For physicians and other medical professionals who are fans of Apple, MacPractice has been the go to electronic medical record for many.  Because of this, it has been surprising MacPractice has not offered a native iPad solution to their EMR.  To be clear, MacPractice has offered a jerry rigged iPad solution – via a VNC interface.

Having to use a VNC interface to access your electronic medical record is not ideal – essentially, you have to use a VNC app on your iPad that allows you to view what MacPractice looks like on your desktop computer – enabling you to control your desktop. You know the situation is not ideal when the MacPractice website has to have a “Tips and Tricks” section for those trying to use the MacPractice iPad VNC Interface.

As an anecdotal example, at a MacPractice demo I saw at my local Apple Store earlier in the year, many of the medical professionals in attendance who use MacPractice were voicing their issues with a VNC interface to the MacPractice representatives on hand – it appeared to be their number one concern.  Needless to say, MacPractice has finally brought an iPad interface that does not require linking to your desktop computer – and I’m sure health care professionals with iPads who use the EMR are breathing a collective sign of relief.

In addition to the iPad interface, MacPractice has also included ePrescribing within the iPad as well – working in a similar fashion to how ePrescribing performs on the native desktop EMR interface.

The following are just a few of the benefits MacPractice is touting with their iPad EMR interface:

Among the capabilities that come along with the new MacPractice iPad Interface with ePrescribe: doctors can create new patient records in MacPractice from the iPad and post procedures and diagnosis from outside the office or in an exam room, daily practice activity reports can be reviewed easily from outside the office, reminders and notes may be sent between the office staff and the doctor, and email may be sent to patients and referring providers. MacPractice users can also see their office schedule as well as patient photos and demographic information. In addition, doctors and assistants may now review and record patient vital statistics and chronic diagnoses, and review prescription history and allergies when seeing a patient, all on an iPad.

Further Details: MacPractice Press Release

This article is part of our HIMSS 2010 coverage. It includes an overview of the MacPractice EHR and its iPhone interface as well as a conversation with Mark Hollis, CEO of MacPractice.

One of the key’s to Apple’s success has been the reliable, simple, and fun UI it has designed for every one of its products. Part of the reason that this feature has stood out is because the Microsoft-based PC world has become known for essentially the opposite. The same is true for many electronic health record platforms built for Windows, where the same security vulnerabilities, networking complexity, and famed “blue screen of death” plague the slightly-less-than-tech-savvy average physician. For this reason, Mark Hollis – CEO of MacPractice – offers a system that runs entirely on the Mac. I had the opportunity to check out the iPhone platform tied to this EHR and also to chat with Mr. Hollis about his vision for this platform and some of the challenges it faces.

The iPhone Platform – From the start, the interface looks pretty slick. There are a number of different functions built in including a calendar of appointments, patient contact information (with a simple touch allowing you to call or email them), charge capture, patient prescription history, and referral management.

The appointment calendar (pictured here with the Rx history) basically consists of the patient’s name, appointment time, and picture. This last feature, a simple picture, is great for two reasons – it could help jog your memory so you remember who this person is (rather than just the diseases they need followed up) and it does wonders for morale (its a lot harder to be unhappy with a packed afternoon schedule when you have those smiling faces looking at you). Honestly though, I was underwhelmed with the remainder of the features. I expected more in terms of ability to view a problem list, recent notes or labs, or other information that would be useful in caring for a patient. This app, at least at this stage, seems to be geared more toward the administrative side of a physician – planning a day, getting all the charges in, etc. I hope that future versions of the iPhone interface improve on the clinical utility of this app.

In addition to this iPhone platform, there are a number of other features that make the MacPractice EHR pretty cool. Among them are the UI which Mr. Hollis noted was designed so that pretty much any office personnel can be up and running with minimal training. It can also be used by patients via a special interface to make appointments, send messages, and so on. For the tech-wary among us, it runs on networked MacBooks/iMacs without a server, which means a far simpler system to manage – according to Mr. Hollis, its not uncommon for a practice to go years without ever needing corrective service of any kind. And if they do, its often fixed with a trip to the Apple Store, thus leveraging Apple’s customer service infrastructure. Finally, its a highly customizable system – this is a particularly useful feature for small specialist practices who often require very different kinds of patient records. In fact, the basic system has been customized for dentists and optometrists as well.

While there a lot of cool features here, MacPractice also faces a big challenge from web-based EHR’s. These systems provide similar benefits – minimal setup and maintenance for example – with very low price points (as low as free). And they too are directed at small-medium sized practices that don’t want or need a complicated, in-house EHR. Mr. Hollis raised a number of very interesting points as to why he believes web-based EHR’s will join the same market space that MacPractice occupies rather than dominate it.

First, most web-based EHR’s come prepackaged, and that packaging is largely defined by the “meaningful use” criteria that will allow clinicians to get stimulus funding. However, those criteria are basically geared to primary care – specialists could be left out on this one. That’s an opportunity for customizable, simple EHR’s like MacPractice.

Second, Mr. Hollis notes that the development possibilities are far more rich using Apple’s XCode, giving him opportunities he wouldn’t have with a purely online platform. Finally, there’s the issue of reliability – what happens if your internet goes down? Clinicians who adopt web-based EHR’s will not only need high-speed connectivity, but they may also need some sort of redundancy and managing that could be a headache.

All that being said, Mr. Hollis doesn’t dismiss cloud functionality as unimportant – in fact, its likely to be essential to meet meaningful use criteria. MacPractice is exploring ways to bring data in aggregate onto the cloud for analysis and take that essential step to contributing to population health management. Additionally, they have been engaged in the development of the Stage 1 criteria, being released in June, and plan to be certified as well. I certainly look forward to seeing how this EHR evolves in the coming months.

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.]