My neighbor, a physician, installed an EMR this year to qualify for Meaningful Use. He has given up the clipboard in favor of a laptop to expedite data entry into this EMR. He has also give up looking his patient’s in the eye while doing rounds. Instead, he’s heads down, keying data into the laptop while asking the patient questions. There is no doubt patient satisfaction, and even patient safety, will decline with this approach. I believe there is a solution and the technology to enable this is available or will be soon, and I blogged about it just a few weeks ago. The solution is tablet computing.
One year after the iPad hit the market, 30% of us physicians had one. Another 28% planned to purchase and iPad in the next six months. The response to the iPad is highly positive and physicians are expressing strong interest in accessing their electronic medical records.
Tablets in 2012 will have sufficient pixels to display patient charts in high fidelity. Apple just announced a 2048×1536 resolution iPad. Samsung is announcing the same. Both of these devices provide higher resolution than today’s average desktop and laptop systems. The concern that data will be missed when using tablets is no longer a valid argument. These higher resolution devices will change the game in portable healthcare.
Tablets can be configured to deter theft. There is no question a smaller, portable tablet is a juicy target for a malicious individual to steal. Technology exists, or should, that would enable these to stop working once they are outside the boundaries of the hospital floor. For example, a Bluetooth device could be required to activate the tablet. If the device is not present the tablet would auto-lock. Attempts to crack this would erase everything, set off an audible alarm, snap a photograph of the user, phone the front desk, or other techniques that would deter theft. If the device is stolen in spite of this, it could be programmed to self-erase when it detects tampering.
This proximity approach could be used for single sign-on for physicians. As a physician approaches a tablet it could detect the RFID in the badge, a Bluetooth device, or some other unique means to identify the active user. It could be setup to launch the medical record application and jump to a pre-defined screen. When the physician walks away from the tablet it would sign off and lock. This type of functionality could be developed to make the tablet as easy as using a clipboard.
Applications could be developed that use the touch and multi-touch features of the tablet. Since typing on a tablet is unnatural, the physician could use the built-in microphone for dictation or applications could be developed that use more checkboxes for routine tasks and dictation for the exceptions. This can all be replayed when a keyboard is present or translated using built-in software. The audio files would be saved as part of the patient record.
Images can be captured using the built-in camera on the device. While these are not highest resolution, it would be beneficial to snap a picture of the wound and save it to the patient record. This could also be used to capture a photo of the patient for later identification. Some of these photos would be beneficial for evidence-based medicine and could be published.
The physician can use the same tablet to help educate the patient. For example, the physician could show a video or presentation to a patient needing a procedure. They could explain each step, the equipment used, the expected results, and walk them through the process with photos and illustrations. Using a tablet would make this fast, accurate and inexpensive. It would make a positive impact on patient anxiety and help the patient prepare for the process. After a procedure, the physician could show photos of the patient, the procedure and discuss the outcomes.
The physician could use this tablet for online training and credential management. They can manage their calendar, contacts and even review and respond to electronic mail. Savvy physicians are working more with social media. They can attend webinars from their desk, in-flight, or during the family reunion.
This year’s technology is taking away the major objections to tablet-based medicine. The resolution, security and usability continue to improve. Costs continue to drop. Unlike older technology, tablets have battery life that outlasts a shift. They can be quickly charged and are easy to carry and use. It has been my experience that many web-based applications can be run sufficiently on a tablet device already. More applications are evolving every week.
Are you using tablets in your practice? What’s stopping you?
