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Mobile computing and interoperability in microcosm

April 8, 2008
by jlee
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Although I should be spending my time working on big picture, “strategic” things, every now and then some little something catches my interest and I find myself veering off into a skunkworks project. That probably would fall under the category of “poor time management”, but it’s surprising how much you can learn that way.

Recently, we’ve been thinking through options for mobile access to our EMR. I was an early advocate for the Tablet PC platform as a valuable enabler with the EMR.

When we first rolled the EMR out to our doctors and nurses, we did a semi-scientific evaluation of products from several vendors, including Fujitsu, Toshiba, Motion, and HP. We ended up buying 300 or so of the HP TC1100s, because we thought they had the best combination of form factor and versatility- removable keyboard with integrated pointing device, etc.

We’ve pretty much beat the heck out of those devices. They’ve been old and slow for a while now and are dropping like flies. We need to replace them in mass, but there’s not an obvious upgrade path.

The TC1100 was a unique device. What remains in the market are devices that are strictly slates- Motion is big on those and Fujitsu has a good one- or “convertibles” with a permanently attached keyboard that rotates and folds back to allow you to use the pen more easily.

The slates are frustrating to those who actually know how to use a keyboard- which I suspect includes most people under 40 (50?). The convertibles are a little oversized to my way of thinking. You don’t gain much over a plain old notebook computer, except for higher cost.

For what it’s worth, the Motion C5 has fascinated me since I first got wind of it. But, there’s that missing keyboard issue and, more damning for me, the device feels underpowered- Core Solo processor and a max of 2Gb of memory. Some of our docs use Dragon for voice recognition, which is a real memory hog.

Anyway, we’re still trying to answer the question, “What’s the right Tablet device for physicians?” But while we were thinking about that one, I got to wondering about nursing staff that do intake work and put patients in exam rooms for the doctors to see. (Skunkwork alert.)

We had defaulted into giving them the same devices that our doctors used, but I’m not sure that makes sense.

The duties of our “nurses’” (a generic term we throw around that includes RNs, LPNs, CMAs, and nurse’s aides) include calling patients back from the waiting room, taking vital signs, starting a clinic note in the EMR, verifying patient’s allergies, meds, problems, and taking a brief history of the present illness. If the patient is for follow up of ancillary testing results, they confirm that the results are available for the doctor. If the doctor orders in-office testing, treatment, or prophylaxis, the nurses provide whatever they can under their scope of practice and document accordingly.