JUVENILE JITTERS Tablets loaded with games are more effective than sedatives for calming kids before anesthesia.

Smartphones and tablets are already widespread in the OR, but experts say there are more ways to use them than just as modern-day beepers. We asked around and found the 7 coolest ways to use mobile devices in your facility.

1 Patient communication

Apps for smartphones are changing how doctors are interacting with their patients. After seeing patients struggling with colonoscopy preps, Paul Berggreen, MD, at Arizona Digestive Health co-created an app to communicate instructions to patients more clearly.

Dr. Berggreen has improved his SmartClinic app since it first launched in 2012. It now works with other clinics and specialties. Patients download the app for free (there's a fee for facilities to join), and it places notifications in their calendars, sending them appointment reminders and passing messages between providers and patients. Other features include written or video pre-op instructions and satisfaction surveys. Best of all, he says, SmartClinic sends patients their procedure results — before they even leave recovery.

"It clarifies the whole process," says Dr. Berggreen.

There are plenty of medical apps out there for Apple and Android phones to help facilitate physician-to-patient communication, but the best let doctors demonstrate procedures to patients clearly, says Satish Misra, MD, managing editor of iMedicalApps.com and a cardiology fellow at the Johns Hopkins Hospital. Free apps like drawMD and Orca Health are 2 that work great, he says, and let surgeons draw on X-rays or anatomical bodies. Tablets can also be used in the waiting room to let patients watch videos or read fact sheets on the type of procedure they are receiving. This way "everything they hear isn't totally new" when they first meet the surgeon, says Dr. Misra, noting that increased communication often equals increased satisfaction.

2 Visualization and navigation
If a piece of OR equipment uses a camera, there's a good chance developers are making it compatible with smartphones and tablets.

Most scopes are slowly adapting so that you can use mobile devices with them via adapters or wireless Bluetooth connections. This can often replace bulky and expensive video towers, says Dr. Misra. Many systems also let surgeons take and immediately send photos and video to patients, other physicians or medical records.

Other products can turn mobile devices into GPS systems for the body. When software connects a smartphone to an arthroscope, you get a measurement instrument that displays live values for accurate alignment of joint replacement implants during orthopedic surgery.

These devices can range greatly in price, depending on the sophistication of the equipment and whether you just buy the adapter or include the scope and other accessories. Many of these devices are in early stages, says Dr. Misra, but the smartphone's camera is expanding the field. Checking with your vendors to see what's available is a good place to start.

"Anything that has a fiber optic camera at the end is certainly becoming more available to work with a smartphone or a tablet," he says.

3 Reference
Want a quick way to look up drug interactions or pre-op guidelines? Smartphones may be your best bet.

Pamela Ertel, RN, BSN, RNFA, CNOR, FABC, CASC, administrative director of The Reading Hospital SurgiCenter at Spring Ridge in Wyomissing, Pa., says that she knew her anesthesia providers needed apps to help them do their jobs, but she wanted to make sure that they weren't distracted by Angry Birds or Facebook. Her facility solved this by buying tablets and pre-loading them with apps the staff needed, including drug reference ones like Epocrates and Micromedex, Webster's Dictionary, Google Translate, M&M Clinical Anesthesiology, Convert Units Free and Medscape.

"For me, it gives peace and comfort that it's for that patient," says Ms. Ertel. "They needed to have the apps to do their job."

A quick online search shows there are hundreds of medical apps that cover everything from knee replacements to medical definitions. Others even let surgeons perform simulated surgery. References are a personal preference, says Ms. Ertel, and if your facility is deciding which apps to put on tablets, the "most important thing to do is to get staff involved."

GOOGLE GLASS
Benefits of Live-Streaming Vitals onto Eyewear

GOOGLE GLASS Could the wearable technology be the next big thing in surgery?

Google Glass may offer several benefits to those who wear it in surgery, including increased situational awareness and patient safety, a new study suggests.

A pilot study by the Department of Surgery at the Stanford University School of Medicine tested whether surgery residents who wore Google Glass showing patients' vital signs during surgery performed any differently than those using traditional monitors. Surgery residents participated in standardized thoracostomy tube placement and bronchoscopy simulation scenarios in the study. Traditional vital signs monitors were available during all procedures, but some residents were randomly given Google Glass with VitalStream, which streams live vital signs and alarms directly into the glass-wearing surgeon's view.

Those wearing Google Glass recognized critical vital sign changes up to 10 seconds sooner those who only used traditional monitors.

— Kendal Gapinski

4 Records
Ms. Ertel's center has also adapted the tablets to work with their EMR system. "The staff would never go back to paper," she says.

The tablets make it easier for staff to move from patient to patient, she says, and they no longer worry about losing a paper in the process. Plus, the docs love them because the tablets come with a stylus that lets them sign records when they're on the move.

Many facilities are following suit. Using tablets with EMRs saves time, and many of the new apps even let patients access their records from a HIPAA-secure app on their smartphone, so they can take them with them when they visit different doctors. "One of the problems in the healthcare world is siloed medical information," says Dr. Misra. "A number of platforms work to change that."

Some facilities are also having patients use tablets in the waiting room to fill out questionnaires, which are then copied immediately into their records.

Samuel Seiden, MD, associate chief medical informatics officer at the Ann & Robert H. Lurie Children's Hospital of Chicago, says that the hospital has found a new app offered by its EMR company "very, very helpful" so far. This is something several big-name services are developing, he says, and many can be used with either smartphones or tablets. With these, doctors can receive calls from patients at home and can pull up their medical records, write prescriptions and send them to the pharmacy without leaving the app — or the comfort of their couch.

5 Calm pre-op jitters
Mobile devices can cause distraction, but that's not always a bad thing. Having children use tablets pre-loaded with games before going under anesthesia keeps them calmer than oral sedatives do, allows for quicker recovery times and makes for happier patients, according to a study Dr. Seiden recently completed.

"People used to say video games were like a drug," he says. "This is one time that it's not a bad thing."

The key, Dr. Seiden says, is finding an app that allows for interaction between the patient and the tablet. For example, young children are "mesmerized" by a free app called Pocket Pond, where the user is overlooking an animated koi pond and can touch the screen to splash water. It may sound simple, he says, but it's engaging enough to calm kids down before anesthesia.

While Dr. Seiden notes the upfront costs are high to buy the tablets and the gear to protect them (he recommends looking for a heavy-duty, waterproof case that can stand up to disinfectant), the apps rarely cost more than 99 cents. If a patient comes in and asks for a new game, it'll take you less than a minute to download it and relieve his anxiety.

SMARTCLINIC Screenshots of the app designed by Paul Berggreen, MD, which helps patients organize their health care.

6 Dictation
Dictation in surgery is also getting a makeover with the smartphone. New apps and software are making it possible to record notes and transcribe them quicker than ever before, minus the $500-plus price tag for traditional voice recorders. The smartphone's microphone is allowing for "all sorts of collaboration that previously wasn't possible," says Dr. Misra.

There are several apps on the market for surgical dictation, but many work alongside traditional transcription services. Depending on the service and type of application, there are plenty of options. Some services immediately transcribe the recording and send it as a text document. Others upload the recording to a cloud storage base, which can then be accessed by an outside service or in-house staff to do the transcription. Some apps also connect to EMR software, so the transcriptions can go directly into a patient's medical record.

Most popular dictation services are now offering these apps. If you're tempted to just use a free recording app found online, you may want to think again, experts say. You'll miss out on the cool features and may risk patients' privacy.

RECORD KEEPING Using a tablet to keep records is portable and efficient, staff at The Reading Hospital SurgiCenter at Spring Ridge say.

7 Patient monitoring
Even standard things like tracking vital signs are changing to work with mobile devices. Several new apps on the market let doctors live-stream a patient's vitals, letting them be seen in multiple locations at once. This can be especially helpful for anesthesia providers, who may be watching over a couple of cases at one time, experts say.

"I can use my tablet to cover multiple ORs, since I'm an anesthesiologist," says Dr. Seiden. "By using an app, I can see the monitors that are showing the vitals of the patients even if I'm in a different room."

The monitoring software works by taking real-time patient data from the monitoring station and letting it be accessed remotely through an app on a phone or tablet, says Dr. Misra. Most software also provides access to patients' medical histories and allows staff to send messages within the app. These apps require up-front costs, including contracting with the service and purchasing any necessary equipment, but one study has suggested that these services can improve patient safety (see "Benefits of Live-Streaming Vitals onto Eyewear").

DIGITAL DEVICES IN THE STERILE FIELD
The Sterile Solution for the Digital OR

PROTECTIVE POUCH eShield sterile covers for handheld electronics let you bring phones, cameras and tablets inside ORs without fear of infection.

Much has been made about the distraction risk that tablets and smartphones pose in the OR, but what about the infection risk? Orthopedic surgeon Alexander K. Meininger, MD, of Steamboat Springs, Colo., has come up with a way to keep those gadgets germ-free and sterile in the OR. The FDA just approved Dr. Meininger's eShield (eShieldOR.com), a clear plastic pouch that lets you use cell phones, tablets and cameras in the sterile field. The eShield lets you maintain touch capabilities of modern screens even while wearing surgical gloves, says the company. eShield covers come in various sizes.

— Dan O'Connor