EHR use on an iPad is not ready for prime time. This opinion is being offered by a technology geek. Our home has six iPods, two iMacs, a MacBook, an iPhone and two Samsung Delve phones, and a Dell laptop PC, plus a wireless router, back-up hard drives, and a printer/fax/scanner. Our practice has an automated phoropter, computerized tonometry instruments, a pachymeter, topographer, and retinal nerve fiber layers analyzer, plus our trusted old visual fields machine and a brand new aberrometer. Today’s optometry practice can drown in technology and that can cause some ODs concern if they are not tech savvy.
When doctors consider EHR technology, they don’t want to be anchored to a computer to care for a patient - we often hear about desires for user simplifications like touchscreens and voice recognition and portability of computers. In the last month, I cannot begin to count the number of questions about EHR compatibility with the new iPad. While it is not easy to appear against a cool new technology, EHR is best managed by sturdy, powerful desktop computers.
Practically, doctors do not think completely enough about the issues of office hardware when they adopt EHR. When our web-based software product was new, we told doctors that all they needed was a PC or Mac with a 17″ monitor and a high speed internet connection, and that was a mistake. While our original recommendation was true, the internal guts of the PC or Mac made a huge difference in user experience. We evolved the standards to a point of “recommended” standards instead of “minimum” requirements. Lots of memory (RAM), a large high-definition screen, a keyboard with a full numberpad, and a high speed processor significantly improve the user experience. Rarely can you get those features in portable machines — laptops, tablets, and now, iPads.
Doctors think that their EHR implementation will be easier with a computer that can be carried under one’s arm like a paper chart, that can be placed on one’s lap to retain the traditional doctor facing position to the patient, and that allows the electronic record to be along for the ride no matter where the doctors goes. But portability must be put well down the list of priorities when considering EHR hardware.
Here’s why: data entry. Portable computers do not provide as efficient data entry means as desktop computers. Can you enter data on a tablet easier than a desktop computer because it has a touchscreen? Some you can, some you can’t. It looks cool to see someone demo EHR on a touchscreen but not all data is entered effectively in that way. Can you enter data into an iPad easier than a desktop computer? I don’t think so, unless you carry around a Bluetooth keyboard or buy a bunch of docking stations that include a keyboard. And don’t forget about the other issues with portable devices — you have to plug them in to keep the battery charged and batteries do run down based upon intensity of use, and portable computers are at risk of breakage when dropped, and they are sensitive to Wi-Fi connection reliability and speed.
I’m telling optometrists to not be distracted by the stories about how great it might be to have an EHR on an iPad because the iPad does not yet offer easy data entry capability. Doctors type into EHRs regardless of the number of dropdown menus, autofill fields, or other cool data fill features. That means that data entry will need to be done by pecking on the iPad’s flat screen keyboard, which is nearly impossible.
Test it yourself; go to an Apple Store today and pick up sample iPad. Hold it like you want to hold it while sitting on your exam stool - you’ll find it’s not a laptop device, so it needs to be put on the counter in the exact same place you’d put a desktop computer. Then test the data entry capabilities — go to the Safari browser and type in www.mapquest.com and start typing in a search for directions from your home address to your office. It’s an exhausting experience that will prove my iPad-is-not-for-EHR point.
When you are done testing an iPad, you might very well buy one for browsing the web or checking email at home. But you will not come away thinking that an iPad is an efficient EHR device. This geek believes there will be a day, but it’s not today.
