Not long ago, I recently posted an item on HospitalEMRandEHR.com discussing how one hospital dropped plans to distribute iPads as front-ends for its Cerner EMR.  Doctors at hospital, Seattle Children’s, gave the iPad very bad reviews as an EMR-connected device, in part because they felt that Cerner’s system was too hard to use via a Safari browser.

Since then, a few readers have commented on the story, and interestingly, they’ve offered more nuanced feedback on what works (and doesn’t) in deploying a tablet as an EMR device for clinical use, including the following:

* Deploying the iPad initially offers a patient “wow factor” — in other words, it may make providers look hip and up-to-date technically — but that doesn’t last very long.

* Even a well-designed, tablet-native tablet app may still be frustrating for clinicians to use, given the high volume of information they need to enter. (Paging through a dozen screens is no fun.)

* When choosing a tablet, be aware that the physical performance of the tablet (especially the touch screen) can be a big issue.  If clinicians “touch” and the screen doesn’t respond, it can throw them off their stride.

It’s hard to argue that hospitals (and medical practices) should take mobile access to EMRs seriously. And anyone here would know, most organizations are.  After all, now that health IT industry is looking hard at mHealth, smart new ways to use mobile devices in care seem to be springing up daily.

But before you dig too deeply into your mobile strategy, you may want to hear more clinicians on how their mobile EMR usage is playing out. Call me a curmudgeon, but it seems to me that it may still be too early to invest big bucks in a tablet for mobilizing your EMR just yet.

Don’t get me wrong: I’m convinced that someday, every doctor will enter and access patient data via some sort of mobile device. But it seems that there’s some fairly important technical issues that still need to work themselves out before we can say “this is how we should do it.”

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well.

20 Data collaboration is key to patient safety
I think this tip might need to be worded, “Data collaboration should be key to patient safety.” Unfortunately, it’s a mostly unrealized dream at this point. You might even be able to say that data collaboration will be key to patient safety. There really are amazing use cases where data collaboration can improve the care patients receive. It’s a sad state of affairs that so many of the major EHR companies are dead set on protecting their walled gardens. One has even gone so far as to say that patient safety is in danger with multiple systems. Certainly there are some risks associated with multiple systems, but the benefits far outweigh the risks. In fact, patient safety is at stake thanks to those who won’t participate in healthcare data collaboration.

19 Know how customizable the clinical work flows are!
This is a good tip when doing your EMR selection. It’s incredibly valuable to understand how the EMR handles clinical workflows and how well those workflows fit into your established clinical workflows. I’m a proponent of doing the best you can to use established workflows when implementing an EHR. Then, over time adjusting those workflows as needed to gain more efficiency.

18 How easy is it to customize the system overall?
I’d take this EHR tip from a couple angles. First, is how easily can you customize the EMR system. Yes, some of it could be the EMR workflows that I talked about in EMR Tip #19 above, but it could be a whole set of other options (billing, scheduling, messaging, etc). The second part of this suggestion relates to how well this EHR will adapt to the constantly changing clinical environment. Will they be able to handle ICD-10 without too much pain for you? Will you be able to make it work in an ACO environment? Healthcare is constantly changing and so you want to make sure your EHR can be customized to fit your changing needs.

17 Know work flow can be hard coded to ensure compliance.
There are times when hard coding the workflow is incredibly valuable. Certainly this will frustrate some providers, but if done correctly most will understand the need to hard code the workflow to ensure compliance. It’s a fine line to walk, but there are plenty of instances where hard coded workflows can do wonders to improve the care you provide.

16 Ensure easy access to the system via multiple platforms.
As much as providers might not like checking in on the EMR remotely, it’s often absolutely necessary. So, it’s important to ensure that your EMR is available on every medium possible. Can it be connected to remotely? Does it work on the latest devices? Yes, the iPad has a huge portion of the physician market share right now, but we’ll see how long that lasts. Every year a new device comes out and you’ll want an EMR vendor that’s keeping an eye on this movement and making the EMR available on the best technology.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

I found this great article which highlights a number of the reasons I’ve been saying that the iPad needs its own native EMR interface and not just some Virtual Desktop solution to access your EMR.

First it offers two reasons why the Virtual Desktop solution is a good option:
-Security
-Cost

The first benefit of security is a good once since as long as your virtual desktop and access to your virtual desktop are secured, then you don’t have to worry about healthcare related data on the iPad. The second benefit is mostly a benefit to the EMR software vendor. Sure, they could make the argument that the price to develop a native iPad app is passed on to the end user. However, most doctors won’t feel that cost. In most cases it just means that other features on the EMR development roadmap will just get pushed back. Although, even this can be a bad strategy if your developers are good at developing EMR software on your current platform, but aren’t familiar with developing a native iPad app. Then, it’s worth spending some money on an iOS developer who knows which features of the iPad they can really leverage.

Now on to the reasons the article suggests that you develop a native iPad app and not just do the virtual desktop solution:
-Doesn’t Make Use of Native iPad Functionality
-Requires Constant Connectivity
-Virtualized Apps are Not Optimized for the iPad

The first and third in the list are very much related and are the biggest reasons why a native iPad EMR app makes so much sense if you’re going to do something on the iPad. The second item actually doesn’t apply very well to an iPad EMR app which even when created as a native app will likely need to have internet connectivity to have any value. An EMR iPad app could be made that didn’t need connectivity, but I have yet to see one that’s done that.

The holiday season is officially upon us, or so said both of my daughters after they saw Santa Claus conclude the Macy’s Thanksgiving Day parade. Black Friday and Cyber Monday have come and gone – not unnoticed by the average American consumer if recently released retail figures are any indication. The economy seems on the verge of a slight upswing, if our holiday spending this early in the season is any indication.

How does healthcare fit into all this? Two holiday headlines recently caught my eye. The first, “Apple Breaks Black Friday Record,” notes that iPad sales “surged 68%” that particular day, breaking the company’s own purported predictions that it would achieve Black Friday sales four times higher than normal. The second, “Mobile Healthcare and Medical App Downloads to Reach 44 Million Next Year, Rising to 142 Million in 2016,” makes the prediction that “[a]cceptance of new healthcare practices like remote patient monitoring will come directly from consumers becoming engaged in mHealth through the smartphone.”

Forty-four million medical app downloads next year might not be such a high number to reach when you take Apple’s record one-day iPad sales into consideration. Physicians and healthcare consumers alike seem to not only be jumping onto the tablet bandwagon, but gearing up to race it to the finish line as well.

So now that we’ve established the healthcare connection, what’s all this got to do with EMRs? Will these predictions and likely outcomes coincide with an upswing in mobile EMR app development? As of yesterday, 60 apps popped up when I searched for “EMR” apps for the iPad in the iTunes store. Forty-seven results came up for “EHR,” many of them the same. I’ll be interested to see what this number is six months and then a year from now.

As this blog has well documented for some time now, healthcare’s love affair with the iPad was a slow burn at first, but has now become fast and furious. I can only imagine that EMR developers will take their relationships with the iPad to the next level in record time just to meet customer demand. While I won’t necessarily be waiting with baited breath for Practice Fusion’s launch next year of its iPad app, I will definitely check it out while at HIMSS, where I assume they’ll give it a Vegas-style launch.

I’d love to hear from physicians as to how inundated the market is likely to become with these types of technologies. And aside from EMR/EHR apps, will mobile health downloads really take off as predicted? Share your own predictions in the comments below.

Full Disclosure: Practice Fusion is an advertiser on this site, but they didn’t pay Jennifer to mention their iPad app. In fact, I’m not even sure if Jennifer knows they’re an advertiser.

I’ve written many times about the amazing phenomenon that we call the iPad and particularly how EMR vendors are reacting to the widespread adoption of iPads in healthcare. As I’ve written these dozens of articles, talked to hundreds of doctors, and far too many EHR vendors it’s become clear to me that an iPad interface is basically a Must Have feature for an EMR.

No, I’m not talking about some remote desktop type connection from the iPad to an EMR. Yes, every EMR is available on the iPad using a remote desktop type application. While that’s neat that it can do that, EMR vendors whose whole iPad strategy revolves around remotely accessing your PC which can run their EMR software are missing out on the real benefits of the iPad. The love affair that so many people have with their iPad is much more than just remote connectivity and a small touchscreen device. If that was all that mattered, tablets would have gone mainstream in healthcare long ago.

If an EMR vendor wants to leverage what’s made the iPad so popular, they need to create a native iPad app that can interact with their EHR software.

I’m not talking about replicating your entire EHR software on the iPad. That would be a mistake as well. Does your biller really need to do the billing on the iPad? Do you really want to do all your documentation on the iPad? Probably not, but with some thoughtful discussions with your existing EHR users, I think vendors will find some real value in leveraging the iPad technology connected to their EHR software.

I can imagine EHR vendors that create beautifully done iPad EMR apps will do very well in the market. Why? Because the doctors that love their iPad EMR app will start showing it off to their doctor friends.

My biggest fear with this commentary is that far too many EHR vendors are busy coding for meaningful use and EHR certification that they’re not looking for smart ways to leverage technologies like the iPad. Time will tell how this plays out, but I’ll be surprised if the iPad doesn’t play a part.

Could the iPad app of an EMR vendor become a real differentiator between the 300+ EHR vendors out there today? I’ve long believed that the biggest problem with EHR software today was their interface. The iPad is all about a new interface.

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.

One of the regular EMR and EHR readers, Judy, recently took up the challenge I posed in my previous post about Every EMR Vendor available on the iPad. She downloaded the LogMeIn Ignition app that I mentioned in that post and tried out her PIMSY EMR software on it. Thanks to Judy for sharing her experience.

The following is her experience and review.

I tested the new LogMeIn app to see if I could access PIMSY EMR from my older Droid and from an iPad. It takes a little getting used to: you have to familiarize yourself with how to navigate on the screen and how to change the size to get the screen view that works for you. Once you get that done you are good to go. That said, there are 2 ways to change the size: a magnifying option at the bottom of the screen or a zoom in bar on the right hand side; you can enlarge as much as needed. There are also 2 options for moving around: you can move the screen with your finger (the cursor stays put) or you can move the cursor like a regular mouse; I prefer navigating around the cursor. Both options make it simple to maneuver.

If you’re used to texting and typing on a smaller keyboard, it will be easier to adjust. The app itself gives you a keyboard that takes up approximately half the size of the screen, so larger phone screens like Droid 2 or iPhone would have a bigger keyboard than a regular Droid, and the iPhone keyboard was comparable to a regular size. For those who aren’t used to navigating and typing on a phone screen, there will be an adjustment period. If you’re connected to dual monitors, you can easily switch to either one, and I was able to watch a video.

The speed is slightly slower from phone or iPad to computer but very good from computer to computer. The app is not offered on a Blackberry. I would highly recommend this app to anyone who wants to connect to their desktop remotely; it worked great to get into PIMSY. Well worth $29.99.

I’m about to make a big announcement about the iPad. Something that every iPad loving doctor will be happy to know about. It’s a simple announcement, and something many of you probably already know: Every EMR software vendor out there is now available on the iPad.

That’s right, you can pretty much run any and every of the 300+ EMR companies software on an iPad. All it takes is an iPad, a cell or WiFi internet connection and some form of remote desktop application. There you go, I solved all the EMR companies iPad strategy problems.

Practice Fusion sent out a press release recently about support of the iPad for their Free EHR. In the press release they highlight a number of the benefits of access to an EMR on the iPad and they describe the use of the EMR iPad model that I talk about above. They use the remote desktop app for mobile devices called LogMeIn Ignition. $29.95 and you can connect to your computer from your iPad. Not to mention that it also support Android and Windows. Yes, that’s right, I guess we could also say that every EMR software is available on Android and Windows phones and tablets as well. Of course, there are also some free RDP options as well, but probably aren’t quite as easy to configure.

Now, I’m sure the purest out there are going to come and say that there’s a lot of difference between a remote session to your computer than a native iPad EMR application. They’re right. In some ways, the remote connection to your computer is better. There’s no new EMR interface you have to learn. You have remote access to all the files and programs on your main computer. You have all the preferences you’re use to having at your desk. I could go on, but there’s certainly some benefits to remotely accessing your computer on an iPad.

Some might argue that the latency (Translated: slowness) of a remote session could be a major issue. I think these comments are from people on super slow connections and/or people who haven’t used the latest remote desktop sessions. Remote access has come a long way and the experience of using a computer remotely is almost as good as being at the computer itself.

The more important argument that I’ve left out is actually the EMR user interface. The problem with most EMR user interfaces is that they were designed with a mouse and keyboard as the input devices. The keyboard can generally be overcome with good templates, voice recognition, the iPad keyboard, etc. However, the mouse is a more difficult challenge since the precision of the mouse is so much better than your finger (This is the true fat finger issue).

Point being that while you can certainly access your EMR remotely on the iPad, it’s going to be important to know how well your EMR software is designed for a touch screen interface. Spacing of elements in your EMR, size of buttons and a number of other design elements can drastically change your experience using a touch screen interface. Plus, that doesn’t even cover the unique touch screen gestures that are available like swiping, 2 finger taps, etc.

Yes, it is fair to say that EVERY EMR software out there can be run on an iPad. However, that definitely doesn’t mean that you will want to run that EMR software on the iPad. The good thing is the cost to try your EMR software on the iPad is really low. Once you’ve tried it out, let me know your experience so that others can learn as well.

At least that’s the case that was made in this blog post on the Software Advice website. The post is a few months old which is centuries in the tech world, but I have to disagree with them on their take that EMR vendors are slow to move their products to the iPad platform. In fact, I mentioned in their comments that I think every single EMR vendor has an iPad strategy.

They do get it right that doctors are adopting the iPad at a really dramatic pace. Here’s my reasons why it’s been so popular:
1. Battery life that lasts a full shift
2. 3G and Wireless Connectivity
3. Intuitive interface
4. $500 price point

We’re still waiting on some enterprise features that it seems like the Blackberry Playbook is trying to implement for healthcare. However, I’m pretty sure they’ll get there in time or someone will create an app that will create those features anyway.

Back to the iPad, the article only states 2 companies that have an iPad EMR offering. There are many more than that. I’ve seen some from Practice Fusion, GE, and VitalHealth to just name a few.

What I haven’t yet seen is how well doctors like the use of their EMR iPad interface. Is it really that usable for a doctor doing his rounds? Does it work well for clinical documentation? Is it a nice compliment to a desktop environment?

Sadly, I still can’t give my first hand account of using an EMR on an iPad. I got my refund from HIMSS since despite all the free iPad giveaways I came home without one. Oh well, the iPad 2 is out now and it would have been a shame to only won a first generation iPad. I’m told by Christmas there may even be an iPad 3, but I digress.

What might even be more interesting than EMR use on an iPad is the other creative ways that people are using iPads in healthcare. For example, I’ve heard of people using an iPad as a check in device for their clinics. There’s something cool about handing over an iPad instead of a clipboard for your patients to fill out their paperwork. I’m sure some patients would hate it, but I for one would be much happier feeling out the stack of paperwork electronically.

The iPad has been a regular topic on EMR and EHR since last year when we first wrote about the Apple iPad EMR. While it’s normal for there to be a lot of hype around the announcement of a device like an iPad, I must admit that the hype around the device hasn’t really slowed down any.

If you’re a blogger and want your article read, all you need to do is mention your iPad and people will click through to read about it. I’m not immune to it either. Just take a look at the list of giveaways at HIMSS. If you’re not giving away an iPad, then you probably don’t belong there.

One healthcare IT vendor on a HIMSS LinkedIn thread recently said they were giving away an iPod at HIMSS. Turns out that was mistake. Of course, he meant to say they were giving away…wait for it…an iPad. Think how lucky Apple is that hundreds of iPads will be given out at the largest Healthcare IT conference on the planet (30,000 people attending). Plus, Apple didn’t even have to pay for the promotion.

With all these free iPads hitting the healthcare IT world, I wonder how many more iPads will be purchased. Now some might wait to see what the second generation iPad will look like (I wonder if some creative vendor will giveaway the second generation iPad instead of the first generation), but no doubt there’s some mythical quality to the iPad. You see someone else using it and want one. At least I do. I’m not even sure why I want one, but I do. It’s not because everyone else has one cause I like to buck trends. However, there’s just something really nice about the form factor of the iPad tied with all its apps.

The real question is how well will the iPad do in an enterprise situation. I’ve started to see stories come out talking about the challenges of IT staff in supporting and deploying large numbers of iPads in their organizations. One such story had the CEO promise everyone iPads for Christmas. Then, the CIO had the amazing challenge to distribute and support thousands of iPads in their organization. You can’t take back a Christmas gift.

Since this is an EMR and EHR site, let’s just say that from my point of view, the EMR and EHR apps for the iPad still have a ways to go. I’ll be sure to do an informal poll of all the EMR companies I talk with at HIMSS about their “iPad EMR strategy.” I’m certain that they all have one. I’ll be interested to know EMR companies various approaches.

Of course, if you don’t like to run with the popular kids, maybe you should check out the Blackberry Playbook in Healthcare. I’ve heard it’s a great device and maybe they’ll actually care about the enterprise. I’m pretty sure the iPad is positioned that they won’t care all that much about the enterprise.

If you are going to HIMSS and want to learn about my giveaway. Tomorrow, I’ll post the details on EMR and HIPAA about how to win a 42″ HDTV. That’s over 4 times as big as the iPad’s little screen.