Tuesday, January 26, 2010

Will Apple's iPad save EMRs and Healthcare?

Apple is about to launch their new device - the iPad or iSlate or something similarly named. Since it is supposed to be the miracle cure for so many things - how about healthcare?

Assuming they have created a cheap, lightweight device that has high speed connectivity and allows for easy data entry similar to an iPhone (type, touch, voice)... how could a physician use this in their clinic workflow... how would an EMR optimized for this product work?

It might make sense to have "apps" for different workflows. In the exam room, a physician would want an app that displays the relevant data for a patient, and allows for easy documentation and ordering. Of course, we want that now with our big PCs...and are usually somewhat disappointed as no EMR is perfect at this point. So is there anything that makes the iPad concept better for doctors?

Carrying around a "pad" is most similar to paper and thus doctors will accept it more - right? Well, so far that philosophy has usually not worked in a busy office setting. The previous "pads" (e.g. handheld tablets) have been too heavy and bulky, too expensive and the battery life too short. Additionally, data entry has been limited to touch pen. The new iPad would likely be better in all categories... and so I could see it being used for data retrieval, some ordering, and possibly some basic documentation - although I think the majority of documentation would likely be voice (e.g. Dragon voice recognition).

Overall, this might make the most sense in the inpatient setting where there is a lot of movement and a big limiting factor has been not enough computers for all the rooms... or the COWs are too bulky to move around easily. We have already seen many EMR vendors come out with iPhone apps... so there is even some software to start using in these situations.

In the outpatient setting, where one doctor usually works consistently in 2-4 rooms, I think having a regular PC type device (or net device) with a large monitor and keyboard still makes the most sense for now. And even when voice recognition improves, this set up will still likely be easier and cheaper for this more controlled situation.

Of course, since EMR adoption is low now... any new technology that provides for the ability to innovate is welcome with open arms - and I am very much looking forward to see if this is going to be closer to the Newton or the iPhone in it's success.


  1. Lyle,
    I'd like to better understand the "App" application to addressing workflow that you alluded to.

    Most if not all EMRs are a big app today. That apps has two main sides:

    1) a provider organizer (scheduled, patient(s) list(s), notification/email/signature queues, etc), and

    2) the other side, a patient "chart". Within that patient chart, the mini-apps today include flowsheets, documentation tools, order tools, and, single-click methods to jump between those contexts.

    You suggested that an app specific to specific workflows, following the iPhone App usage "pattern", using the home screen launch or app-to-app cross launches.

    What do you see that looking like? Will it require a bread-crumb method to move around? How will a complex, async data exchange workflow like discharging a patient (complete with medication reconciliation, production of a D/C summary, patient instruction, referral letter, and prescription generation) work as an app or apps?

    Is is practically necessary for some or all of those apps to be OSS? Alternatively, do you see this kind of a workflow needing to be anchored in Epic, Cerner or other vendor's platform to assure business process fidelity?

    Given your broad experience with commercial and homegrown systems, I would guess that you'd have a more informed view than I've read elsewhere about the relevance of the iPad. I get the idea of charge capture or results review; I'm struggling with workflows common to seeing patients in ED, ICU, in consultation, or in a busy ambulatory setting, where the iPad (or even Tablet PC) is tightly integrated. Perhaps the current NextGen or Allscripts interfaces are fine as is, whether on a PC or an iPad. Forget about app-ifying them.

    Thanks for your thoughts, Lyle.

  2. I agree that IPad plays a big role in e-health, but some questions are still unanswered. I search some sites on net which provides you online medical transcription services.

    Steve Parker

  3. The ipad will only work if the emr is web based or a vnc connection is made to a more powerful computer. Most of data entry is not done in the room, its too awkward... still, its nice to be able to recall something about the patient you haven't seen in a year via emr. Old Joe who walks in every week will unlikely benefit from emr because the doctor has his entire medical record memorized by then.

  4. Interesting read. Thanks for sharing this info article.

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  6. Anonymous4:14 AM

    The best iPad EMR on the market, hands down is drchrono.com.
    Check out some of there stuff...



  7. Anonymous9:13 AM

    Most well designed web-based EMR can be used/accessed by the iPad easily, via wifi and work great with the browser .We may not need specific applications for that.