FEATURE: 05.05.20 – The use of tablet computers in modern medicine is a useful technological tool that aids doctors and nurses with remote interaction between themselves and their patients but one specific device, Apple’s iPad, is showing how telehealth is changing the game in how those infected with COVID-19 are being cared for during the global pandemic surrounding the novel coronavirus.
In April, Wired magazine staff writer, Paris Martineau, reported that hospitals were deploying tablet computers and smartphones in order to protect staff, preserve personal protective equipment (PPE), and help patients connect with loved ones. Key among those devices was the specific use of the iPad — designed by Apple in Cupertino, California — which, according to the writer, have been crucial health care tools in the combat to fight COVID-19.
The picture perfect example is Massachusetts General Hospital in Boston, Massachusetts where the Wired staff writer found herself at where she observed the transformation that the medical facility had gone through after the state was hit hard and became one of the hot zones for the coronavirus in the United States. Martineau would note that at most hospitals, COVID-19 patients see few other people, all of them cloaked in masks, goggles, and gloves.
“It’s a very frightening experience. With the iPad device in place, they get to interact verbally and in a reassuring way with a nurse who they can’t touch, but whose facial expressions they can now see,” said Dr. Lee Schwamm, who leads Massachusetts General Hospital’s Center for TeleHealth, speaking to Wired magazine.
Martineau reported that every room in the isolation ward that houses a patient infected with COVID-19 is equipped with an iPad mounted to an IV pole via a special gadget. The Apple-branded tablet computers have custom software installed on them which make the devices, in the writer’s own words, virtual extensions, of the more than 2,000 nurses on staff at Massachusetts General Hospital who can use them to check on — and communicate with — those patients without having to put on PPE (e.g., masks and gloves) which, as a result, reduces the risk of exposure to the virus.
In the three weeks since the system was deployed, Massachusetts General Hospital said that its PPE usage fell by 50 percent, which has helped the medical facility cope with a nationwide shortage of the gear.
Martineau also observed that the once normal routine of disorderly groups of doctors carrying about their business each day and visiting patients’ beds to perform their rounds has been substituted with a single physician clothed in PPE who would push around a cart through the halls of the hospital with a notebook computer on it. According to the Wired staff writer, doctors would participate virtually through an app configured by the hospital to facilitate medical care in order to limit potential exposure by staff. In addition, some doctors would join in on virtual rounds from a sanitized conference room down the hall where they were seated 6 feet apart, while others would do so from their own places of residence.
The doctors at Massachusetts General Hospital — some of whom have resisted telehealth efforts in the past — rapidly have adopted the technology during the pandemic. Most importantly, it has converted longtime opponents of telemedicine in hospitals into fierce advocates of the technology.
According to the Wired staff writer, hospitals from California to New York and even Texas have been building virtual care systems using tablet computers and smartphones with promising results similar to what Massachusetts General Hospital has experienced. Many began as efforts to provide patients with high quality care and access to the outside world amid visitor restrictions. Hospital officials at all three locations said they have been surprised by the impact of the newly established program in telehalth and telemedicine.
Per Martineau, the Harris Health System in Houston, Texas also has looked to the use of tablet computers to assist in the rationing of PPE at its three hospitals by reducing the amount of staff members who normally would have physically gone into the rooms of patients in isolation who were infected with COVID-19. The writer reported that hospital officials soon realized that the program could do more for providers and patients as well.
Currently, the Harris Health System uses the tablet computers (Martineau did not specify whether they were Apple’s iPad in this instance) to provide instant access on demand to interpreters for non-native English speaking patients, patient consultations with pharmacists and dietitians, and video chats with patients’ family and loved ones.
Just last month, according to Martineau, the hospital network deployed a new system designed to streamline end-of-life care and ensure that the families of patients in critical condition could be quickly contacted and virtually brought to the patient’s bedside to be with them in their final moments.
David Riddle, administrative director of patient experience at Harris Health, speaking to Wired magazine said that he hopes the service will alleviate some of the emotional burden for providers on the front lines, who often are the only ones around a dying patient.
“It’s not a perfect situation, but as a clinician, you might find some sense of relief or some of the burden lifted off of you knowing that the family was able to at least tell their loved one something, and be with them virtually,” Riddle told the publication.
Over at SUNY Downstate Medical Center in Brooklyn, New York — a hospital in the process of a transition to housing only patients infected with COVID-19 — the Wired staff writer observed the use of donated iPad units and smartphones (Martineau did not identify if the latter were Apple’s iPhones) — by staff, all in limited quantities, — which allowed patients in isolation to connect with their loved ones. She would observe another five Apple-branded tablet computers on carts which were used for video interpretation services in multiple languages, notable among them, sign language.
“The hearing impaired find the device extremely helpful and it provides a lot of confidence and comfort,” said Wren Lester, chief experience officer and director of patient relations at Downstate Medical Center speaking to Wired magazine.
According to Martineau, Downstate Medical Center — at the moment — has not been using the technology to provide inpatient virtual care unlike Massachusetts General Hospital and others have been doing. The writer reported that due to the intensity of the City of New York’s coronavirus crisis (another hard hit area in the United States and a hot zone for COVID-19), it has not allowed staff much time at all to implement a similar system.
Lester told the publication that the hospital hopes to expand the program after the crisis (is over).
Yet another medical facility Martineau reported on was St. Francis Memorial Hospital in San Francisco, California — which is home to the city’s first dedicated COVID-19 treatment unit — where its staff, in preparation for the influx of patients, established a special area to serve as an extension of the hospital’s emergency room (ER). The surge facility was not located within the ER itself, but rather, the physicians of the ER would be able to conduct visits remotely as well as perform remote consultations for the surge facility without the need to leave their stations.
Dr. Kathleen Jordan, Vice President of St. Francis Memorial Hospital, speaking to Wired magazine, said that there were still many tests and procedures which only could be done in person, but for those that could be conducted remotely, many clinicians found that virtual appointments have provided them with the opportunity for greater intimacy with patients and that the adoption of inpatient telemedicine also has helped with staffing, by allowing more providers to participate in care at the hospital. She noted that in addition, doctors who felt healthy but were quarantined because of COVID-19 exposures now were able to contribute, which, has helped the hospital to avoid dire personnel shortages.
According to the Wired staff writer, St. Francis Memorial Hospital also thought to turn to tablet computers and smartphones as well (again, not indicated by Martineau whether either device was from Apple) to help patients stay in touch virtually with their loved ones after local officials banned most types of visitors to the medical facility in mid-March. In addition, doctors themselves began to use the devices to check on patients in the hospital. This also allowed immunocompromised and other at-risk providers to be able to weigh in remotely, whereas, in the past — for their own protection — they were kept away from the patients..
“We were dealing recently with an end-of-life situation and had actually quite a beautiful experience with extended family from multiple locations being able to be present in a virtual way,” Jordan told the publication. She also said it was the first time that they had used the technology with such a large audience and in an end-of-life experience.
Per the Vice President of St. Francis Memorial Hospital, since then, the devices have been adopted for other uses throughout the medical facility.
“Change is difficult in medicine. Historically, telehealth has been an exercise in pushing so that people begin to see how technology can make a difference. These last three weeks, we are not really pushing, we are being pulled. This huge community of providers is clamoring for these solutions now. It’s amazing,” said Juan Estrada, who oversees Virtual Consults Services at Massachusetts General Hospital, speaking to Wired magazine.
Martineau reported that Estrada spent years trying to get the technology into the hands of health care providers, but until recently, was met largely with resistance.
“The rapid adoption of digital tools during the pandemic “is going to transform healthcare permanently in the United States,” Schwamm of Massachusetts General Hospital told the publication.
A Note from the Author: the image featured herein was procured from and courtesy of Wired magazine via the same article cited within as source material for this story.