Tripp Weeks, President of XLEMR, sent over an interesting list of concerns he and the people at XLEMR are going over when it comes to the iPad. As most readers know, we’ve talked about the various iPad EHR options many times before. However, I think Tripp’s analysis of the challenges and concerns of EHR on the iPad are worth a much larger discussion. So, here’s Tripp’s comments (with some minor revisions by me).
1) Readability – The ipad only has so much glass, our clients constantly ask us to display more details at a larger font on our larger piece of glass. Our strength is that we can easily scale Excel as needed to satisfy this request.
2) Speed – My personal observations of ipad users are that:
a) Data Entry – They only seem to look at the iPad, not actually use them for any real data entry other than a Web Search. Your point about a stylus is excellent, but I am just not convinced it will be any faster than using a stylus on our convertible based tablet solutions. Doctors frequently don’t use the stylus and prefer the keyboard and mouse.
b) Navigation – When they want to do something simple like calculate some numbers, it takes iPad users longer than it takes me to do it in my head. There seems to be a lot of “drill down” to get to where you want to be. While our application presents nearly all the data on a sliding window which is very fast navigation.
c) Comfort – Learning an iPad Application with as many data entry points as an EMR has is going to take training. This is a deal killer for most applications that are considered “too complicated to use” because it takes the physician too long to get the job done.
3) Cost – Our product will not be “free” it will cost approximately $400/month because it delivers this much value. I am concerned that the iPad market will not support this cost.
After reading our previous iPad EHR posts Tripp also offered this summary of our previous discussions and the missing discussion about speed on an iPad.
1) Buzz – It’s what’s cool.
2) Tool or Toy – Seems to be more toy than tool.
3) RDP – Quick and Easy and cumbersome.
4) Speed – I was fascinated to NOT hear SPEED discussed anywhere in the blogging. Our EHR application is as fast as Excel, which is dang fast, like instant. And yet our clients constantly want to go even faster and at the same time demand we capture even greater volumes of information. I feel we have seen all Certified EHR’s need to increase the data capture volume to meet current MU requirements, you can bet this will only increase in the future. I admit that I don’t have an iPad. But when I see iPads in practice in meetings and in public, what I see isn’t even close to as fast as my clients would demand for comprehensive medical data capture… And SPEED is the deal killer, I have witnessed the big box EHR’s get thrown out time and time again over issues that all fundamentally all boil down to lack of SPEED.
Some really interesting points of discussion. I love when EHR companies open up their discussion like this to a broader group for discussion and understanding. Reminds me of my early days of blogging and participating on the EMRUpdate forum. We’d have these type of discussions all the time.
My quick thoughts on some of the points above.
I agree that most doctors don’t and won’t do much data entry on the iPad itself, but mostly will use it as a viewing device. The exception might be for things like orders, prescriptions, diagnoses codes and billing items. However, I haven’t seen many people using the iPad for the other charting. Nurses capturing vital signs is another place where data entry on the iPad can work well. I’m interested to see some voice recognition enabled EHR software on the iPad. Although, the iPad processor might not be ready for this type of experience…yet?
$400/month will definitely not be supported by the iPad market. The standard for iPad EHR software up until now has been free. Or I guess I should say that the cost has been bundled into the price of the EHR. I think charging for the iPad software itself would not go over well.
Speed is an issue on the iPad. Although, I think there are 2 parts of speed. One is speed of navigation. The second is speed of data entry. I think the iPad is as good or better than any device when it comes to speed of navigation. It’s the speed of data entry where I think it’s still in its infancy.
Hey John, Excellent Job rendering our e-mail discussion in your blog. I’ll be monitoring this discussion as an industry we iron out the strategic wrinkle of the iPad… 🙂
Here is a blog by our friend Jonathan about this topic:
http://www.bnjcc.com/ipad-tool-or-fad/
If an iPad EHR has all those issues, it means the EHR is not designed properly. The iPad is very difficult to develop for and it’s not easy to create an EHR without issues. No matter how good, there is always room for improvement.
But the iPad is a great pathway into the future. It forces developers to create a simpler navigation and easier ways to enter information. The iPad creates a wealth of possibilities like an Onboarding App that links to an EHR.
Disclosure: I work for Drchrono, developer of the first Meaningful Use certified EHR on the iPad. And yes, we are developing an Onboarding App that will link to our EHR.
Hey Hong,
You are certainly correct, our EHR was designed for Excel, and thus Excel navigation which functions on may platforms, but is cumbersome on the iPad/iPhone.
Because speed is critical to EHR success, I want to find a Time and Motion Study that looks fundamentally at Speed. I think this would be ideal:
1) Every day Common NON-EHR function Test
a) Post Status to Facebook. “Conducting a Time and Motion study of the iPad vs Tablet PC, are you interested in the results?”
b) Google Search “Time and Motion Study Excel Download Free”
c) Download and Open Time and Motion.xls and create metric capture columns for iPad and Tablet PC.
2) Every day Common EHR and Business Test
a) Send Meeting Invitation to 5 People in your contact list for a http://www.GoToMeeing.com Conference call today at 3:00pm via V-calendar with details.
b) Move Conference call to 4:00pm and add 1 person and remove 1 person
c) Call into Meeting using Skype manually key in phone number, Conf#, CallerID, and stop timer on first ring. Demonstrate Participation of GoToMeeting and Skype running simultaneously.
3) Every day Common EHR only Tests
a) Lookup ICD-10 Codes for “Sleep Disorder”
b) ePrescribe Drug for Sleep Disorder
c) Review Chart of Lab Tests for last 5 A1C scores in Graphical Format, Not Table.
d) Capture Medication Dose Change, Update Assessment “Reduce Dosage due to digestive issues” and Plan “Check Labs in 3 weeks” (Speech Recognition is allowed)
At the end we could see what the time differential is between the two platforms and then create a simple calcualtor that would show based upon individual work habits which platform would be best for any given provider.
What do you think about this idea?
Tripp,
While I would love to see a study like the one you’ve mentioned, I think we would be able to tell the difference between the 2 EHRs if there is dramatic difference in speed.
By speed, we are talking about workflow and workflow is hard to master. One way to improve workflow is bring everything into one place and have tight integration. By using a native iPad App, you’ve already eliminated the time you’ve spend on your first point.
Per your 2nd point, if the EHR had integration with a video chat, it would also save you lots of time. One thing we’ve been looking at is integrating Facetime with our EHR, allowing doctors to interact with patients & doctors. The iPad really opens up new opportunities to streamline workflow.
Completing your final task shouldn’t be a problem if the EHR is designed well. Looking up codes, prescribing drugs, and changing dosage should be a click away and it shouldn’t take too much time. Allowing you to finish your note before the patient leaves is something we stride for and it’s should be a requirement for any good EHR. It should really be that simple.
I blogged a long time ago that the iPad will not do well with EMR. The device is too slow, too small (just a little) and the touch screen does not perform well with button-dense EMR templates.
We docs need something better than just a viewing device. We also need to document some and we need to initiate workflow.
My next tablet will probably be a Win7 Asus.
Honestly a quick browse of website http://www.eKlinik.com will change one’s world view of iPad’s role in EHR management. Hong has correctly indicated iPad’s true value if running EHR applications designed for mobile web based systems; not apps written for desktops and worse still for LAN architectures. Try the iPad on apps written for browsers and welcome to the world of mobile wireless healthcare cloud computing. Rgds