The Dilemma of the Tablet-Enabled Physician

I was gifted an iPad by the hospital after going through their EHR training about two years ago. At first I didn't want it, but I have learned to love my iPad much more than my laptop. The tablet boots instantly, unlike my regular computer that takes many minutes to come alive. With a swipe of a finger I can get my e-mail, Facebook page, and Solitaire. I can read books and the newspaper instantly and ordering goods online comes with individual apps.

We are switching to a new EHR later this year that features an iPad app. This means it will be much easier to get to my charts and my patient information. That seems like a great innovation … until you realize it means I am technically "on call" all day, every day. While I can connect my computer with Wi-Fi, the iPad with cellular connectivity will extend the capability of my physician responsibilities … so will it extend my culpability?

I value my time off. Years ago when first going onto EHR, I could not connect from my house so I learned to get everything done before leaving the office. My time off was truly unconnected. This EHR change to mobile is going to necessitate another change in work flow for me.

There are two ways to approach this subject:

1. It will allow me to follow my patients more closely since I can get their lab results and follow-up data without being in the office. This will improve my relationship with my patients and result in more detailed care for them.

2. I will never really be out of the office. This could have legal ramifications.

The answer will likely be having a better buddy system and sign-out criteria in our practice. Right now, I have a buddy that will keep an eye on my charts and labs when I am away. We try to notify our buddies when they need to take over. Sometimes, it doesn't always work that way. So far, nothing serious has gotten missed … but we must remain vigilant in making sure follow up happens.

I also try to notify the doctor on call for the evening and weekends when I have a lab or patient follow up during my time off. However, I am surprised frequently when I am on call with patient issues that I was not told about. While it will be easier to see the charts and the details with my new mobile device, it would still be nice to hear things from the patient's provider.

Time away from the office is precious. We all need that "de-stress" phase. For those of you that already have an EHR that is truly available through mobile apps, how do you deal with the follow-up issues and how do you manage to absolutely take a vacation from the office without having to worry about patient care in your absence?