We found that 65.7% of patients admitted to our new inpatient tower used an integrated RC app installed on tablet computers inside patient rooms. After controlling for other predictors, we found that the AHPIAI race and other/mixed/unknown race was associated with increased RC app use. Surprisingly, we also found that increasing age was associated with increased RC app use. In addition, longer hospital length of stays were predictive of RC app usage. Finally, compared with general medicine, patients admitted to general surgery and bone marrow transplant had more RC app use, whereas patients admitted to medicine specialty, surgical subspecialty, critical care, neurology, and obstetrics/gynecology all had less RC app use than general medicine.

There has been growing concerns that elderly patients may be disadvantaged by the influx of technology in health care today [17]. However, in our study, we found that as age increased, use of the RC app also increased. This may be partly explained by the intuitive nature of the tablet interface, and previous literature has shown success in using tablet-based apps in elderly patients [18]. Furthermore, this finding showcases that RC apps can potentially function as a gateway for elderly patients to access other patient-facing technology.

Another interesting finding is the large variation in RC use among admitting services. Patients admitted to the bone marrow transplant service may have had the highest rate of RC app usage because these patients are often admitted to the hospital for prolonged periods of time. However, even after controlling for length of stay, these patients were still more likely to use the RC app. This is most likely because their movement in and out of their unit is limited owing to their disease process and are thereby more likely to explore hospitality features. Increased use of the RC app in general surgery patients may be because these patients are often confined to their hospital beds after surgery and are unable to control the blinds or lights through the usual physical switches on the wall. In this case, the RC app gives patients more control over their environment, which may improve the patient experience during a highly vulnerable time. This pattern is not seen in surgical subspecialty patients, potentially because these patients, especially neurosurgery, head and neck surgery, and orthopedic surgery patients, may not be physically able to operate a tablet computer after surgery. This may also explain the decreased usage of RCs in neurology patients. Therefore, further work will be needed to increase accessibility in these patients (perhaps through voice-enabled features). Patients admitted to the critical care service are clinically very sick, which may limit their usage of ancillary technology such as tablet computers. Similarly, medicine subspecialty patients may also represent a group of patients with high clinical acuity. Obstetrics and gynecology represent a very diverse group of patients, making interpretations difficult with regard to their usage of the RC app. Future studies will focus on barriers to RC app usage unique to each admitting service and exploring potential ways to increase RC app usage for each service.

Given its retrospective nature, we are unable to ensure that RCs were used by the patient and not by a family member. However, RC app use by family members may still encourage use of other apps found on the tablet. It is also possible that the RC app was used by the nursing staff to demonstrate the RCs to the patient, though we suspect this occurrence is rare. Interpretation of use patterns of obstetrics and gynecology patients was difficult because they represent a diverse group of patients, with different indications and acuity. This service includes patients admitted to labor and delivery for observation and patients undergoing postoperative care after a large cancer operation. The former group may be more similar to general medicine patients, whereas the latter group may be more similar to general surgery patients. Unfortunately, we are unable to separate the different obstetrics/gynecology patients in the current analysis. Although RC apps may increase inpatient portal usage [5], we are unable to track the usage of other apps on the tablet at this time. In addition, we do not have granular data of RC app usage, such as average daily use length and specific features accessed. Obtaining this type of data may require a prospective analysis (ie, installing a tracking software) and will be a source of future studies. In addition, patient-level data, such as income and education, were not available. These factors may play a role in the adoption of the RC apps.

Our study shows that approximately one-third of patients are not using the RC app to control critical room functions, and future initiatives to increase RC app usage should take these populations into consideration. Despite its intuitive interface, there may still be accessibility limitations to the current RC app, especially for patients admitted to certain services. A more thorough exploration of why the RC app usage is low in these patient populations is needed in the future.