Practices Embrace Tablet PCs

By John McCormack
John McCormack is a writer for Physicians Practice

Despite the clinical and cost advantages that computers can bring to medicine, many physicians are loath to give up their tools of choice: clipboard, paper and pen.

Why? Computers, in a word, are clumsy. It’s difficult for physicians to use a full size or even laptop computer while sprinting from exam room to exam room, patient to patient. On the other hand, personal digital assistants, while offering much needed mobility, simply don’t meet physicians’ needs (see sidebar).

Enter the Tablet PC. These devices, about the same size as a clipboard, offer wireless access to data whenever and wherever it is needed. Running on standard operating systems, Tablet PCs enable users to take notes using natural handwriting with a stylus or digital pen on a touch screen.

Although Tablet PCs were introduced to the market with a great deal of hoopla about a year ago, the question still remains: Will these devices provide the silver bullet necessary to get physicians to embrace computers? Many early adopters sing the praises of Tablet PCs. Others, however, say that the devices still don’t measure up to pen and paper.

Looking good
Certainly, the Tablet PC appears to offer everything a physician could want, according to Bill Crounse, M.D., global health care industry manager for the Healthcare and Life Sciences Industry Solution Group at Microsoft Corp., Redmond, Wash.

“Although the Tablet PC is being used with customer applications by different industries around the world, it seems especially perfect for medicine because its design mimics the patient chart physicians have been jotting their notes in for years,” Crounse said.

Tablet PCs are available in two formats, a convertible model with an integrated keyboard and display that rotates 180 degrees and can be folded down over the keyboard — or a slate style, with a removable keyboard. The user’s handwritten notes, which can be edited and revised, can also be indexed and searched or shared via e-mail or cell phone.

Tablet PCs offer substantial computing power. Many come with the Microsoft Windows XP Tablet PC Edition operating system, which can translate handwritten notes to text instantly or save handwritten notes as digital ink files. Tablet PCs also can include voice recognition software.

Catching on
Certainly, many doctors are adopting Tablet PCs because they offer the features needed to use computers at the point of care.

Carlton Hays, M.D., for example, decided that Tablet PCs are the answer to a long-standing computer usage problem at the Jackson Clinic in Memphis, Tenn. Before adopting Tablet PCs about a year ago, the 132-physician practice had virtually ignored its electronic medical records system.

“For a couple of years, we maintained both electronic records and paper charts,” said Hays, who in addition to maintaining a full patient load acts as the medical informatics advisor for the practice. “One of the obstacles to getting rid of the paper chart, though, was providing doctors with a way to view the record. We needed a device that would be easy for doctors to use at the point of care.”

In the initial effort to get doctors to use the Physicians Workstation EMR from Wang Healthcare in North Billerica, Mass., Hays installed PCs in all of the exam rooms. But the doctors found the PCs to be much too cumbersome.

With a PC sitting in the corner of the exam room, the physician would come into the room, log on to the computer and then look up a patient’s record. The physician would do all of this while the patient waited for the exam to start.

“We would have to pull up the last note to find out what was going on with the patient and to learn a little more about who the patient is,” Hays recalled. “It was very awkward because the patient would be sitting there, and we really wouldn’t know much about them. We couldn’t start a conversation.”

The Health Insurance Portability and Accountability Act (HIPAA) regulations also prompted security concerns. If the PCs were left on, patients could potentially view private information on the screens. But shutting down the computers after each use would mean that the doctors would have to spend an inordinate amount of time logging on and off of the system each day.

The Tablet PC seemed like a viable option. After testing a number of Tablets from various vendors, Hays chose a slate-shaped Tablet PC from Motion Computing in Austin, Texas. The Tablet’s bright 12.1-inch screen allows doctors to view a full-page document without scrolling. Its 3-pound slate design, which is about the size of a clipboard, is easy to carry in one arm and enables doctors to work as they do with a pen to access patient records and enter notes.

Because the practice’s physicians continue to dictate notes, Hays chose not to add an integrated keyboard, which adds extra weight and a cumbersome swivel mechanism.

Working with the Tablets makes life much easier for the doctors, Hays said.

“Although we have not yet quantified efficiency, the doctors spend a lot less time looking for things that they need,” he said. “Before if we were trying to find an immunization record, we would spend an inordinate amount of time flipping through paper trying to find the immunization stamp. Now, we just click on a tab and the immunization record appears.”

Providing hardware options
Jeffrey Hurless, D.P.M., also wanted to implement an electronic medical records
system in his Thousand Oaks, Calif.-based practice. He knew, however, that he wanted a system that could be used with multiple types of hardware to accommodate the various needs of his staff. Hurless settled on the Patient Chart Manager from Prime Clinical Systems, Pasadena, Calif. — an electronic medical records system that is built to work with numerous types of hardware.

A number of PCs around the office enable staff members to access the system, but Hurless did not want to use PCs in the exam room because he thought they would have a negative impact on patient-doctor interaction.

“I really wanted to reap the benefits of using an EMR but I didn’t want to significantly change how I interact with patients. Essentially, I wanted to conduct patient visits in the same manner that I had conducted them when I was using a paper chart,” he said.

As such, Hurless eventually decided to use a Stylistic 4300 Tablet PC from Santa Clara, Calif.-based Fujitsu.

“I simply carry the Tablet under my arm, just as I would carry paper charts, and then use the pen stylus to unobtrusively write notes, while maintaining eye contact with my patients. I wanted to continue to look patients in the eyes and talk. To me, that is what the patient-doctor relationship is all about,” he said.

Having the completed medical record right at his fingertips enables Hurless to quickly assess each patient’s clinical situation — making it possible to offer better service to patients.

Waiting for the next iteration
Although early adopters are singing the praises of Tablet PCs, widespread adoption might not be in the cards yet, said Gregg Malkary, managing director of Spyglass Consulting Group, a market intelligence firm based in Menlo Park, CA.

“I have interviewed hundreds of doctors — and many are still reluctant to use a Tablet PC,” Malkary said. He says doctors are shying away from the devices for the following reasons:

• Cost. Tablet PCs cost about $2,000, whereas PCs can be purchased for less than half of that amount.
• Weight. Tablet PCs weigh about 3 or 4 pounds. “Doctors would be comfortable with a 1- to 2-pound device — but 3 or 4 pounds is too much,” he said.
• Size. Physicians find the Tablets to be too big. They want something that will fit into a lab coat.
• Durability. The Tablets are too fragile for physician use. Doctors work in a fast-paced environment. So, they are likely to drop the Tablets. “They don’t want to spend $800 [for repairs] every time they accidentally drop the device,” Malkary said.
• Battery life. The average battery life for a Tablet is only about three hours. Physicians want a device that will carry them through the entire day.

Tablet PCs, however, could catch on in the future — if the form changes, Malkary predicted.

Vendors are already trying to accommodate the health care industry’s needs. For example, Motion has added a light sensor so that the batteries only use the minimal amount of power needed, based on the light — increasing battery life in some instances.

“The hardware is heading in the right direction,” Malkary said. “If the manufacturers can come up with a Tablet that is 1.5 to 2 pounds and has a battery life of eight hours or more — and only costs about $1,000, then I think there will be more widespread adoption.”

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