Docs Prescribe Tablets For Better EHR Access

Edited by John Morrissey

Tablet PCs are becoming the medium of choice for many doctors to access EHR data. What’s driving this demand and how can you ensure you leverage these devices safely?

The demand for adaptation of mobile devices to the EHR is on the rise, with doctors pushing vendors to offer them as primary interfaces. According to a recent survey by Black Book Rankings, only 8 percent of office-based physicians use a mobile device for e-prescribing, accessing records, ordering tests, or viewing results. But 83 percent indicated they would immediately use mobile EHR functions if available. In fact, 100 percent of practices responding to a follow-up poll now expect EHR systems to allow access to patient data wherever physicians are providing or reviewing care, according to Black Book managing partner Doug Brown. Vendors are aware: 122 of them reported they would introduce a fully functional native version of their EHR via mobile devices, and another 135 claim to have such mobile applications on the horizon.

Though smartphones are ubiquitous among clinicians and are used by 68 percent of surveyed physicians, 95 percent of surveyed docs said small screen size was their biggest problem with mobile devices, and 71 percent were not happy with non-optimized touch screens. Nearly 60 percent said they used iPads and tablet devices, which are more likely to overcome those problems.

Ultimately, a tablet strategy is a personal one, wrapped up in the physician/patient relationship. Health IT Outcomes tapped the experiences of two physicians in getting at the rationale for using tablets for day-to-day interaction with their EHR system: Michael Jordan, M.D., a pediatrician with East Lake Pediatrics, near St. Petersburg, FL; and James Rieger, M.D., a plastic surgeon based in Wichita, KS.

Q: Why are clinicians demanding to use tablets for this purpose?

Dr. Jordan: Being able to enter the data efficiently and at the same time not take away from the physician-patient relationship are very important to me. A tablet is the only thing I’ve ever used with an EMR. With my vendor Vitera Intergy (formerly Sage), I started with an Acera C110 tablet in 2004 when I opened a practice, and today I use a Motion J3500 with a solid-state hard drive. The staff has desktop PCs for entering data, but as a physician I wanted to be mobile with it — I had Wi-Fi in my office, so it was very convenient and made the most sense.

When I was in medical school and residency training, I’d go in to see a patient, sit down at the desk, take notes as I’m talking to him, maintain eye contact with the family, and try to let them know I’m listening to them and their concerns. I felt that if I had a laptop where I was typing, I would just have my head buried in the computer all the time. The tablet is very natural, it has handwriting capabilities, and the way the Vitera EHR works, you can design forms where the data can be collected very easily with clicks or a little bit of free text. So I can spend most of my time talking with patients, looking at them, and understanding and addressing their concerns rather than entering data.

Dr. Rieger: Tablets have changed medicine forever. I can spend quality time with patients and seamlessly record that visit — without paper or tape recorders — via a tablet. Medicine is actually now about patients and not about paperwork.

I use the drchrono EMR platform with iPad and iPhone. A tablet is absolutely the best way to interact with patients. I can show patients any of their information easily. I can use the iPad to review my website with them and access the Internet as an education tool together in a personal way. A neat new feature of the drchrono platform is access to Mayo Clinic education material. But unlike a brochure or laptop, information is shared in an intimate, elegant way. An iPad EMR also makes the interaction alive. I can scroll, show videos, zoom in on surgery diagrams, and review CT scan pictures.

Q: What security considerations should they pay close attention to?

Dr. Jordan: We have passwords that change regularly, passwords to get into the tablet, and passwords that get into the software that allows you into the database. Those are specified to change every 90 days or so. That way we know that things are secure. And then in the server itself, the data is encrypted on the backup disk.

I have data-breach insurance if something happens, because a breach can be quite expensive. But I leave the tablet at the office. I have two locations, and when I go from one to the next, I’ll take the tablet home that night and then to the next location. It’s password-protected if it’s not in my possession. Vitera is also up to date on what needs to be done as far as making sure things are encrypted and data is protected. I’ve had a security assessment done — there were a few things I had to do here and there, but mostly it was pretty well locked down.

Dr. Rieger: I have had nurses and other doctors ask me, “What happens if you lose your iPad with all that patient information?” The answer is simple: There is no patient information stored on the iPad. In my practice, it is stored through the drchrono platform’s secure cloud. An iPad can access the EMRs of every person in the practice and not have a drop of patient information inside it.

Q: What should an EMR tablet app provide a clinician from a functionality perspective?

Dr. Jordan: I love to do free text and click onto the forms I created. I can create notes quite rapidly without having to worry about dictating. I’m used to using the handwriting feature. The free text will be mostly descriptive factors for aches and pains, things like that. If I want to annotate something — say I marked off that a kid had a fever — then I could annotate that it was 102 degrees. The software allows you to add different modifiers such as “started yesterday,” for example. When you learn the system, you can do that really quickly without it being very distracting or taking a lot of interaction away from the family.

Dr. Rieger: It should allow great interaction with the patient. This separates the great apps from the basic fillin- the-blank template EHR apps. Simplicity and speed of documenting a visit will make the app a doctor favorite, so more time can be spent with a patient instead of worrying about all that time at the end of the day spent documenting.

One patient favorite is the interactive drchrono mapping app for e-prescriptions. From patient info, it places a pin on the patient’s home and then marks pins for pharmacies nearby. I turn the iPad to the patient to select the desired pharmacy on the map, and one more press sends the e-prescription. It makes sending prescriptions absolutely fun and quick; I actually look forward to sending them. The other must-have app is a function that allows patients to fill out their information on the iPad in the waiting room. This is currently a “wow” type of feature, but I expect very soon it will become standard. Then we will wonder how in the world we ever made it with those paper clipboards, PCs, or even laptops.