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Tablet EHR: Physicians crave them, so what's the hold-up?

by David Raths

March 19 2012

With demand high for EHR on tablets and mobile devices, it's surprising how few software vendors have actually developed native iPad apps.

James Grant, M.D., corporate chair for anesthesiology in Michigan’s multihospital Beaumont Health System, started using an iPad as part of his daily practice becuase it makes his professional life easier.

“I use the iPad in the field because I walk around a lot in and out of operating rooms,” he said. “Our IT team is phenomenal in terms of supporting physician end-users. We haven’t had any support problems,” he said.

But Grant is only able to put the iPad to use in his clinical work because the electronic health record (EHR) software vendor Beaumont works with devoted resources to developing a native iPad app.

While many leading EHR software companies have so far taken a wait-and-see approach to tablets, Epic Systems Corp. of Verona, Wis., jumped in early last year with an app called Canto, a follow-up to an earlier iPhone app called Haiku. Canto offers secure access to clinic schedules, hospital patient lists, health summaries, test results and notes.

“I think Canto is great. I can get labs, demographics, and medications, as well as e-mail and text,” Grant said. “The only thing it doesn’t offer is the ability to do ordering. It is currently read-only. But I think the graphics and layout are great. It definitely has that native iPad app feel.”

But where's everyone else? 

But clinicians at hospitals and clinics using other types of software may not sound as pleased as Dr. Grant. Most software vendors have not yet produced a native application for iOS or a web application, which means clinicians wanting to access the EHR on an iPad end up having to use a third-party application such as Citrix Receiver.

Aaron Berdofe, an independent health information technology contractor based in Minneapolis, said he has tried to access Meditech software, which is popular in community hospital settings, in that way. He noticed that the Meditech window was a little too big for the screen, which means you have to scroll horizontally to see all the information.

Actually, he noted in a blog posting, “It’s double scrolling: once using multi-touch gestures and the other to use the Meditech window’s scroll bar.” Ultimately, Berdofe told me, “Using Citrix Receiver to access Meditech was too frustrating. It just doesn’t work very well. The users I tried that with said they were just trying it out, not using it regularly.”

Physicians and nurses are unsatisfied with EHRs in general, he added, so this experience of trying to access them on an iPad using Citrix just exponentially increases the frustration.

Most physicians tend to love Apple products, he said. They want to access their information wherever they are. “Doctors have been looking for something like this with a clipboard-like apparatus, and the iPad meets most of their criteria,” Berdofe said. “The software vendors are definitely getting requests and pressure from users to create native iPad versions.”

Jim B-Reay, a principal with healthcare consulting firm Aspen Advisors, agrees with Berdofe that the consensus is that although technically speaking Citrix-delivered apps work, it is an unsatisfactory experience, and physicians won’t use them. “That’s a barrier for non-Apple tablets as well,” B-Reay said. “It has to be a native product and that means full GUI redesign.”

“We haven’t seen a great deal of development on the tablet front yet from EHR vendors,” B-Reay added. Cerner released an iPad version and it was pretty widely panned, he said. “The reaction was, ‘Nice try guys,’ he noted.

Other vendors such as Siemens are solidly focused on rolling out new platforms and coping with federal incentive guidelines for “meaningful use” of health information technology and the switch from ICD-9 to ICD-10 coding systems.

That is not to say there is no activity on the iPad front, particularly in ambulatory settings. GE Healthcare offers a native iPad application designed for primary care physicians in small practices using its Centricity Advance web-based EHR and practice management system.

Smaller EHR vendors with web-based products for physician practices, such as DrChrono and ClearPractice’s Nimble, tend to be more, well, nimble, and can more readily develop iPad versions, B-Reay said, “and it is a good direction for them to go, but I would be surprised if a small startup vendor picked up significant market share based purely on this access device.”

For Allscripts, tablet EHR offers an opportunity to 'paint a target'

If some EHR vendors are worried about retooling their software for tablets, Stanley Crane, chief innovation officer for one of the largest vendors, Chicago-based Allscripts, said his company saw this as an opportunity to start over and re-envision what an EHR should be. 

Any vendors who think providing access to the EHR through Citrix will satisfy customers are wrong, he said. “This is like the change from DOS to Windows. Some vendors chose to keep their programs very much the same but let them run in a Windows environment. Word Perfect comes to mind,” he said. “But this is a whole new way to operate and it requires an adjustment.”

First, Allscripts focused on giving providers access to the information they need to make important clinical decisions on the go. Its Remote product is available for the iPhone, iPad, Blackberry and Android. To date, 10% of users are on Android, 10% on Blackberry, 50% on iPhone, and 30% on iPad.

The focus of Remote is on offering physicians access outside the workplace, like at a child’s soccer game, so the smartphone is likely to be the device of choice. Allscripts is also working on an iPad product code-named Wombat that follows the same idea as Remote, but for use in the practice’s office.

It doesn’t have the full features of the EHR, but it targets the 20% of features that clinicians use 80% of the time, Crane said, such as entering vital signs and allergies or changing medications.

Being Allscripts’ chief innovation officer is a dream job, Crane said. “We were able to carve off two dozen experts to envision and create the kind of products we think are going to have a big impact, and we think iPads and Android tablets are the wave of the future.

"People ask if I am worried about our competition copying what we have done here. I say that is the point. I want to paint a target for them. I think it will be better for the nation as a whole if they catch up with us.”

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