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Intelligent Healthcare Information Integration 2/5/10

February 5, 2010 News 4 Comments

In Defense of Tablets

The good DrLyle recently sent a submission to these hallowed pages in which he stated, “…it is well known that the general idea of using a tablet in healthcare has tried and failed multiple times.” Hmmm…

Now, this isn’t the first I’ve heard of people poo-pooing the pen tablet as less than functionally desirable for doctoring duties. But, it inspired me to offer a defense of our little PT pals, a form factor which works in our office every single day.

Maybe having a desktop PC in every exam room works in an internist’s office, but when I see what the children do (and what the parents let them do) to our beautiful office space every, single day …Hoo Boy! I simply can’t imagine the condition of exam room PCs nor the cost of repair and replacement over time. We have video monitors in recessed wall boxes behind protective Plexiglas panels in each room for patient educational and PR purposes; even those have been pried into. The images of spilled goo and repeated poundings that a desktop would take in an exam room, if unattended by a staffer for even a few minutes, makes me shudder.

Currently, we use Lenovo X200 convertible pen tablets. They fly with Windows 7 and their battery life is much better than the Lenovo X41s we used previously. (Our EHR isn’t completely compatible with Windows 7/IE8, but the speed gain is worth the few glitches or inaccessible items. Besides, compatibility will be full-blown soon and we have a few XP machines around to access those items when infrequently necessary.) We often use them more as laptops than tablets; most of us prefer the regular keyboard and TrackPoint to the onscreen keyboard and pen. Still, the flexibility is there and we do employ all the different configurations at various times.

I haven’t yet seen a data input device — short of a scribe — that works as well as the old pen and paper in a busy, noisy pediatric office. Tablet pens, mice, TrackPoints, voice recognition, trackballs, regular or on-screen keyboards, handwriting recognition — all have their workflow problems. But the TrackPoint and keyboard combination, in our regular day-to-day chaos, works pretty well for us. Voice recognition is becoming a second choice away from the noisy hubbub, though I am admittedly slow getting going with it. (No excuse… just one of those cool things that keeps getting put off while life pressures edge it from the top of my To Do pile.)

It isn’t perfect, our little pen tablet arrangement. But, desktops wouldn’t be either, at least in our world. Plus, we never have an issue with turning our backs upon our patients to address the PC, something a desktop might require and which could sometimes be dangerous with our “rambunctious” clientele.

For now, I stand by — and with — our pen tablets.

From the trenches…

“I know that you believe you understand what you think I said, but I’m not sure you realize that what you heard is not what I meant.” – Robert McCloskey

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.

Comments 4
  • Well- no reason to try and defend a blanket statement implying all tablet devices have failed- GA clearly has explained that there can be a time and place for everything. But I do still feel my point was sound- that tablets have certainly not proven themselves to be world-changers, and in fact many providers have been lulled into thinking they would easily replace paper and then are quickly disappointed by how much they weigh, how hard it is to input data, how hard it is to see data… albeit that this is even more true via my bias of practicing outpatient primary care. As mentioned, I think tablets will make more sense in some acute care settings where a provider has to be in many places, and the issue at hand is more focused (e.g. pt with new onset headache in the ER, vs. pt with Dm, Htn, Afib, high Chol and a new HA in my exam room). Will the iPad be a secret sauce for tablets… not by themselves, but perhaps with an innovative application in the right setting- they could really rock… looking forward to see what happens! And if you ever have trouble with it in your peds practice – your patients can likely help you figure it out!!!

  • As a fellow pediatrician, I have to disagree with your comments. Not about the usefullness of tablets (to each his own) but about the problems of desktops in exam rooms. I have heard that argument many times over the years, and it is always from someone that has never tried them. I have been in solo practice for 2 years now, and have the same desktops, keyboards, and mice that I started with. They are sturdier than you think. And the rooms are designed so that my back is never to the patient, even when typing.
    Different people certainly have different preferences. I just couldn’t imagine carrying around a tablet or laptop all day long.

  • I agree, DrLyle; tablets never hit the grand slam many thought they would in healthcare. I remember GO Corporation in 1992 bringing their show to a little “Computers in Pediatric Practice” seminar I spearheaded during residency at Geisinger. There was such a rave about them then.

    As to the iPad revival for tablets in primary care – could be. I know a Silicon Valley brainiac who may be a step or two ahead of the pack here. He has me on the edge of my iSeat (though, honestly, I’ve never been iHip, what with my trusty Palm Pre and my Windows Du Jour tendencies.) Still, I don’t think it’ll be the tool so much as the right app development that’ll hit the big one we need.

  • Admittedly, Kiddoc, I made assumptions based upon experiences with indirectly-related patient behavior and how I’ve seen some docs’ exam room PC setups. Your direct (& pediatric) experiential take is valuable and appreciated!

    However, you accurately note, “I have heard that argument many times over the years, and it is always from someone that has never tried them.” In a slight reversal, I’ll turn that around on your imagination of “carrying around a tablet or laptop all day.” From the voice on this side of experience, none of us carries anything around all day. Just as I never carried a paper chart around all day, I set my pen tablet down MOST of the time. I rarely wrote in a paper chart as I held it mid-air. Just as I grabbed a chart going from exam room to lab, I now grab the PC. Even my 95 pound RN of 30 years has no trouble with the weight. Cripes, some of our old paper charts weighed more than our tablets!

    I submit that both our experiences with the different form factors and workflow styles are, hopefully, helpful to those who are still considering their deployment. And, I completely concur, “to each his own!”

    (Personally, I’m still awaiting the “Minority Report”-esque, floating-in-mid-air, no-need-to-carry-anything user interface.)

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