyboards for use with tablet computers have begun appearing. Some competitors are making tablets with a small keyboard, in a clamshell design. The keyboard folds backward underneath the screen when not needed. These additions would make the devices more functional for data input. However, there still would be no mouse, which would be a drawback when trying to navigate through multiple checkboxes in EHR forms.


Selecting a Tablet

There are far more apps for doctors available on the iPad than for devices with Android, BlackBerry, Palm, or Windows Mobile operating systems. This makes the iPad the simplest, fastest way to gain the benefits of tablet computing. But as the marketplace becomes more competitive, the choice of which tablet to buy may get more difficult.


Dr. Kitchens reports no financial interests. Dr. Maturi developed AmslerVision, a vision self-checker for patients, which is sold on iTunes. Dr. Melendez developed Ophthalmology Buzzwords (www.medrounds.org); proceeds from its sale go to the Juliette RP Vision Foundation.


1 Modahl M. Tablets Set to Change Medical Practice. Published June 15, 2011. Accessed June 19, 2012.


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