Apple iPad and Electronic Medical Records – Could it Replace the Physician’s Clipboard?

Having had the opportunity to visit nearly a dozen academic medical centers in the past few weeks, I saw quite the spectrum of IT systems – from simple order entry to fully-integrated decision support systems. And for programs with the former, that revelation was quickly followed by the timeline for the coming upgrade. But what’s next for the most IT-savvy institutions? Well, Steve Jobs thinks he has an answer. Rumors abound that Apple is already pitching the iPad in LA-area hospitals as the replacement for the old physician clipboard. For outpatient practices already running a Mac-based EMR, MacPractice has already announced development plans for an iPad interface. According to their press release, they plan to develop apps that will allow patients to fill out registration, medical history, and other forms on the iPad. For physicians, it will integrate with the MacPractice EMR to manage schedules, view patient records, and even enter clinical notes. So could the iPad become the new best friend of healthcare providers? Well, there are a few challenges that need to be overcome first but the opportunities are exciting.

First, it has to be useful enough that I’m going to want to carry it around and that usefulness largely rests on the ability to write on the iPad. As we’ve discussed previously, handwriting functionality does appear to be coming to the iPad. But just having it isn’t enough. It has to really good. As experience with previous tablets has shown us, most of us can type faster than we can write on a tablet screen. So for me to carry around an iPad, that handwriting functionality has to be good enough that, at the minimum, I don’t get slowed down by using it. Either that, or the dictation apps have to learn words like “heliotrope” and “sulfasalazine.” Granted, order-entry can probably work well without this functionality (all you need is a good user interface with an excellent search for medications and tests). But if the iPad is going to be my sidekick, it needs to relieve me of the chore of finding a computer to enter orders and write my daily progress notes.

Second, even if the functionality is all there, the fact that the vast majority of EMR’s run on a Windows OS is another challenge. While Citrix has released an app that enables the iPad to run Windows 7 remotely, which would conceivably allow one to access any Windows-based resource, we would then lose the user interface that made us want an iPad in the first place (having to spend a lot more money to do it). That being said, the Epic-Apple partnership clearly found a way to make it all work with Epic now having released Haiku, the fruits of their pilot at Stanford. That on the iPad plus the functionality I just talked about – then we’ve got something.

The day is probably not far of where a tablet like iPad becomes a healthcare provider’s primary portal into the their health IT system. Issues like battery life (I suspect 10 hours will be a stretch), infection control, multitasking, and ports for peripherals – these can all be improved in the coming iterations of the iPad. One thing worth remembering though – Apple’s Windows-based competitors will not be as far behind this time (see number 9).

[Side note: Now you may wonder “what’s the clipboard for if you work somewhere with an electronic medical record?” Well, the fact is most providers don’t like running to computer every time they need to check what dose of antibiotic their patient is on or what type of COPD they have. So we carry printouts with that information. I, for example, carried my patient’s admission notes (which generally detailed their past medical history) and an EMR-provided daily summary of their medical condition(s) and medications/doses. The advantage with paper though, I found, was that I could ditch the clipboard with a few folds and an empty pocket.]

Author:

Satish Misra, MD

Satish is a Cardiology Fellow at the Johns Hopkins Hospital in Baltimore, Maryland. He is a founding partner and Managing Editor at iMedicalApps. He believes that mobile technology offers an opportunity to change the way health care is delivered and that iMedicalApps is a platform through which clinicians can be empowered to lead the charge.

7 Responses to Apple iPad and Electronic Medical Records – Could it Replace the Physician’s Clipboard?

  1. StatCoder February 5, 2010 at 8:41 am #

    Do you think that these iPads will be owned by the clinicians or deployed by institutions? Starting at $500, these devices are less expensive than most smartphones if you consider the cost of the data plan.

    Given the restrictions imposed by IT departments and other hassles, I believe that most iPad users will own and maintain their own devices. If it’s really going to be a personal data assistant like a traditional PDA or smartphone then it will need to incorporate non-work related functions, also. I have no doubt that we will begin see iPads in clinical settings in the next few months.

    Regarding handwriting functionality, I’m not sure how much that will be developed. There will be the need for some kind of text input that can be accomplished while standing and holding the tablet with one hand.
    _____________
    StatCoder.com
    Unique Clinical Apps for iPhone/iPod Touch
    http://www.statcoder.com

  2. Iltifat Husain February 5, 2010 at 1:27 pm #

    StatCoder-

    I think the point about these devices being cheaper than most smart phones (without the data plan), is a good one. And I agree, I think they will first be accepted by personal users first, and then later with IT departments. I think many IT departments are really waiting to see how they will be embraced by the physician community before they roll out many pilot studies.

    • Donald Tillman March 12, 2011 at 7:02 pm #

      Many are rolling them out NOW! With Citrix being available for the iPad, corporations are NUTS to spend money on trouble-making Windows PC’s. Spend less money and have more control over Windows running Windows remotely with an iPad. The future is here!

  3. Jared Houck April 7, 2010 at 2:11 am #

    There is a large gap between what many HOPE the iPad will do and what it actually CAN do. Tablet PCs have been on the market for many years and promised many of the same things. The limiting factor has been (and most likely will continue to be) software. In the US, the ARRA certification (via the HITECH stimulus) will be the badge that differentiates what healthcare facilities will actually support and purchase. I’ve listed another 10 reasons the current iPad will not be significantly deployed in healthcare if you have the time.

    • Don Tillman March 12, 2011 at 7:06 pm #

      There is BIG difference between the iPad and “tablet” computing as it was sold to us my Microsoft. First Microsoft made it’s first mistake by essentially “hacking” windows to handle pen input. The iPad on the other hand was designed from the ground up to be a HIGHLY functional tablet, with the OS being designed around the best tablet experience. Regardless of this amazing design, it is still running OS X underneath. That said is has all the power and security you would want without the headaches of support Windows..

    • Don Tillman March 12, 2011 at 7:09 pm #

      There is BIG difference between the iPad and “tablet” computing as it was sold to us my Microsoft. First Microsoft made it’s first mistake by essentially “hacking” Windows to handle pen input. The iPad on the other hand was designed from the ground up to be a HIGHLY functional tablet, with the OS being designed around the best tablet experience. Regardless of this amazing design, it is still running OS X underneath. That said is has all the power and security you would want without the headaches of supporting Windows..

  4. Michael Padilla,L.Ac April 3, 2011 at 12:42 pm #

    “The advantage with paper though, I found, was that I could ditch the clipboard with a few folds and an empty pocket.”

    -An iPad will fit in a lab coat pocket :)

Leave a Reply

Your email address will not be published. Required fields are marked *