Tablet or Desktop PC - Which is best?

I know, the title of this posting is a little ambiguous. Obviously there are many different solutions which may be applicable to the same physician if placed in different situations. If you want more information about Windows XP Tablet PC Edition, the preceding is a link to the Microsoft Tablet PC home page.

I am posting this message just before I leave my office as I have a very interesting day using a Wireless Tablet PC. I have been using a Motion Comuting M1300 Tablet PC for the past month and I am very impressed with the responsiveness and the comfort with which I am able to capture patient data and prescribe medications. I was sitting in the exam room with a patient late this afternoon and showed her how I could click and prescribe her medications directly to the pharmacy. She is quite tech savvy and enjoys learning about the uses of IT in different situations. We also reviewed her past lab results and graphed a hypertensive profile chronologically against her medication profile. Her comment before leaving was that she should tell her mother to see me as a physician, because of all the medications that she had been taking. This was not the end result I was seeking....!

However, it was also clear that my patient was suitably impressed by the technology and particularly the mobile data input that the Tablet PC provides.

Although many EMR systems will work in a Tablet PC setting, use of the Tablet PC requires a different thought process in using the EMR software. Data input is faster when using drop menus, but in my experience, slower when entering text using the handwriting recognition.

I am interested to learn if other physicians are using Tablet PCs and what the experience has been. To respond, click on the 'Comments' link at the bottom of this posting.

Comments

[John Fernandes]

I've bought a couple of tablet PC's (Compaq TC1000's) to use in an EMR setting on a wireless network.

While I love the Tablet PC's, I have had to conclude that they are simply too slow to use in a real medical setting. The startup time is way too slow - from either power off or from hibernate. Additionally, the input methods are too cumbersome to use at a speed that is comparable to handwritten notes. Opening a patient's file, accessing data, and updating/saving data are also too slow be useful. My nurse can literally walk accross the clinic, open a paper file, update the notes and refile the paper chart in less time that it takes to do the same thing on the tablet pc.
Pointing a clicking "prearranged" choices in an EMR is, in my opinion, unacceptable and tests the boundaries of professionalism. This was tested in a lawsuite in Texas a couple of years ago. A Physician was (deservedly) successfully sued by a patient whos medical information was not accurately captured due to a limitation of the EMR that was being used.

Having said all that, I have found that the best EMR I've yet seen in terms of ease of use and reliability is the Journal Note Taker program on the Tablet PC.

I literally write handwritten notes on my tablet PC. They are stored as a picture file which I can access later. My particular nuances of medical shorthand are then easily captured, and I am able to still convey immense amounts of information in just a few pen strokes.

Then it struck me: I'm using this wonderful $3500 piece of technology as little more than a piece of paper - a complicated piece of paper at that!

So, I've given up and have gone back to paper. My tablet PC's get dragged into the room when I want to go over a CT o MRI or X-ray with a patient. They are also used to fill out certain insurance application forms, etc.

While Tablet PC's are nice and amazingly reliable, they are better suited to Professions where time is plentiful.

John Fernandes.

[Alan Brookstone]

John, I think you have raised some very important points regarding the Tablet PC.

What strikes me from your comments is that we are using an immature technology within the realm of traditional thinking. Tablet PCs have only been available for about 2 years and we have now moved into the second generation versions.

The software is not yet available that fully takes advantage of the pen and tablet platform. I too like the Journal Note Taker that comes standard with the Tablet PC, but I am just starting to use a new application from Microsoft called One-Note. It too is very powerful - but has been designed for the Tablet PC from scratch. I am not aware of the same level of development within EMR systems so that the software intuitively knows what the physician needs to enter into the EMR.

It is my belief that the speed, battery and startup issues will be dealt with and if the development cycle of the Tablet PC technology is like others in the past, it will probably take an additional generation in hardware and two or more generations in software before we really have useful EMR systems that are designed to work the way that physicians work. Like you, I just love the form factor and mobility. I think we are just a little early in the cycle.

[David Woolliscroft]

Dear Alan,

Like the previous writer I am using the compaq tablet pc which, within the boundaries of handwriting recognition is working very well. The EMR is Healthquest and its strengths including adaptability have allowed me to use the system successfully.

I have had problems with the tablets being overly sensitive to the pen and subsequently 'bleeding' across the screen - similar to a leaky pen and therefore really adversely affecting the handwriting recognition, even use of the onscreen keyboard. I have tried a number of fixes and even sent the tablet back to compaq. Most of the time it works fine, but it is very irritating. Having said that I would not change back to ink and paper. I will be upgrading the tablet when I can get a better one (not HP!) and hopefully microsoft's fix for the OS will also help.

I use a lot of menus and phrase lists but I 'edit' them on the fly. I also polish off the the record between patients. Therefore the record is unique and I submit, meets the proper standard. The 'time and cost' savings we have achieved have been from more eficient review of labs, better communication, reduction in wasted staff time looking for lost paper, easier and quicker prescribing, Easier recall of previous records. These savings have allowed more time with the patients and I believe allowed for better, if not perfect, records.

I agree with your comments about immature technology and suggest it is better to play to the strengths of the system rather than expect everything to work immediately. Overall the combination of an imperfect tablet and an excellent EMR is worth it.

[Allan Horii]

I think that handwriting recognition has improved a notch with the release of Service Pack 2 for Windows XP. The interface seems to more intuitive and the recognition is noticeably better.

[Dale Taylor]

I find that desktops work best for me. I don't need to worry about leaving a tablet or laptop out in the open where it can be stolen. My computers and LCD monitors have Kensington locks to discourage the smash and grab thief. Desktop CPU's are faster and a 19 inch screen is a lot less cluttered than a 15 inch screen on a laptop. I find it easy to look at the patient while keyboarding into the EMR so I finish entering my encounter quicker than I would if I was using voice dictation or a tablet. Certainly for longer data entry such as Medical Legal reports I can see the benefit of voice recognition. Presently I voice dictate and my MOA transcribes referral and Medical legal letters. I will eventually install Dragon on my office computer rather than in my exam rooms.

Initially I worried that patients would try to use my computer when I was out of the exam room. I relaxed after installing a free screen saver which I downloaded from the Internet. It is enabled with a mouse click which causes all patient information on the screen to be hidden. When I return I enter my password and start where I left off. This program can be downloaded from
http://www.freeutils.net/savernow/index.jsp .

The one downside of desktops is that software has to be purchased in multiples so each station has a copy. I use the Adobe Reader which is free in my exam rooms but have a full version of Acrobat at my office desk to use with scanning (Acrobat was bundled with my Fujitsu scanner). I avoid software that prohibits me from using it over my network. Software makers for doctors need to realize we need to use their program in each room we are in. I decided against using the electronic CPS because I would have to pay for a network license. Licenses for software should allow a single user to access the program from multiple work stations.

[Ron Joe]

What I have been doing for a while now is to use Windows 2000 Server (Windows 2003 can be used as well). I install all my programs once in this machine. The licensing can be set to “per user”, so if your going from room to room you only need a single license. You would log in to the server using Remote Desktop which works as a thin client. You will also be released from the slow hard drive and networking bottlenecks of your portables as no actual database data is transmitted through the network, only the screen, mouse and keyboard information.

Also, no software needs to be installed on your portable.