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. He is a founding partner and Managing Editor at iMedicalApps. He believes that mobile technology can change the way healthcare is delivered and that iMedicalApps is a platform through which clinicians can be empowered to lead the charge.

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